When Erika Gantt graduated from Harvard Medical School in 1997, hers was the first class in which the number of women outnumbered men. This was touted as proof that women had made significant progress in cracking one of the hardest glass ceilings. It proved that women had finally achieved parity with men in a competitive field at the nation’s premier university. More than 15 years later, the influx of women into medicine is being blamed for exacerbating one of the country’s largest health care problems: the growing doctor shortage.
A study from the Association of American Medical Colleges’ Center for Workforce Studies estimates that by 2020 the U.S. will experience a shortage of more than 90,000 physicians, and 130,000 by 2025. This accelerated shortage in doctors is due in large measure to the millions of aging baby boomers who will need more medical care. There’s also no denying that we aren’t turning out enough doctors to keep pace with population growth. The U.S. population has increased by more than 35 million since 2000, while the number of available residency slots to train new doctors has barely increased.
Although the enrollment rate at medical schools has remained steady, the number of female medical students has increased every year since 1969, when they accounted for just nine percent of all medical students. That number peaked in 2003, at 49.6. In 2012, 47 percent of medical school students and 30 percent of physicians in the workforce were women. The latter is expected to grow significantly as more physicians retire. Here’s a stark reality: Women doctors, in the aggregate, have shorter careers, take more time off and work fewer hours than male doctors. The primary care field is increasingly popular with women, perhaps because residencies are shorter and there are more opportunities for job sharing. Primary care is also the area with the greatest shortage.
Adding to the problem is the number of cumulative hours doctors work. Since 2005 the part-time physician workforce has expanded by 62 percent. According to 2010 survey data from the American Medical Group Association, nearly four in 10 female doctors between the ages of 35 and 44 work part-time. Another study found that female physicians also tend to work an average of 4.5 fewer hours than their male colleagues. It may be unfair, but this explains why women are blamed for the looming shortage of doctors.
Should medical school admission continue to be gender blind? What happens when these women leave the profession to become stay-at-home moms or decide to work part-time? “We don’t have enough doctors, even today,” said Los Angeles anesthesiologist Karen Sibert in an interview on NPR. “And now the estimates are that for every doctor in their 60s who retires, it’s going to take between one and a half and two doctors to replace him or her because of the expectation that people just don’t have to work as hard.”
Gantt, an orthopedic surgeon, believes attempts to blame women for the shortage are wrongheaded and signal a double standard that ignores her male colleagues who choose not to practice. “Becoming a doctor takes so long, I don’t know many women who give it up completely. But many male doctors in my class also leave medicine to go into business and industry such as biotech.”
Gantt’s specialty continues to be dominated by men. Of the 100 partners in her practice, only four are women, a statistic she attributes, in part, to societal attitudes. Even in this highly skilled profession, women are expected to take on a larger share of family responsibilities than their male counterparts. And unlike their male counterparts, many don’t have stay-at-home spouses.
It seems a simple fix would be to just train more doctors, but that’s easier said than done. Medicine differs from other professions because education and training are heavily subsidized by the government and there are only so many slots available. In 1997 Congress imposed a cap on the number of subsidized residencies, the final hurdle to obtaining a medical license. About 34,000 U.S. and international medical school graduates competed for roughly 29,000 available slots last year. Although bills have been introduced to increase that number, those efforts have gone nowhere because the cost is considered prohibitive. Should the country continue to spend its limited resources subsidizing medical training for those who are not in it for the long haul full-time?
Sibert and others say too often doctors make personal decisions that have a negative impact on patients and society. Does a student who obtains one of these coveted spots have a responsibility to make the most of it? “If doctors aren’t making full use of their training, taxpayers are losing their investment,” wrote Sibert in a New York Times op-ed. “With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.”
Gantt is not convinced doctors owe a career-long debt to the taxpayer. She believes the grueling nature of the residency alone is more than enough payback. “During residency we did our part by providing medical help at a greatly reduced cost,” she says. “We were working 80 to 100 hours a week, making $50,000 a year alongside physician extenders—nurse practitioners and physician assistants—who make double that. All the while your student loan debt continues to accrue. I’d feel more grateful if I hadn’t paid so much for my education. We leave school with enormous debt.”
The cause of the shortage is twofold: There aren’t enough doctors and the doctors we have don’t work enough hours. The latter is largely a generational issue. Regardless of gender, more physicians are concerned with “work-life balance,” a term that didn’t exist in the profession years ago. There is no denying that, compared with men, more women leave the profession and work less while practicing. But until society modifies its expectations of the role of women as primary caregivers, don’t expect that to change. You can expect your wait time to see a doctor to change, however. It will get longer.