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The Next Generation of Primary Care Physicians Will Be Predominantly Women

What Does This Mean for Women Physicians?

primary care doctorsGraduating in 2012, 73% of the 2,355 pediatric residents, 55% of the 2,692 family practice residents, and and 45% of the 5,846 internal medicine residents are women (AMA Physician Master File, 2012). Most of these women will be in an employment relationship with fewer going into their own practices.  Fewer women than men will go on for specialty training.  And it is well known that the incomes for these physicians are substantially lower than for most of the medical and surgical specialties.

Disproportionate representation leads to horizontal segregation.  Why are women disproportionately represented in primary care?  Is this what women physicians truly want? Or have they been persuaded that they “belong” in these areas because they are easier to manage with a family?  And is this really true?

I don’t think so.  Many are persuaded into this niche.  My evidence?  Talking with medical students.  Not infrequently, after giving a talk to women medical students, I am greeted at the end by not too few women medical students whose Deans have told them that it is too hard for a woman to be a surgeon!  Yes, today, in 2012.  Many don’t even try after that.

Devaluation of skills due to non-physician competition.  Do women physicians want to be horizontally segregated into the areas of medicine which are increasingly being encroached upon by non-physicians?  The line is getting blurred about who has the expertise to care for and about patients the best as the first medical contact not only for wellness checks, but also for complex medical problems.

Devotion to career is not any easier.  Will life as a primary care doctor really be easier?  Primary care done well is very difficult to do.  Being able to master a large body of knowledge and keep up with the increasing complexity of even the most “routine” problems, may soon no longer be possible.  Primary care physicians are expected to be available to patients who want a relationship with someone who knows them.  Someone whom they can trust.  People don’t like changing doctors.  They like having their own doctor.

How many see the challenges that are going to be made to the value of their knowledge and skills from the expansion of mid-level providers?   It was difficult to see, but the lines will quickly blur, as the patients will look at their “healers” all as doctors. Most won’t be able to tell the difference.

Debt repayment looms large; digging up the dough to get help.  Where will the financial resources come from so that women physicians can engage the help to manage their professional obligations?  Choosing shorter trainings so as to accommodate their biological clocks results in fewer skills and lower salaries.  Many are in debt, big debt.  Repayment will not be easy, further reducing flexibility, predictability and control.

Female friendly?  Some are comforted by the feeling of having women as colleagues and hence view these specialties as “female friendly.”  But is this really true?  Collegiality may fade as each vies for the time off they want to have children or time with the family.  How many women can be off at once and still be responsible for the patients?

None of this appears to be good for women physicians. Not unless primary care is what they really want to do.  And for many, it is.  But what can save these women physicians is re-defining the way they care and heal.  Embracing relationship based medicine as the driver (and not the step child) of evidence based medicine is a good place to start.  Next week:  Relationship Based Medicine vs. Evidence Based Medicine–How Women Physicians Must Change the Care Paradigm.



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