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OB/GYN Editorial June 2004
An Endangered Species: The Male Trainee in Obstetrics
and Gynecology
Emmet Hirsch, MD
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Beginning every December, our residency program conducts its interviews
for the first-year class in Obstetrics and Gynecology, a ritual
that never fails to inspire and renew my commitment to resident
education. And yet, this annual rite increasingly engenders pangs
of discomfort: Why is it that a diminishing fraction of the eager,
intelligent, capable young candidates are men?
According to Dr Sharon Dooley, a maternal-fetal medicine specialist
and the Associate Dean for Graduate Medical Education at Northwestern
University's McGaw Medical Center, the decline in male enrollment
in OB/GYN training programs is part of an overall trend for both
genders. Only 5.4% of this year's medical school graduates chose
a residency in OB/GYN (down from 7.2% in 1995). Various reasons
are given for avoidance of a specialty which, to many of us who
practice it, provides extraordinary professional and personal satisfaction.
Among these reasons are the medical malpractice crisis, the demanding
training program and postgraduate life-style, the relative attractions
of other specialties, and flawed mentoring by OB/GYN faculty.
Both men and women would appear subject to these influences more
or less equally. So why have men been avoiding our training programs
disproportionately, with males comprising only 23% of current trainees—down
from 51% in 1991 and falling? A big part of the explanation is
that they experience gender-based discrimination in the wards and
clinics, directed at them from patients and (even more disturbing)
from faculty. In a survey of 263 third-year medical students at
the end of their OB/GYN rotation, 78% of males indicated that their
gender adversely affected their experience. In contrast, 67% of
females felt that their gender had a positive effect.1 In
the same study, male students identified faculty as one of the
factors facilitating their exclusion from clinical experiences.
Students also know that employers are looking for young females
to staff their offices in order to meet the demands of their patients.
In 2001, 37% of ACOG members and 74% of first-year residents were
female. Clearly, we are headed for a sea-change in the face of
our specialty.
You may ask, "Doesn't this situation parallel that of the
specialty of Urology, which has long been dominated by men? Is
this such a bad thing?"
I answer: yes and yes.
Diversity is desirable in any endeavor. It is in no one's best
interest to be deprived of the talents of nearly half the pool
of potential practitioners of our specialty. The notion that women
are better equipped to understand and manage women's problems is
prevalent but arguable, if not unfounded. It is not my purpose
to debate that question here. I do not fail to recognize the logic
of women's health care being practiced by women, nor do I wish
to deny patients their right to seek specific qualities in their
doctors. Certainly, there are valid reasons for patient preference
in the matter of gender. Yet, those of us who become uneasy when
a patient asks not to receive care from a male medical student
or resident do so with good reason. The resemblance of these requests
to other forms of discrimination that all will recognize as both
morally and legally wrong is too close
for comfort.
Here's what should happen next:
- our medical schools should teach techniques to enhance communication
and positive interaction between students and patients of the
opposite gender.
- Research efforts should turn from documenting the discrepancies
in male/female student experiences to evaluating interventions
that can enhance equality.
- We should respond to patient requests for differential treatment
based solely upon gender with respectful reminders that there
are many traits other than gender that impact the quality of
medical care, and that egalitarianism in teaching programs contributes
to excellence.
- While we must respect patients' rights and ultimately honor
their preferences in this matter, we should not participate in
frankly discriminatory practices.
- Our professional societies should develop programs designed
to attract more male students to OB/GYN.
The above measures notwithstanding, it is unrealistic to anticipate
a dramatic turnaround of this demographic trend in our specialty.
There is a perception among male students that their postgraduate
career choices in OB/GYN are severely limited. Until this perception
(and any reality upon which it is based) changes, whatever measures
are adopted will have limited success. Is such a change desirable,
justifiable, and achievable? And if so, how can it be effected?
I welcome suggestions from readers, but in my opinion, it will
be a long time before our society is blind to gender in the gynecologist's
office.
For men who find the tables turned on centuries of sexual bias,
there is perhaps some hope. Being male may already increase their
marketability, as residency directors and employers try to correct
an undesirable trend. Also, perseverance is likely to make them
stronger and more empathetic, as our female colleagues have for
generations learned the hard way.
Emmet Hirsch, MD
Advisory Board Member
References
- Emmons SL, Adams KE, Nichols M, Cain
J. The impact of perceived gender bias on obstetrics and gynecology
skills acquisition by third-year medical students. Acad Med.
2004; 79(4):326-332.
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