On Being a Doctor

One Size Does Not Fit All: Unique Concerns For Women

Back in 1989, 44 per cent of Canadian medical school graduates were women, compared with 33 per cent in 1981 and 6 % in 1959. In 1990, 30 per cent of all residents in the United States were women; over the next five years it is predicted that over half of all U.S. physicians will be women. In 2003 the number of women enrolled in medical school surpassed 50 per cent in many provinces in Canada and reached 52 per cent by 2007. In most countries, women tend to choose primary care fields for specialization: internal medicine, pediatrics, obstetrics, gynecology, family practice, and psychiatry. Several studies show that in residency women tend to work more hours, experience more stress, and report more personal, emotional, and relationship problems than do their male counterparts. They have a higher debt load on graduating and tend to earn less money in practice than men.

On the other hand, women have been shown to have similar academic but better communication skills, and to experience fewer lawsuits and higher levels of career satisfaction than men (Some of these findings may be attributable to the fact that women show more candor in surveys on residency stress or may be more open to seeking help.) It is, however, important to recognize some of the unique pressures women face during their medical careers that men do not experience, or may experience to a lesser degree.

Medicine in North America (especially "at the top") has been and continues to be a male-dominated field to which women have been obliged to adapt. Women residents have few female role models among senior academics and administrators in their chosen career, and only sometimes find the satisfying mentoring that all developing physicians require. Women in medicine experience what has been called 'role strain,' in that they are expected to conform simultaneously to cultural stereotypes of the feminine 'caregiver' who will humanize a harsh medical technology and of the competent, competitive physician. Their hectic schedules often wreak havoc with the expectations they and others have of their capacity to manage the responsibilities of housekeeping, parenting, and supporting family members.

In the hospital setting, women nurses sometimes compete with or are less tolerant of women physicians. Male colleagues may expect them to carry a higher female or pediatric patient load, and patients may doubt their credibility or not address them as 'doctor.' Sexual harassment by colleagues and patients is also a more serious problem for women residents than for men. (In one sample of 599 female doctors, 77 per cent reported being sexually harassed by patients at least once since becoming physicians).. Pregnancy and issues related to the timing of a family pose logistic and personal dilemmas for couples. An AMA study found that one-half of women physicians who had children had had their first, and one-quarter had had their second, child during residency. Despite these facts, some U.S. schools and programs still do not have formal maternity-leave policies. (Only a few years ago, a study showed that in U.S. Obs-Gyn programs only 80 per cent had maternity leaves and 69 per cent paternity leaves. And they are in the business of delivering babies!) In Canada, maternity benefits are in all residents' contracts, although the length of leave may vary from program to program. However, a pregnant resident may encounter subtle and not so subtle expressions of resentment from colleagues who believe they will have to carry her clinical load.

Trends among Women in Medicine

• Within a decade of completing training, one-third of women physicians will take maternity leave, and 24 per cent prolonged leave for other reasons. Most will have shorter work weeks than their male counterparts.
• Two-thirds of practicing women physicians in the United States have children.
• For the most recent trends regarding women in medicine, visit the Women Physicians Congress at the AMA I(www.ama-assn.org).

Suggestions for Women

• Apply to a residency program that has a significant or growing representation of women, particularly in leadership roles.
• Review contract issues on maternity leave and time-sharing options before applying.
• Make an effort to form links with women colleagues. If you encounter an attending physician or lecturer who appears to have managed juggling family and career life successfully, ask to keep in touch with her from time to time. Find a mentor.
• Consider forming a women's residency support group or lecture series. Nominate a person in your hospital as a contact person for women's issues or grievances. Include medical students.
• Investigate the services provided by the national and international medical women's groups. Here are some useful resources for assisting the process:
  • The American Medical Women's Association offers a Harassment and Gender Discrimination Resource and Information Service (www.amwa-doc.org)
  • Association of American Medical College's (AAMC) Women in Medicine Homepage (www.aamc.org/members/wim/start.htm)
  • Canadian Women's Health Network (www.cwhn.ca)
  • MomMD.com (a community of medical mothers offering tips, support and advice)

Pregnancy

• Where possible, plan carefully the timing of your pregnancy. Notify your residency program director of your dates so that together you can plan a reasonable schedule (i.e., lighter rotations before delivery, outpatient rotations upon return).
• Be open with colleagues about dates and continuing difficulties. Do not become apologetic or overcompensating.
• Maintain close ties with your obstetrician, general practitioner or midwife in case you experience complications or need letters for sick leave or scheduling recommendations.
• Three months has been shown to be the minimum period that should be allotted for maternity leave to allow for adequate rest and reorganization and to take account of daycare regulations on the age at which infants are accepted.. The CIR (www.cir-secu.org) has prepared a highly recommended resource packet of union ideas/proposals/programs called Pregnancy in Residency: A Union Perspective. Plan carefully, and well in advance, the support you need with the logistics around your delivery and child care. Consult your own housestaff or postgraduate medical office for guidance. The websites listed above also cover issues relevant to pregnancy/ parenting and maintaining healthy family relationships.

Reference :

Chapter Six, Staying Human During Residency Training; How To Survive and Thrive After Medical School, Allan Peterkin, University of Toronto Press (Toronto/Buffalo 2008)