Are there too many female OB/GYNs?

The Los Angeles Times recently published a piece on the lack of men in OB/GYN. Only 17% of new trainees (residents) in OB/GYN are men and the male OB/GYN physicians who weighed in worried that this “lack of diversity could weaken the field.” Apparently, it sends a “horrible message to men,” and with the lack of men we might “lose the next person who is going to find a cure for cancer.”

I have some thoughts.

The first one is 55% of pediatric residents in 1990 were women and currently 75% of pediatric residents are women yet I have never once heard any pediatrician talk about how that might prevent us from the next big breakthrough in pediatrics. I’ve never read an article on how the gender discrepancy in pediatrics or family medicine or psychiatry (the latter two also female dominated as approximately 57% of trainees in both are women) impacts those fields either. Then again those fields tend to pay less than OB/GYN.

Is it just access to higher paying jobs that is bad for men?

My second thought is I have not read any think pieces on how the dearth of women in the areas of medicine that are still male-dominated, such as neurosurgery, affects advances. No one there seems to worry that the lack of woman brain hampers much of anything.

I could just leave it at that, but I’m me and today is International Women’s Day so buckle up.

There are more medical role models top to bottom for men than women

My medical training was 1986 to 1996. In medical school, the only lectures I received from women were given by basic scientists (Ph.D.s not M.D.s) and pathologists. I was never given a lecture by a female surgeon or cardiologist or even a female OB/GYN. Maybe there was one, and I was sick that day. I never had one textbook authored or edited by a woman. A chapter written by a woman was a treat.

When I did an elective in the U.K. in 1990 and heard that they referred to surgeons as “Mr.” I asked a male surgeon what that called female surgeons. His answer? There aren’t any.

In my residency, there were three female OB/GYNs out of a department of about 20.

During my ten years of training, I never met one female surgeon. Not one. Most of the faculty in all fields were men. I never heard of a female chief of a department never mind meeting one. Not just of OB/GYN, of any department.

What about now? Are there men in leadership positions so male trainees at least have someone to look up to when they take a break from the textbooks largely written by men? The most recent data tells us that for OB/GYN 79.4% of department heads or chairs, 64.9% of vice chairs, and 71.4% of division directors are men. The American Congress of OB/GYN (ACOG) elected its first female president in 1984. In 65 years they have had five female presidents.

The Royal College of OB/GYN in the U.K. has its first ever female president.

Patient preference

Some women will ask to see a female provider, and this bias will be greatest against medical students. This is new. When I trained most providers were men, so there was no choice. The few times there were women providers the female patients were less empowered to speak up. Women now have more power to say what they want. That is not a bad thing.

If men in medical school or OB/GYN residencies are working a little harder to overcome some biases, then I can assure them from my personal experience that it will make them a kinder, better doctor because they will learn how to gain a patient’s confidence that much quicker. I think every woman of my generation who has been called a “little miss” by a patient and been asked to step aside so the man (a.k.a. real doctor) could do the procedure has some empathy for the situation some men in OB/GYN face today. Although at least men are not sexually de-credentialed as they step aside.

It is interesting to hear women who have had bad experiences with doctors talk about their providers. In my experience when they were unhappy, and the provider was a woman she was “uncaring” or a “bad doctor.”  The men, well, they just “didn’t understand.” That is how systemic our biases are against women.

Sexual assault and general demeaning talk

I’m not sure how many men in OB/GYN have had their scrotum cupped by a female attending in the operating room, but I have certainly been positioned next to a male surgeon, so his arm rubbed against my breast for an hour or so. I’ve had more hands run up and down my back, and I’ve been cornered, literally pushed up into a corner, by a male surgeon trying to goad me into letting him drive me home late at night. I’ve also had a tongue stuck down my throat. I know that many men in medicine have been sexually assaulted, but I believe the numbers pale in comparison to the female experience.

Then there were all the times male surgeons, and even OB/GYNs spoke about hockey or golf in the operating room in a pointed or “humorous” attempt to exclude me from the conversation. Or the good times when the men in the operating room joked about not knowing how to talk about knitting!

Ha ha.

This not specific to OB/GYN, but just to demonstrate some of the additional barriers women experience.

Pregnancy bias

I have heard story after story of women being turned down or passed over for training positions because they might get pregnant or because they (God forbid) had a pregnancy in residency. A friend of mine wanted to be a neurosurgeon. She applied to a variety of programs in Canada. She was conditionally accepted into what was considered one of the best programs. The condition? She signed a contract stating she would not get pregnant during her residency. This was in 1989. Not 1889, 1989.

I bet not one man in any medical school or residency ever has been asked about his plans for procreation.

Job bias

If you thought being a woman in OB/GYN brings bigger bucks you would be wrong.

Male doctors who get awards from the National Institute of Health make $13,399 more per year than women doctors (controlled for specialty, academic rank, leadership positions, and number of publications). It’s not about pregnancy or kids either as women with no children still had lower salaries than their male counterparts.

In academic medicine OB/GYN ranks the 4th worst (out of 18 fields) for a gender pay gap. Women in OB/GYN earn $36,390 per year less than men in an adjusted analysis.

Overall (so not just in a university setting) women in OB/GYN make $48,000 less on average than men. This specific data set didn’t control for number of hours worked, however, looking at all the other studies on gender pay gap in medicine that do control for hours worked and other factors it is very likely the pay gap still exists.

If indeed women are taking jobs away from men in OB/GYN they are only taking away  the lower paying ones freeing men up to stay in the higher paying positions.

It is still harder for women in medicine. Period.

When there hasn’t been a male president of ACOG for 10 years and all OB/GYN textbooks are written by women and no one asks me if I am a nurse or forgets to call me doctor when they introduce me at a professional function and when women out earn men in OB/GYN and have 80% of the leadership positions and when opinion pieces about the dearth of women in surgery and the excess of women in pediatrics fill our newspapers and when men are asked about their procreation plans at interviews I will be concerned that OB/GYN has developed a gender diversty problem. However, as the women I have worked with in medicine tend to be concerned with all stake holdeers equally and support parity because they have been on the receiving end of inequali,ty I doubt we will ever see that kind of bleak, all female future.

It is true that most residents in OB/GYN are women, but a man who wants to go into OB/GYN will never, ever face the systemic oppression and bias and lack of role models that women have faced and still face today. Any man in OB/GYN on graduating residency will likely end up with a higher paying job than the women he trained with and history tells us he won’t seem to mind. After all, if men in OB/GYN minded so much about the gender pay gap, we wouldn’t have one because they have always been, and are still, the ones in charge.

Jennifer Gunter is an obstetrician-gynecologist and author of the Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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