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From Past to Present: The Changing Demographics of Women in Medicine

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Despite ongoing challenges, there are currently more women in medicine than at any point in history. And, according to Ann M. Renucci, MD, a corneal and external disease specialist in Grand Rapids, Mich., women continue to gain greater representation in academic medicine and in leadership positions.

“It took decades for women to crack the first ‘glass ceiling’ in the medical profession and further progress has often been slow,” Dr. Renucci said during a symposium sponsored by Women in Ophthalmology at the 2007 Annual Meeting of the American Academy of Ophthalmology.

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 AMA was founded the same year and accepted its first female member in 1876. However, as Dr. Renucci points out, the AMA did not elect its first female board member until 1989.

As she reviewed the changing demographics of medicine, Dr. Renucci 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 comprised about 10 percent 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,” explains Dr Renucci.

She noted that, in 1905, women comprised 4 percent 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. The Women Physicians Congress of the American Medical Association reported that there were more than 235,000 women physicians in 2004, compared to just 25,000 in 1970.

The number of women in medicine reached 7.6 percent in 1970 and climbed significantly to 24 percent by 2000. The year 2003 marked a milestone, in which more than half of U.S. medical school applicants and half of matriculants were women. In 2004, women accounted for 25 percent of physicians and 40 percent of all residents and fellows in training. “It’s projected that by 2010, women will account for 30 percent of practicing physicians,” Dr. Renucci said.

“We’ve also made some great strides in ophthalmology,” she continued. In 1994, women made up 25 percent of members in training, a number that increased to 34 percent by 2004. These figures contrast to the current U.S. membership in the Academy, whose membership is 16 percent female. Dr. Renucci predicts that the growing number of women preparing for a career in ophthalmology heralds significant changes in the Academy’s membership in coming years.

While there has been an increase in women residents 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 OB-GYN. In fact, in 2005, 53 percent of women residents were in one of these four specialties.”

She added that, at present, 74 percent 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.

Underrepresentation in Academic and Leadership Positions to Change
Women have also made great strides in academic medicine. Dr. Renucci reported that as the number of women graduating from medical school has steadily increased, so has the percentage of medical school faculty they comprise — up to 32 percent in 2006. Among all medical faculty, women comprise 16 percent of full professors, 28 percent of associate professors, 37 percent of assistant professors and 46 percent 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 percent) than in orthopedic surgery (2 percent).

Faculty demographics will continue to shift as 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. Also, as Dr. Renucci points out, as women have attained greater prominence in academic medicine, they have also become more visible in executive leadership positions. Women currently account for 10 percent of department chairs, 16 percent of full professors and 11 percent of medical school deans.

However, women still remain underrepresented in these executive positions, a fact that could be partly attributable to an age disparity. Sixty percent of women physicians are under the age of 45 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. “For instance, women physicians gravitate to larger cities and urban areas. Twenty percent of family physicians in urban areas are women and 12 percent of family physicians in rural areas are women. Women place a high value on personal life and lifestyle and they tend to spend more time in activities related to family.”

“More women seek shorter work hours,” she continued. “Four times as many female physicians in the U.S. 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 to 9 percent of men pediatricians. Women also tend to retire at an earlier age.”

Studies bear out these contrasts between male and female physicians. One examined mean work hours per week of women and male physicians in three English-speaking countries and found that, across the board, women tended to work fewer hours. According to Dr. Renucci, a study of Canadian female ophthalmologists also showed some interesting patterns. 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, while 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.

Closing Message
More women in the United States are practicing medicine than ever before and they are entering medical school in record numbers. Women remain underrepresented at the higher levels of academic medicine and in executive positions, but these trends are certain to change as more female physicians now starting their careers accumulate experience.

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About the author: This article was written by Nancy Groves for the February 2008 issue of Ophthalmology Times. It was reviewed by Ann M. Renucci, MD, FACS.