The changing demographics of women in medicine

New Orleans-Despite ongoing challenges, more women work in the field of medicine now than at any other point in history, and women continue to gain greater representation in academic medicine and in leadership positions, according to Ann M. Renucci, MD, FACS.

"It took decades for women to crack the first 'glass ceiling' in the medical profession, and further progress has often been slow," she said during a symposium sponsored by Women in Ophthalmology at the annual meeting of the American Academy of Ophthalmology. Dr. Renucci is a corneal and external disease specialist in Grand Rapids, MI.

The first medical school in the United States opened at the University of Pennsylvania in 1765, and it was 1847-more than 80 years later-before Elizabeth Blackwell became the first woman admitted to a U.S. medical school. The American Medical Association (AMA) was founded the same year and accepted its first female member in 1876. The AMA, however, did not elect its first female board member until 1989, she said.

As Dr. Renucci reviewed the changing demographics of medicine, she noted other breakthroughs. Isabel Hayes Chapin Barrows (1845-1913) was the first woman to practice ophthalmology in the United States as well as the first woman appointed to a medical school faculty, accomplishments she managed while financing her husband's education and raising two children. Her list of achievements also includes serving in roles such as a missionary, editor, reporter, prison reformer, and ambassador.

Despite Dr. Barrows' success, following in her footsteps was not always easy. "In the late 1800s, women made up about 10% of practicing physicians, but in the early 1900s there was strong opposition to women practicing medicine. Women remained a minority in medicine throughout much of the 1900s. In fact, there was little growth in the number of female physicians until 1970," Dr. Renucci said.

She noted that in 1905, women composed 4% of physician graduates, a number that remained largely unchanged as late as 1965. The major growth in the number of female physicians seen now has occurred over the past four decades, and the number has nearly quadrupled in the past 20 years.

Rising percentages

The Women Physicians Congress of the AMA reported that there were more than 256,000 women physicians in the United States in 2006 (27.8% of the total physicians in the United States). In 1970, the number of women in medicine reached 7.6% and climbed significantly to 24% by 2000. The year 2003 was a milestone in which more than 50% of US medical school applicants and 50% of matriculants were women. In 2004, women accounted for 25% of physicians and 40% of all residents and fellows in training. "It's projected that by 2010 women will account for 30% of practicing physicians," Dr. Renucci said.

"We've also made some great strides in ophthalmology," she continued. In 1994, women made up 25% of members in training, a number that increased to 34% by 2004. These figures contrast to the current U.S. membership in the American Academy of Ophthalmology (AAO), where membership is 16% female. The growing number of women preparing for a career in ophthalmology heralds significant changes in the AAO's membership in coming years, Dr. Renucci predicted.

Although an increase in women residents has occurred in all specialties over the past 10 years, their career aspirations within medicine have remained remarkably similar. "What's interesting is that there has been minimal change in the percentage of women choosing particular specialties," Dr. Renucci said.

"Women tend to gravitate to nonsurgical specialties and primary care, such as internal medicine, pediatrics, family practice, and obstetrics and gynecology(OB-GYN). In fact, in 2005, 53% of women residents were in one of these four specialties."

She added that at present, 74% of OB-GYN residents are women, and it is estimated that women will make up the majority of practicing OB-GYNs in the United States by the year 2020.

Leadership positions

Women also have made great strides in academic medicine. As the number of women graduating from medical school has steadily increased, so has the percentage of medical school faculty they represent-32% in 2006, Dr. Renucci reported. Among all medical faculty, women make up 4% (16%) of full professors, 6% (28%) of associate professors, 15% (37%) of assistant professors, and 7% (46%) of those at other ranks.

Differences in female representation among academic departments are highly noticeable and tend to mirror their numbers in specialty practice. Women, for example, are more heavily represented in pediatrics departments (22%) than in orthopedic surgery departments (2%).

Faculty demographics will continue to shift because a higher percentage of women than men now choose an academic career, Dr. Renucci said. By 2025, there could be roughly equal numbers of women and men on medical school faculties.

As women have attained greater prominence in academic medicine, they also have become more visible in executive leadership positions and currently account for 10% of department chairmen, 16% of full professors, and 11% of medical school deans, according to Dr. Renucci.

Women remain underrepresented in these executive positions, a fact that could be partly attributable to an age disparity. Sixty percent of women physicians are less than 45 years old, and many do not yet have the experience and credentials typically required for high-level leadership jobs. However, the representation of women and men approaches parity among recently recruited faculty members.

"In other words, younger cohorts of full-time faculty have a more balanced representation of women and men," Dr. Renucci said.

Differences in practice patterns

A look at medical demographics also reveals that men and women have different practice patterns.

"Women entering medicine may have different personal and professional expectations, and we shouldn't always measure ourselves against our male counterparts," Dr. Renucci said. "Women physicians gravitate to larger cities and urban areas, for instance. Twenty percent of family physicians in urban areas are women, and 12% of family physicians in rural areas are women. Women place a high value on personal life and lifestyle, and women tend to spend more time in activities related to family.

"More women seek shorter work hours," she continued. "Four times as many women physicians in the United States work fewer than 20 hours per week, in contrast to male colleagues. More women tend to work part time. Twenty-seven percent of female pediatricians, for instance, work part time, in comparison with 9% of men pediatricians. Women also tend to retire at an earlier age."

Studies bear out these contrasts between male and female physicians. One study examined mean work hours per week of women and men physicians in three English-speaking countries and found that, across the board, women tended to work fewer hours. A study of Canadian female ophthalmologists also showed some interesting patterns, according to Dr. Renucci. Overall, practice patterns of male and female physicians were quite similar, but women reported spending more time in activities related to home and childcare.

The employment of the spouse or partner also appeared to affect the physician's work routine. Women physicians were more likely to have a spouse or partner who was a physician and who worked full time, while men tended to have a partner who worked part time or not at all. Gender differences also appeared in childcare arrangements. More women reported using a nanny, whereas more men relied on their spouses.

"You can see that practice patterns of men and women physicians tend to differ. This is probably partly due to the continuing challenge of balancing work and family responsibilities. These factors will likely influence the face of medicine in years to come," Dr. Renucci concluded.OT