An influx of women

When I enrolled in medical school, there was an enforced gender ratio of only 80 women and 80 men per class. To lay out slots based on sex, of all things, seemed arbitrary. However, we heard that young women — who seemed in general to earn better grades than their male counterparts — would make it into medical school in higher numbers but would later be more likely to opt out of practice or higher training, usually to start their own families. Men, it seemed, were a wiser investment.

This preconception of women as a liability and their uteruses as ticking time bombs follows them all the way to higher training. It seems as good a time as any to talk about this as women across the Philippines are battling it out to make it to their chosen residency programs, with some venturing into traditionally male dominated specialties. I can imagine their feelings — trepidation and self-doubt, with an ounce of defiance. In 2015, I wrote about the challenges women face in entering surgical training, from casual sexism from colleagues and staff to the expectations of skeptical patients. To read about it now is interesting, as women have since swiftly climbed the numbers even in those surgical residencies which have “belonged” to men: neurosurgery, orthopedics, urology. Is it because of more progressive, more inclusive training committees? Are there just more women applying in surgery, emboldened by their predecessors? To be sure, this cultural shift has left the path slightly easier for women surgeons in 2019, just as we had it easier compared to women who trained in the last century.

Indeed, the trend worldwide has been an increase in the number of women doctors. In 2017, the Association of American Medical Colleges reported for the first time more female than male enrollees. As early as 2014, in the United Kingdom, there were more women than men doctors under 30. These are great strides considering that the male-female ratio was 10:1 in the 1960s. It’s also heartening that a number of studies have shown similar patient outcomes for women, including equal or slightly lesser rates of mortalities and readmissions and similar postoperative outcomes.

But numbers aren’t everything. Challenges still exist, both for women in medicine and those struggling to get in. Last year, a Tokyo medical school admitted that admission scores were manipulated for over a decade to give male applicants an advantage. (The system has been overturned, and interestingly, women outperformed men in the 2019 entrance tests.) The justification is familiar — that women doctors would abandon their profession to have children. Women
admittedly have been shown to be more likely to dedicate less time to clinical and administrative work due to family responsibilities: In a 2014 survey, female physicians were shown to be spending more time on childcare and domestic labor than their male counterparts, illustrating how societal expectations of women as the “default” caregivers and designated worriers can impact their careers. In addition, the pay gap exists in medicine as well, with female physicians earning an average of 26.5 percent less than their male counterparts. Women are also outnumbered by men in faculty and leadership positions. This barely even touches on the reality of gender bias, discrimination and sexual harassment endured by female doctors at large.

A former president of the United Kingdom’s Royal College of Physicians said in 2004 that the influx of women would “harm” medicine: the issue was not whether women were capable, but whether they would be as likely as men to commit time and effort to research and leadership, and to pursue more demanding training. While controversial, her statement echoed the thoughts of many. Fifteen years later, have we proven her wrong? For one thing, the rise in the number of women pursuing surgical specialties, considered to be the most time-demanding and antisocial, ought to prove that women are capable and willing; but challenges exist, including both discriminatory attitudes and the domestic expectations of career women, which continue to hold them back.

kchuarivera@gmail.com