UNIVERSITIES

Where have all the men gone?

In the Canada of tomorrow, your doctor will probably be a woman. Most of today’s medical students are.

CATHY GULLI September 24 2007
UNIVERSITIES

Where have all the men gone?

In the Canada of tomorrow, your doctor will probably be a woman. Most of today’s medical students are.

CATHY GULLI September 24 2007

Where have all the men gone?

UNIVERSITIES

In the Canada of tomorrow, your doctor will probably be a woman. Most of today’s medical students are.

CATHY GULLI

In the future, when medical experts reflect on the most transformative health care development of this decade, the discussion may have nothing to do with vaccines or prescription drugs, but rather the male-to-female ratio of doctors in Canada. Today, women constitute the ever-increasing majority of medical students, and soon the entire health care system will be dominated by female physicians. We’re in the midst of a sea change in medicine: nearly 30 years ago, 88 per cent of doctors were men; today that number is about 67 per cent. But 52 per cent of doctors under the age of 35 are women,

and the numbers are going to keep growing. “It’s a fact, there are more women going to medical school,” says Evens Villeneuve, director of admissions at Université Laval’s faculty of medicine in Quebec City, where female enrolment has hit 70 per cent for the last two years, after peaking at a record 80 per cent in 2005.

While Laval’s female admission rate is the most lopsided, it’s not the only campus where women far outnumber men. The majority of students at 13 of Canada’s 17 medical schools are women, according to the Association of Faculties of Medicine of Canada.

Besides Laval, the most female universities are Montréal, Sherbrooke, Ottawa, Northern Ontario and McMaster; on each of these campuses, more than 60 per cent of first-year medical students last September were women. Even at those few medical schools where there are more first-year men than women, the difference is slight: Western’s female enrolment rate last year was 49-9 per cent, and the universities of Manitoba, Saskatchewan and Alberta were near that point. If trends persist, it won’t be long before the student bodies of even these schools are mostly female.

“The acceptance in academia of women is much better” now than decades ago, says Shelley Ross, secretary-general of the Medical Women’s International Association. Ross, who is also aBurnaby, B.C., family physician, says the change is also due to the fact that,

contrary to old stereotypes, “women do well in the sciences.” And not only are more women applying to medical school—between 60 and 70 per cent of applicants to Laval are female, says Villeneuve—their high marks, and the attributes many see them bringing to the profession, mean more and more are getting in. Observers tout a long list of benefits to having more females in health care, everything from better patient-doctor relationships—because women physicians are thought to be more compassionate—to enhanced focus on women’s health beyond predictable specialties such as gynecology.

But there are also concerns that the diminishing presence of men could have some negative consequences. “When we got 50 per cent [female enrolment] we said, ‘Wow!’ Now we’re saying, ‘Hold on,’ ” acknowledges Ross, who warns that medicine could become thought of as a “pink-collar profession” if women physicians fail to assume more leadership roles, or aren’t taken seriously as policy makers. There is also apprehension that female medical students won’t pursue specialties such as surgery, which has historically been a male-dominated area of expertise. And still others are worried that the current physician shortage in Canada will be exacerbated as more women—who have been shown in the past to work fewer hours than their male counterparts—enter the field.

Still, the trend is widely viewed as a sort of medical breakthrough. Decades ago, “women were restricted from studying medicine, and were told it would cause problems with their

wellness,” says Janet Dollin, president of the Federation of Medical Women of Canada, and a family physician. (In fact, the first female doctor in Canada, Dr. James Miranda Stuart Barry, dressed, lived and practised as a man to gain credibility.) “There was a serious historical bias against women that thankfully is gone,” says Dollin. Now, female students are actually outperforming their male peers in many cases. “If we look at the highest grades,” says Laval’s Villeneuve, “it’s always the same: 70 per cent of the highest scores are for women.”

Besides achieving top marks, women tend to fulfill the “sensitive doctor” role that is increasingly in demand as medicine continues to recognize the importance of mental and emotional well-being, not just physical health, says Marie-Hélène Dufour, a fourth-year medical student at Laval. “I think there is a relationship between the focus on sensitive doctors and the large female student [body].” Dufour, who says she and her peers often discuss how the growing female population will affect their field of study, anticipates more shifts in physician practice as women take up the majority of posts. “The changes are good,” she says before adding, “depending on the view of a person.”

The primary beneficiary will be the patient, many believe. “It’s a profession that would come naturally to women who are good at relationship issues, empathy, social responsibility and interpersonal skills,” says Dollin. Patients often feel that female doctors spend more time with them, says Ross, and are per-

ceived to be nurturing. “Of course there are men doctors like this too,” says Dufour, but “women are more attentive.”

Those good relationship skills also help nurses, who have been shown to get along better with female rather than male physicians. A study entitled “Gender and Power: Nurses and Doctors in Canada,” from a 2003 issue of the International Journal for Equity in Health, found that “when nurses and doctors are female, traditional power imbalances in their relationship diminish,” which suggests conflicts have as much to do with gender as they do with professional hierarchy.

What’s more, the growing number of female physicians will be a catalyst for more discussion and research about women’s health issues and the impact of social, cultural and economic status on well-being, says Dollin. Already the effects are noticeable. “We are seeing women’s health beyond traditional [parameters], which was reproductive,” she notes. And there is also more focus on how conditions and diseases are experienced differently between men and women.

That fuller appreciation of health will also allow doctors to feel validated in creating better work-life balance than physicians have historically been afforded. “To help others, we have to be healthy in our head and body,” says Dufour. She says that many of her peers insist that they will work a fraction of the old 90-hour-a-week expectation for doctors. “They want to have a social life, and children, and they don’t want to only work.”

WOMEN IN MEDICINE: A STEADY RISE

Since the late 1960s, when women represented fewer than one in five medical students, female enrolment at medical school has been steadily rising, surpassing that of men beginning in the mid-1990s

Source: The Association of Faculties of Medicine of Canada

MEDICAL SCHOOL ENROLMENT

The gender split at Canadian medical schools varies, but as these 2006 figures show, women outnumber men, sometimes by a wide margin, at 13 of 17 institutions

*Northern Ontario School of Medicine is located at Lakehead and Laurentian universities. Source: The Association of Faculties of Medicine of Canada.

But this new work ethic is exactly what has some people worried that the current physician shortage in Canada is about to get a lot worse. In its annual survey published in March 2007, the Ontario College of Physicians and Surgeons wrote that it is consistently the case that “female physicians work fewer hours than their male counterparts.” Because female doctors are younger than their male counterparts—and generally, younger physicians work fewer hours than older ones—the situation is doubly dire, the college found. “If this trend continues over time, the consistently increasing proportion of female physicians in the workforce could be a significant factor to consider in the efforts to improve and

ensure patient access to physician services,” the college warns.

Adding to concerns about doctor shortages is the fact that women medical students have tended to veer away from some specialties that will need replenishing, such as urology or orthopedics, which, like surgery, are male-dominated areas of expertise. A 2006 study in the Canadian Journal of Anaesthesia proposes that fewer women may go into this specialty because it does not lend itself to cultivating patientphysician relationships. More interestingly, the study suggests that the lack of women in anesthesiology creates a self-perpetuating cycle where few female medical students can identify same-sex mentors who can encourage them to pursue the field.

Similarly, the absence of women in medical leadership roles—on research committees, and working as policy makers—could deter upcoming female physicians from getting involved, and exerting influence in the same way that men have. That would be dangerous, says Ross, because it would compromise the authority of medical professionals. “We run the risk of losing influence, and

value,” she explains, adding that womendominated fields such as nursing and teaching struggle to maintain influence. And practically speaking, Ross says, doctors could lose their ability to help decide where health care funding should go: “So we need to train women who are interested and ready to take over leadership.”

All this said, there is a growing body of research that suggests future changes to the health care system will ultimately have less to do with gender than with age. The current generation of young people are committed to working smarter, not harder, than their parents and professional predecessors, says Ross. A September 2005 study in the Academic Medicine journal found that “men and women expressed similar and significant rates of declining interest in specialities with uncontrollable lifestyles.” And the Canadian Journal of Anaesthesia paper also cited research showing that both men and women physicians “will value lifestyle more in the future.”

More females in medicine has made the practice more balanced—not just for women, but also for men, says Ross. “This critical mass of women was a catalyst for reform so medicine is not such a time-consuming job,” she insists before adding, “That’s good.” Even patients might appreciate a more empathetic, less time-crunched doctor, provided they can find one. M

MEDICAL SCHOOL: HOW DIFFICULT IS IT TO GET IN? In the table below, Success Rate indicates the percentage of applicants who received at least one offer of admission. Note that success rates for in-province applicants are generally higher than for out-of-province, because most medical schools reserve nearly all of their seats for local students. The grade point average (GPA)—or R score in the case of Quebec’s CEGEP system—shows the average for incoming first-year students. The medical college admission test (MCAT) is a standardized test required for admission at many faculties.

Total Year 1 Success Rate (%) Success Rate (%) Success Rate (%) Average GPA Average Applicants Admissions In-Province Rest of Canada International (4.0 scale) MCAT Alberta 1,113 134 28.2 8.4 12.5 3.7 10.97 UBC 1,766 221 20.9 5.4 7.7 3.66 10.21 Calgary 1,545 136 26.3 10.7 47.1 3.7 11.13 Daihousie 667 98 31.2f 7.6 43.8 3.8* 9.67 Laval 1,686 209 23.3 5.1 1.4 R score 33.5 (CÉGEP)* Not required R score 31.7 (university)* Not required Manitoba 816 94 34.8 10.9 33.3 4.13 (4.5 scale)* N/A McGill (5-yr) 343 79 32.4 N/A N/A R score 35.8* Not required (4-yr) 881 169 57.1 6.3 9.3 3.77* 10.98 McMaster 4,599 146 5.6 2.9 2.1 3.8 Not required Memorial 796 61 29 5.8 19.2 3.75 9.35 Montréal (5-yr) 1,375 198 27.5 9.1 1.9 N/A Not required (4-yrj 662 67 13.5 0 0 N/A Not required Ottawa 3,159 150 7.6 5.5 2.3 3.66 Not required Northern Ontario** 2,049 56 4.3 2 3.6 3.7 Not required Queen's 2,200 95 8 7.2 0 3.68* N/A Saskatchewan 531 60 29.3 8.2 0 90.51% 9.84 Sherbrooke 2,039 194 21.9 23.1 0.5 N/A Not required Toronto 2,751 207 11.4 8.6 5.6 3.87 10.57 Western 2,529 138 9.5 3.7 0 3.7* N/A

tlncludes all Maritime provinces *2007-2008 grades **Located at Lakehead and Laurentlan Note: Higher international success rates at some universities may be misleading given that at some institutions the number includes students who applied for positions available under contract with foreign governments or educational institutions. Source: The Association of Faculties of Medicine of Canada; Canadian medical schools