Women change the face of medicine

Can the healthcare system survive a kinder, gentler profession in which both sexes work shorter hours? It's an evolutionary thing

By Giancarlo La Giorgia

"Being a doctor is almost a unisex profession, you're not a man or a woman, you're a doctor," says Kathryn Lecesse, a 23-year-old med student at l'Université de Montréal. That's probably just as well, these days almost a third of all practising physicians are women. For those under age 35 it's already half and half. Fifty years ago the ratio was nine men to every woman.

Not all male physicians are comfortable with the idea of the increasing number of women entering the profession. Some even see the changing demographic as a threat to the healthcare system. The most misogynous suggest that more female doctors could mean thousands of physicians out on maternity at any given time. Others see a shift away from the more "technical" specialties (neurosurgery, orthopedics, cardiology, gastroenterology, Ob/Gyn) toward areas that offer more regular hours (pediatrics, dermatology, ENT).

Ms Lecesse isn't persuaded that more female doctors mean more problems. "I don't think it will really affect the quality of care that patients receive," she says. She credits her unbiased attitude towards medical practitioners to her learning experience in overwhelmingly female classrooms. Fully 70% of students attending med school at l'Université de Montréal are women. She sees advantages for women studying in such an atmosphere. "There's less inhibition about asserting your opinions."

In Quebec, half of the doctors in the 35-to-44-year-old age group and 62% of the under-35s are women, the highest proportion in the country. All the more remarkable in that the province once had one of the lowest percentages of female doctors.

To explain the drop in male high schoolers who go into medicine, Dr André Ferron, vice dean of undergraduate studies and professor of neurophysiology at the Montreal school, points out that male enrolment is down at all faculties in Quebec's three French universities. Nor does he believe "certain specialties may be less attractive to women and that we may eventually have shortages in certain areas." At his university, at least, he says he's unaware of any specific discipline lacking in applicants.

DOCTORS AT HOME
Despite the academic advances of female med students in Quebec, Ms Lecesse does think that being a female physician will present more of a challenge when it comes time to have a family. Without being specific, she expects she will have "to make certain sacrifices" if and when she becomes pregnant. That time is still far off. She says she wants to have one or two children but not until her early 30s, after she's completed her residency and entered the workforce.

She's confident that a woman can balance motherhood and a medical practice efficiently — and without any collective shock to the healthcare system. "After all, women have been having babies since the beginning of time."

CMA president Dr Sunil Patel's not so sure. He welcomes the change in physician demographics that "reflects how society treats and engages women," but says female physicians have told him what a tough time they have juggling the roles of doctor and homemaker.

According to a recent association questionnaire, female doctors worked about 49 hours per week in 2002, nine hours more than they did a decade ago. The same study showed male physicians clocking in 56-hour weeks but revealed that female docs continue to assume the lion's share of domestic responsibilities. Women reported they devoted 54 hours of their week to household and child-care duties, more than double the 23 hours performed by their male counterparts.

That said, the numbers are changing. Dr Patel points out that younger male doctors share more duties at home and that physicians of both sexes are looking for more leisurely lifestyles than previous generations.

Can the healthcare system survive such a shift? Yes, says the CMA chief. "It's just a matter of re-engineering the work environment." He likens the work patterns of female physicians of childbearing age to those of doctors in their 50s, who remain productive as they near retirement by sharing their practices.

Dr Patel sees a more serious challenge in the "shortage in health human resources brought on by provincial decisions to reduce med school enrolment and increase tuition fees during the 1990s." He calls these artificial factors. On the other hand, he believes the increase in female enrolment in med schools stems from "natural" causes. As such, he's confident that society will find an equally "natural" way of changing to accommodate them.