Women making gains in medicine, but much work remains to be done

According to the Association of American Medical Colleges’ annual report on medical school enrollment, 2019 marked the first time that the major­ity of U.S. medical school students (50.5%) were women. (Image courtesy of Adobe Stock)

The sense that the role of leader within the health care system is not an appropriate career goal for a woman physician was just beginning to change with the publication of a 1995 monograph titled Women in Medicine and Management: A Mentoring Guide.

At that time, women represented about 19% of all American physicians, a jump from just under 8% in 1970. By 2012, with the publication of the update of the original monograph, titled Lessons Learned: Stories from Women in Medical Management, 30.4% of practicing physicians in the United States were women. A decade later, women make up 36.3% of all practicing physicians in the country.

In a letter in the Women in Ophthalmology (WIO) website, WIO President Grace Sun, MD, wrote that the number of female medical students is approaching 50% and ophthalmology has made gains, with the percentage of residents that are female increasing from 29% in 2000 to almost 40% today.

However, gains have been slower in leadership roles, with Sun noting that as recently as 2018, of the 111 ophthalmology programs across the country, were chaired by men. This means that only slightly more than 10% of programs – barely double digits in absolute numbers – are led by women.

Men continue to dominate some ophthalmology subspecialties.

The rise in the number of female physicians is the direct result of a steady increase in the number of female medical students. According to the Association of American Medical Colleges’ annual report on medical school enrollment, 2019 marked the first time that the major­ity of U.S. medical school students (50.5%) were women.

At the same time, while medical school classes continued to include more racially and ethnically diverse students, those groups remain significantly underrepresented in the overall physician workforce when compared with the general population and the patients they serve.

In terms of specialties, there have been significant shifts. Only seven specialties had more than 1,000 female physicians in 1970, whereas 25 specialties had more than 1,000 female physicians by 2006 and 35 by 2019.

Although most women physicians are still more prom­inent in primary care specialties such as family medicine, internal medicine, pediatrics, and obstetrics/gynecology as well as psychi­atry and anesthesiology, younger graduates today are choosing residencies in virtually every specialty, including cardiothoracic and neurosurgery.

While the progress of women doctors has sometimes been a slow, albeit continuing journey, it may not be long before women dominate medicine, especially as the number of male applicants and matric­ulants has been declining.

These trends are creating a quiet gender revolution — one that brings new opportunities and tensions. Within the broader context of the evolving role of women in American society, women physi­cians continue to explore new career paths — paths that include both clinical medicine and medical leadership.

The good news is that women have been entering medicine in increasing numbers for more than three decades. The not-so-good news is that women are still underrepresented and underutilized in positions of power — especially at the most senior levels. Unfortunately, 60 years after the so-called “sexual revolution,” even as the percentages are rising, there is a relative paucity of women in positions of power in every single sector across this nation.

Moreover, the gender pay gap that still plagues women in the United States remains evident within the health care industry. Several studies have shown that female physicians earn 8% to 29% less than male physicians. A report published in 2020 by the physician network Doximity found after analyzing 44,000 physician salaries that the wage gap between male and female physicians is 28% this year, with male doctors earning over $116,000 more annually than their female counterparts.

Disparities continue in various corners of health care:

• Women are underrepresented at the highest levels of hos­pital administration, even though according to the U.S. Bureau of Labor Statistics, women comprise at least 80% of the health care industry’s workforce today and are the largest consumers of health care. Only 19% of key leadership roles in hospitals are held by women (physicians and non-physicians). This gender inequality issue is compounded by the fact that few physicians in general are tapped for senior hospital management roles.
• By 2020, the number of women graduating with a medical, bio­medical, or biological degree at least equaled that of men. However, fewer than 10% of biopharma chief executive officers (CEOs) are women and even fewer are women physicians

When it comes to leadership roles, in the 26 years since the publication of the first version of the book, women have made incredible strides in terms of the level of formal education achieved and numbers within the workforce. Yet relatively few have risen to the highest levels in politics, Fortune 500 compa­nies, or health care organizations — public or private.

The commonly cited reason for their poor showing in leadership positions, apart from sexism, has been that women choose not to be leaders, that they lack interest and skill in leadership, and that they choose to devote their time to their families rather than concentrat­ing their attention on professional advancement. While past studies justifying male physicians as administrators declared that men like wielding power more than women do, there is more agreement today that when women have an opportunity to be decision makers as medical managers, they enjoy the role.

Lessons Learned: Stories from Women Physician Leaders, with first person accounts of 33 accomplished women physician leaders,sets out to document the career paths that some successful women physician leaders have taken.

The women in this book have found success in many different areas of medical management. They include corporate medical directors, managed care executives, managers within government, the pharmaceutical industry, academic leaders, hospital executives, and entrepreneurs.

Perhaps the problem is visibility, and that is the reason for showcasing these women’s stories.

Or, as we have quoted Marian Wright Edelman, founder of the Children’s Defense Fund, “you can’t be what you can’t see.”

Deborah Shlian, MD, MBA is a board certified Family Practitioner and MBA with more than two decades of clinical and management experience. She is the author of Lessons Learned: Stories from Women Physician Leaders. This article was published in Medical Economics, a sister publication of Ophthalmology Times.