Rose’s latest post got me thinking about the culture of medicine, and how it may have changed as the result of more women entering the field. Though I am not a woman myself (as my gravatar can attest, though perhaps that image is not a 100% accurate depiction), I believe that I have benefited personally from the ways that culture has been affected by the influx of women.
Medicine was once a male-d0minated field, but that has been changing dramatically over the past few generations. However, the distribution across the different specialties is inconsistent. My Googling skills seem to be failing me this morning, so I can’t find good numbers on the rates of women entering the various fields. I have a strong impression that women tend to favor primary care specialties, with men still comprising the majority in fields like surgery. (Anyone with actual figures, I’d love it if you’d drop them in the comments.) My own field of pediatrics has long been a top choice of female physicians. From residency through my fellowship and into my current job, the women have outnumbered the men; my previous job was the only one where there was an even divide.
Now, the most obvious way that women have benefited me as a doctor is by being great instructors and colleagues. Perhaps that goes without saying, but I felt like saying it anyway. I am one of only two men at my current practice, and I am lucky to be working with each and every one of the physicians and nurse practitioners in our office. Medical care without the contribution of professionals such as them would be indescribably impoverished.
But there’s more to it than that. Medicine has a tradition of being one of those professions that define the whole of your life. Everything was to be subsumed into one’s being a physician. It took precedence over everything else, and it was expected to be one’s top priority. I saw evidence of this attitude myself a few years ago when I attended a hospital staff meeting at a previous job and listened to an older physician gripe about what he saw as the misplaced priorities of younger doctors, who evinced reluctance to do such thing as attend staff meetings during time set aside for family. (I think I may have even written about it, but if so it’s lost in the misty ether of my archives.) Being one of those younger physicians who was fiercely protective of his private time, I didn’t have much sympathy for his viewpoint. Indeed, the hospital was having some recruitment troubles, and failing to accommodate the work/family demands of younger providers would certainly have stymied those efforts.
I am absolutely clear about the line between my work life and home life. As a partner, I have some obligations that extend beyond those of being an employee, but that’s more about being a business owner than being a physician. When it comes to demands on my time that accrue to my being a doctor per se, there are bright lines around how much I’m willing to give. One of the things that drew me to my present job (which, for the record, I love) is how flexible my then boss (now partner) was willing to be with my schedule to maximize my time with my family. Less than a week ago I sent a regretful e-mail to someone at the hospital, explaining that I could not commit to attending certain meetings because they had been scheduled on a day I don’t work. I did so without any hesitation, with the full expectation that my response would not be questioned. I do not think I could have done so in decades past, certainly without getting some blowback.
I strongly suspect that this change in culture is due to the influx of women into medicine. As more and more women demanded a balance between their careers and their private lives, medicine was forced to adjust its expectations. I imagine that some of the reason that women pick certain specialties over others is that they are more amenable to this kind of balance. I don’t think it’s because women are innately less ambitious. (I’m plenty ambitious, and I don’t see that as being in conflict with the priorities I describe.) I’ve certainly known a few women who were clearly driven by career above all else, so it’s not like this is a cut-and-dried gender split. But insofar as there’s been a general change as more women have become doctors, it’s been in the direction of allowing for family to have its place in their lives.
I think that change has been good for everyone, men and women alike. Obviously, those who choose to prioritize their careers still have that option. But for those of us who want to spend time with our kids or spouses, it’s good to know that the profession is increasingly open to those values. And I think we have women to thank for it.
I don’t think you’re being entirely fair to yourself. While the photo is very flattering, I would still call it an accurate depiction.
In philosophy, schedules are pretty flexible. I can do work late at night, or wake up at 5 am. So in that way, it’s a boon to any parent. I would have had to quit my job to take care of my special needs kid if I had one with a rigorous schedule.
That said, there is still a culture of “If you don’t devote your life entire to this, you can’t do it.” There’s still a tinge of the desirability old Oxford monastic life – one devotes oneself to philosophy. I remember asking someone a bit older what novels he’d read recently. He looked at me as if I’d asked if he’d enjoyed pulling his pants down in public recently, and said, “If I have spare time, I don’t read novels, I read philosophy.” As I’ve said in the post below, it has been discussed whether or not I can do philosophy because I have three children, one of whom has special needs. My husband is never asked that question, even though we are at the same level of our careers, and split the housework. I do wonder if that question would not be asked if the field were not 80% male.
This should probably go on the other thread, but…
In my industry, things are a bit different.
Imagine, if you will, that there were a trade organization among philosophers, the United Philosophical and Thinkers Organization (UPTO), and several smaller associated regional organizations, ie Upper Midwest Thinking Trades, etc. And imagine if you yourself worked for an organization which supplied them labor, the Brotherhood of Obtuse Philosophers, A-holes, and Bullshit Artists (BOPABA).
Every once in awhile, you get a call that tells you to go three states over and Philosophize (after having been certified in a specialty area of Thinking) for about five months or so. You might have to go teach a seminar seven days a week for the next three weeks, or eight weeks or whatever. They might tell you that you’re going to be gone for three months, and you end up being gone for ten.
In between those calls, you might get a month-and-a-half of downtime, to rest up your brain, and allow any aneurisms you may have to heal. Then you get the next call.
There is no work/family balance. It’s all at one time, one or the other.
That’s what it’s like.
Men and women are equals, according to their ability. Everything is set by contract, and the contract cares nothing for whatever manner of life you might choose to live– it’s all about the work.
There are women in my trade, and most of them tend to find a specialty where they’re really good.
They’re free to place themselves in the line of fire if they want to. It’s not a comfortable place.
And, as I’ve told you individually, after shopping around a bit, we’ve settled on a pediatric practice that’s entirely staffed by part time women. Could not be happier with our care.
Question, though: it is my impression that pediatric primary care docs have a large proportion of women, while that doesn’t seem to be true for pediatric subspecialties. Is that your impression as well?
It’s one of the (many, many) points of contention that Clancy is expected to attend meetings on the days she doesn’t work (and is expected to move around doctors’ appointments* accordingly). I think a number of the troubles, actually, are actually not-unrelated to the male-tilt of the place. We actually might be looking at the gender-balance on our next job hunt. I hate to stereotype but sometimes you don’t know until you take the job.
Doc, I’ve been meaning to email you to ask your thoughts on this. There is actually a growing pay gap between men and women despite the fact that women are increasingly moving into specialization. I have my theories (some benign, others less so) but would be interested in yours. If you need any postfodder, that is.
* – This may sound confusing. With the exception of the pregnancy (and that took weeks of decision-making), Clancy does not seek medical care with her employer. So she’s having to move it around to attend the meeting, not because the doctor she would be seeing isn’t available.
Please forgive me, but when I first read this, I thought you were referring to your husband, and then I was a little confused about you marrying your boss.
Unfortunately, I have nothing of substance to contribute to this very excellent post.
This seems pretty accurate, and in more than just medicine. Similarly, I wonder if, as the number of women in the workforce increased (and became normalized, shall we say), there became more demand from men to have more work/life balance, since now they were the ones who often/sometimes/occasionally had to run the kids to appointments or pick them up from school.
That certainly seems like a reasonable conclusion to draw.