It’s Here, the Feminization of Medicine: Good or Bad?
Susan P. Phillips, MD, MSc, CCFP; Emily B. Austin, MSc writing a Commentary in the February 25, 2009 issue of the Journal of the American Medical Association titled “The Feminization of Medicine and Population Health” (not available online without subscription) describe the current physician gender relationships and generalist to specialist relationships in medical care specifically with regard into what area of medicine graduating female medical students go and how they perform in their medical work. After describing the details, the authors write in conclusion:
“Although physician density is not a determinant of health outcomes, a greater proportion of generalists to specialists among those same physicians is associated with increased longevity of the population. Because women across time and place tend to become primary care physicians, the feminization of medicine may well have beneficial health outcomes possibly attributable to the nature of the care they provide irrespective of women's lower volume output relative to that of men. Such an improvement in outcomes may occur because of the practice styles of women, who outnumber men in primary care, or because of the nature of generalism. Either way, as women increasingly enter medicine and become generalists, rather than being a liability by not working excessively long hours or abandoning parenting, the quality of the care they provide may result in improved population health.”
If the studies described in the article and assumptions are correct, it would appear that the feminization of medicine which is certainly currently becoming more and more a reality is to the benefit of society. What do you think? The authors, both women, would answer my thread title with the word “good”. ..Maurice.
Graphic: Photograph of Elizabeth Blackwell (from Wikipedia)(February 3, 1821 – May 31, 1910) who was the first woman doctor in the United States. She was the first woman to graduate from medical school (M.D.), a pioneer in educating women in medicine, and was prominent in the emerging women's rights movement.
posted by Maurice Bernstein, M.D. @ 8:02:00 PM
6 comments
6 Comments:
As women enter Ob-Gyn in large number they join larger groups so that they may have time with their families. In my city some of these groups have as many as fifteen doctors. The chance of one woman seeing the same doctor twice or being delivered by a doctor is knows is almost zero.
Practices have become MacDoctor's franchises. I do not believe that the individual patient has received benefit from the shifting demographic in this field.
Re obdoctom: Fair enough, but what about the hum-dinger comments left by socially inept physicians at patients' bedsides or while sitting half-naked on an exam table, which are almost certainly more likely to be delivered by a man than a woman? I base that on personal experience and my own hunch rather than well-documented evidence, but I'm sure that there's some social-scientist out there who has studied the gender effects on interactions between patients and their physicians, and I suspect that my fellow Y chromosomes don't come out as well as a group with respect to particular metrics (e.g. patient satisfaction that they've even been listened to).
I am, however, skeptical of the claims of Dr. Phillips and Ms. Austin. It seems fair to me that the huge influx of women physicians within the past 25 years has had all sorts of profound effects on how residency education is scheduled, how academic careers are judged, how medical students are trained, how patients are treated (including the ways the OB doc above points out). But to suggest, as they do, with a touchy-feely optimism that "the quality of healthcare they provide may result in improved population health" seems a stretch. Even if true, how do you measure that kind of effect across a whole population? And I suspect the authors provide docs with far too much credit for affecting the health and welfare accross the whole population. Public health campaigns for vaccinations and getting people to stop smoking almost certainly have a bigger effect on overall health than those of us who dish out a bit of avandia and lipitor to at-risk groups.
I guess I think a more measured conclusion would be warranted: the fact that there are now many options for patients, particularly female patients who may feel more comfortable consulting with a female physician, is but one obvious and beneficial effect of the changing demographics. And that's nothing to sneeze at, so to speak.
--billy rubin
billy rubin, not that's a pseudonym.
Although I've run into a couple of notable exceptions, I've generally found most female physicians take my symptoms matter of factly and deal with them objectively--this is compassionate to me. On the other hand, I've found many male physicians will attempt to throw antidepressants at a problem. I've also had them claim that anxiety causes--not contributes to-- my tachycardia, even though we know what the cause is. People don't have resting heart rates of 130-150 asleep no matter what their anxiety level is. I *don't* get anxious about it since I've lived with it a long time--there's no reason to, but apparently getting seen for it is evidence of "anxiety." I strongly doubt they'd say the same to a man with the same symptoms--they just wouldn't.
When I go to a woman physician for a medical problem like respiratory or bladder infection, they treat it and I go home. I go to a male physician and they lecture me, regard me as somatic for symptoms that can be objectively verified, even pneumonia or what turned out to be acute and lasting gallbladder attack.
Their bias prevents them from seeing.
There are a few male physicians I've found who aren't this way.
I meant to say, billy rubin, that's a great pseudonym. I do remember being distracted when I wrote that.
I have had good and bad providers of both genders, compassion and ability are not defined by gender. What is neglected in these post is that the feminization of medicine has caused a disportionate focus on female health care at the expense of male concerns. 94% of nurses are female, yet it draws little to no attention even in the face of a severe nurse shortage. Visit a couple of hospital web sites and see how many have womens health sections and or women health centers in the facilities, there is a Dept of womens and childerens health in at the federal level, there are many womens clinics but mens health clinics are nearly non-existant. Men visit the doctor far less than women, are 60% more likely to die of cancer, 2.5 times more likely to have an heart attack before 65 years of age, and die younger....do you honestly think the feminization of health care will improve that...health care is female focused from the staff to the magazines in the waiting rooms....so it may be good for some...but I doubt for men...
Although the feminization of medicine in terms of the gender of physicians has been a relatively new phenomenon, the feminization of nursing has long been with us. Of interest might be how the feminization of physicians effects the relationship between the physician and the nurse.
The January 2010 issue of the American Medical Association's Virtual Mentor ethics journal discusses nurses as part of the medical team and their relationship with physicians. Here is a link to the pdf file of that issue. ..Maurice.
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