JAMES N., a physician, writes:

I just googled “physician burnout” and got 3,600,000 hits.”Resident burnout” got 5,580,000 hits. “Medical student burnout” got only 228,000 hits.

Prior to, say, 1990, “burnout” as applied to medical students, residents, and physicians was not a concept in general use.

What is different? The question answers itself. As the blogger Dr. Helen points out here, women often are surprised or shocked at what is actually involved in holding a job, never mind in constructing, developing, and holding a career. The low number of “medical student burnout” hits is probably because medical school is the last place a bright and studious girl can get by with her exemplary social (teacher pleasing) and academic (studying hard) skills that she has been crafting since kindergarten.

Once she starts holding people’s lives in her hand, it’s different. It’s very different. It is, as Dr. Helen puts it, “working like a man.”

I should add the reflexive, “of course, there are excellent women physicians.”

There are. The thing is, the pool to choose from among women, for probable career excellence in medicine, is quite small. This is because normal women, even very, very smart normal women, do not find the sacrifices needed for excellence in medicine congenial. Now, in our present distorted view of the world, this statement will be held, by almost all, to be “discrimination against women.”

That would be true if I held that NO woman should be accepted to medical school because MOST women won’t find being a doctor appealing. I do not hold to this view. But I do think that a “nondiscrimination policy” in admissions, which uses only grades, test scores, and a sappy post-adolescent essay about career “goals,” which results in 60 percent female medical school classes, overlooks something important – which is the history and pattern of career success throughout the ages.

There are very few white NBA players. Does that mean that no white basketball player (with NCAA Division I success) should be allowed to play in the NBA? Of course not. But it does mean that, with realistic selection criteria (foot speed, vertical reach, jumping height, and athletic competitiveness) that most NBA players are not going to be white. And that’s fine.

A return to 10 percent female medical school classes would also be fine, if admissions committees were allowed to use proper selection criteria.

Laura writes:

A ten percent quota on female admissions to medical school makes sense. (In 2010, forty-eight percent of medical degrees were awarded to women. See previous posts on this issue here, here, here, here and here.) Women who want to become doctors would have to show even more extreme commitment and talent than they do today, the sort of commitment that proves they are not normal women who will want to balance work and motherhood ten years down the road.

It is wrong for society to invest so much in the training and preparation of applicants who cannot repay that investment as well as other applicants. To refuse to consider the sex of applicants to medical school is grossly unfair, giving those who will probably want to work less in the years ahead the same consideration as those who will not have those limitations. A physician’s work is by nature one of long hours and heavy responsibilities. A woman applicant is entitled to a realistic assessment of what she can accomplish from those already in the profession.Young women should not be blamed for wanting to become doctors when everyone tells them they can do it and when motherhood is so devalued. Quotas, of course, will never come about until there has been a widespread change in attitudes and a respect for excellence in medicine that exceeds the desire for utopian equality.

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