I am surprised that The Times would print the truth on the subject of women doctors. Here are some further thoughts.

 

There have always been women doctors, of course. But, to achieve excellence, they surrendered some important things that normal women never would. When normal women flooded into medicine in the 1970s, we were told that they would be just as good – no, that they would be better – than the men. Better because, in addition to being intellectual equals (true, in a certain sense), they were also compassionate and caring.

 

The actual consequences of the decision to admit normal women to medical school have been very significant, but the most profound changes are yet to come.

 

The entire job has had to be redefined to suit the normal woman. First, training shifts had to be reduced from 36 hours to initially 24, and now 16. This means that one never has longitudinal responsibility for one’s patients, and that one has to learn to “sign off” before one learns what the recipient of the sign-off needs to know.

 

Next, the hours worked in a week necessary to define “full-time” performance had to be reduced. Male internists who had their own practice typically worked 65-70 hours per week, for many years. New hires in Internal Medicine work 38 hours a week, or less. This creates tremendous shortages of primary care physicians at a time when demand is increasing.

 

Extended absences from practice have become normal, even laudable. This virtually requires structured employment of doctors, as opposed to private practice.

 

The most important change is yet to come. Physicians are not leaders, not on top of their game, until their mid 50s, and their leadership roles extend to ages 68-70. One learns from one’s patients. By the time a male physician is a leader, he has had tens of thousands of patient encounters. The female physicians who, in their 30s and 40s, worked half as much or less than their male colleagues have been deprived of thousands of cases, cases which were necessary to fit them for leadership.

 

Karen Sibert in The Times touches on the fact that there are a lot of dropouts. Many women physicians quit before they are 50. But for the ones who stay, and who now are in line to run complex clinical organizations, their lack of clinical expertise has become a major problem.

 

As a result, good performance is increasingly defined as adherence to guidelines rather than what is best for the patient. The guidelines movement has causes that go beyond inexperience of senior clinicians, but it would not have been possible without an influx of inexperienced physicians thrust into decisionmaking roles for which they are unprepared.

 

Of course, the opponents of the admission of large numbers of women to medical school predicted all of these things with precision. But, as with many writings in the 1950s and 1960s, they are down the memory hole – how horrible that the leaders of medicine back then had sexist thoughts!

 

 

                                                                         — Comments —

 

Regarding the ways that female physicians have changed the profession, here’s another (younger) doc’s perspective:

The typical feminist cry is “Feminism has made things better for men, too!” I agree with this when it comes to medicine. I would not want to work the long hours of my forebears. A 60-70 hour week? No, thanks.

But women have changed medicine in other ways that I do dislike – for instance, the attitude and demeanour that is expected from doctors today is different than it was in the past. Many times throughout my medical education I received poorer evaluations than I otherwise might have because of my somewhat serious and grave nature. Essentially, I was penalized for not being a bubbly, chatty, “empathetic” woman. There is much more emphasis on “the patient’s feelings” than there used to be, which is fine so far as it goes, but not when it becomes the primary focus. That is my opinion, at any rate.

A. writes:

I have noticed the decline in competency among the whole of the medical profession, not excluding doctors. 

I have many years and experiences both with which to judge. I was married to a physician before he went to medical school and worked in his office for many years. I have four children, four siblings, my parents and ten grandchildren and all their experiences. I have practicing physicians as close friends. 

The decline is global. It includes the white male as well as the minority, women and all affirmative action entrants. The hours of training required now is laughable compared to those medical students, interns and residents of just forty years ago. .But the issue is much more than hours alone. 

The majority of people in all medical programs are victims of modern educational failures. They cannot speak and write the language (an editor of medical articles and textbooks told me that the grammar, logic and syntax of almost all authors, including doctors, has been abysmal for over twenty years) 

The English as a second language personnel are, in my experience, just plain dangerous. They just do not understand words. In addition, they are in general further away from the Hippocratic ethic than are the English as a first language person. 

I could give you example after example, but will just give you my last one. I asked a question of a minority urologist. The answer given me was anatomically impossible. Just think of that. Anatomically impossible. I told my family doctor who is in practice forty years and he said what I have been saying, that they can’t communicate. 

As the Greeks say; Old doctor, young lawyer. 

Solution? Extremely high standards for admission, including demonstrated competence in language, math, science, logic and physical and psychological vigor and a patient oriented motive rather than a dollar oriented one. After that a ruthless weeding out process. An absolute requirement that all people will be required to put in the long hours to gain the competence necessary or be required to leave. 

Keep nurse practitioners in their proper role. I understand they can now prescribe and administer Morphine without physician oversight.

Georgia writes:

I thought it was too bad Karen Sibert’s article implied not just that women who care about their family might not be suitable doctors, but that women who want to be doctors give up their families and be like the author who is so proud that she managed to make it to soccer games and school plays, but presumably missed quite a lot of her children’s lives.

Either way, intelligent women who are interested in medicine but do not want to displace dedicated men might want to consider becoming physician’s assistants. I saw one for years in lieu of an OBGYN and only rarely saw the doctor that supervised her. She lived in our neighborhood and only worked when her children were at school. Physicians assistants cost less money too.

Laura writes:

Yes, this is a good point. She does not argue that there is anything immoral about a mother spending little time with her children.

James N. writes:

Samson said, “The typical feminist cry is “Feminism has made things better for men, too!” I agree with this when it comes to medicine. I would not want to work the long hours of my forebears. A 60-70 hour week? No, thanks.”

In other words, Samson doesn’t want to work until the work is done. He (Samson claims to be a man) doesn’t want to work until all the patients are, in a manner of speaking, “put to bed.”

Samson wants somebody else to bear ultimate responsibility for making sure that every person he’s responsible for is OK before he rests. Maybe the government. Maybe his partners. Maybe that ultimate refuge of a nurse, “the supervisor.” Maybe the “healthcare team.”

One of the reassuring things about the grinding fatigue is that it defines the profession. Moses Maimonides wrote about this nine hundred years ago, how strange it was that the last house to visit was always at the top of a steep hill.

Samson is in the wrong business.