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 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
that in residency women tend to work more hours,
experience more stress, and report more personal, emotional, and
problems than do their male counterparts. They have
a higher debt load on graduating and tend to earn less money in
On the other hand, women have been shown to have
similar academic but better communication skills, and to experience
lawsuits and higher levels of career satisfaction
than men (Some of these findings may be attributable to the fact that
show more candor in surveys on residency stress or
may be more open to seeking help.) It is, however, important to
some of the unique pressures women face during
their medical careers that men do not experience, or may experience to a
Medicine in North America (especially "at the
top") has been and continues to be a male-dominated field to which women
been obliged to adapt. Women residents have few
female role models among senior academics and administrators in their
career, and only sometimes find the satisfying
mentoring that all developing physicians require. Women in medicine
what has been called 'role strain,' in that they
are expected to conform simultaneously to cultural stereotypes of the
'caregiver' who will humanize a harsh medical
technology and of the competent, competitive physician. Their hectic
often wreak havoc with the expectations they and
others have of their capacity to manage the responsibilities of
parenting, and supporting family members.
In the hospital setting, women nurses sometimes
compete with or are less tolerant of women physicians. Male colleagues
expect them to carry a higher female or pediatric
patient load, and patients may doubt their credibility or not address
as 'doctor.' Sexual harassment by colleagues and
patients is also a more serious problem for women residents than for
(In one sample of 599 female doctors, 77 per cent
reported being sexually harassed by patients at least once since
physicians).. Pregnancy and issues related to the
timing of a family pose logistic and personal dilemmas for couples. An
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
(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
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
- 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
- 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)
- Where possible, plan carefully the timing of
your pregnancy. Notify your residency program director of your dates so
together you can plan a reasonable schedule
(i.e., lighter rotations before delivery, outpatient rotations upon
- 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
and reorganization and to take account of
daycare regulations on the age at which infants are accepted.. The CIR
has prepared a highly recommended resource
packet of union ideas/proposals/programs called Pregnancy in Residency: A
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
to pregnancy/ parenting and maintaining healthy
Chapter Six, Staying Human During Residency
Training; How To Survive and Thrive After Medical School, Allan
of Toronto Press (Toronto/Buffalo 2008)