Women Doctors: Increasing Numbers Have Changed Medicine

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Cover Story - September 2005   

By   Erin Prather
Associate Editor  

Harlingen family physician Adela Valdez, MD, recalls her first visit to the physicians lounge during her residency in McAllen. Pregnant and new to the hospital, she decided to grab a cup of coffee before changing out of her street clothes and into scrubs.

I walked in, got coffee, and then walked out of the lounge. A male physician ran after me and barked out, 'Young lady! Do you know that this is the physicians lounge?' I was surprised, but responded immediately that I did know and I was, in fact, a physician. He was most embarrassed and apologetic. We actually ended up becoming close friends."

Dr. Valdez understands why the man immediately assumed she was not a physician. There weren't "many women in medicine, certainly not pregnant women" when she graduated from medical school in 1980, and there had been only one woman resident before she arrived in McAllen.

Encountering a woman physician anywhere in Texas then was not as common as it is today. Texas Medicine reported in 1975 that 112 women entered Texas medical schools in 1973. That number rose to 665 by fall 2004. Last year, the Association of American Medical Colleges (AAMC) reported that women applicants made up just over half of the 2004-05 national applicant pool, outnumbering men for the second straight year.

The fall 2002 Journal for the American Women's Association (JAMWA) predicts that by 2010, nearly 1 in 3 U.S. physicians will be female. This boost in medicine's female population has become a catalyst for the ways women are changing the field of medicine. 

Overcoming Adversity  

It's no secret Texas women often were discouraged from pursuing medicine, or that such dissuasion rarely prevented their medical dreams.

In 1896, Leslie Waggener, MD, president of The University of Texas Medical Branch at Galveston (UTMB), gave his last public address before the Texas Woman's Press Association. There he expressed his disapproval of women becoming physicians. "The work of a doctor or surgeon is not work for a woman," he said.

Not long after Dr. Waggener died, Marie DeLalondre Dietzel became the first woman to graduate from the school in 1897.

Even after Dr. Dietzel's graduation, critics still believed it was a waste of time to train women in medicine. Their chief argument was that women would marry and stop practicing. Worse, they were depriving young men -- who it was thought would eventually contribute more than their female counterparts -- from precious spots in medical school. Finally, it was assumed women were too emotional or incompetent to practice good medicine.

In 1932, Ruth Jackson, MD, the first practicing female orthopedist in the United States, opened a practice in Dallas. The following year, the American Academy of Orthopaedic Surgeons (AAOS) was founded and invited all practicing orthopedists to become members. Except Dr. Jackson. She was not asked because of her gender. Undeterred, she would go on to pass the American Board of Orthopaedic Surgery exam in 1937, and become the first woman certified by the board and the first woman admitted to AAOS.

The father of the woman who would later become the first female Texas Medical Association president dismissed her medical dreams at age 5. "Damn fool idea," he told her.

She ignored him, and in 1935 Fort Worth pathologist May Owen, MD, discovered that the powder once used in surgical gloves (commonly known as French chalk) caused scarring, adhesions, and peritonitis.

This finding is only one example of Dr. Owen's remarkable career. She would later establish the May Owen Trust Fund, which provided low-interest loans to medical students, and would continue to work until her death in 1988.

Dr. Owen, who became TMA president in 1960, blazed a trail for women's involvement in organized medicine. She was followed by Ruth Bain, MD, of Austin, in 1982, and Betty Stephenson, MD, of Houston, in 1994. Women physicians' membership on TMA boards, councils, and committees has increased over the years. In 2000, Fort Worth allergist Susan Rudd Bailey, MD, became speaker of the TMA House of Delegates after serving as vice speaker for three years. Dr. Bailey retired as speaker at the end of TexMed 2005.

As of Aug. 1, TMA had 9,773 women members. Nancy W. Dickey, MD, a family physician in College Station and president of theTexasA&MUniversitySystemHealthScienceCenter, was elected the first woman president of the American Medical Association in 1997. Dr. Dickey strongly believes that women's involvement in organized medicine is imperative as the profession continues to evolve.   

The role of women in organized medicine is very important because we represent a growing proportion of the profession and our perspectives are important for problem solving. No significant subset should be without a voice, and to forego using that voice is to leave the profession poorer," she said. 

There are so many women pioneers in Texas medicine," said Dr. Valdez, assistant dean for education at The University of Texas Health Science Center at San Antonio. "It's been wonderful to watch the population of women medical students change from a handful to the majority. I am thankful for the women who were way before me. They helped make that possible." 

The Sugar Land Four  

In her book, Restoring the Balance: Women Physicians and the Profession of Medicine, 1850-1995 , UTMB professor Ellen S. More, PhD, writes, "Only since the 1970s, in the wake of complex social, political, and legal changes, have significant numbers of women doctors been able -- and willing -- to move toward the center of professional authority in the United States."

Dr. More says that the pioneer women physicians were forced to confront access to the profession, while the challenge for their successors has been to solidify their standing and to flourish on their own terms.

Indeed, an article by Shelley Ross, MD, in the AMA's September 2003 Virtual   Mentor  says some of the changes in medical practice attributed to women are equally advantageous for both sexes. It has become more acceptable for both men and women physicians to refuse work to the point of physical and mental exhaustion. Moreover, there are now more flexible residency training programs, part-time work, maternity and paternity leave benefits, and tax benefits for day care costs.

Dr. Ross's article also points out that solo practices are disappearing and the number of large groups in which physicians work shifts to provide coverage is increasing.

This setup is just one factor behind the success of Sugar Land's Family Practice Doctors Center. Drs. Jennifer Diamond, Jessica McKelvey, Seva Papageorge, and Tayma S. Weber not only manage the all-woman practice, but they also run a hectic home schedule that includes caring for their children.

"The other day a new patient told me she was excited that we were all women," said Dr. Diamond. "She said, 'I'm so glad all four of you are women. This practice is wonderful. You must have great happy hours.' I started laughing. We have seven kids between the four of us under the age of 5. We are rushing in and out the door and sometimes forget to even say good-bye to each other." 

The four physicians say being a part of an all-woman practice has its advantages. They have covered for each other's maternity leave, will see a colleague's patients if she has to leave because of a sick child, and have been able to set hours that accommodate their situations at home.

Additionally, the women recruited the help of hospitalist Tajuddin Momin, MD, something that was not easy to arrange. Originally the hospital and fellow primary care physicians were against the idea. 

Using a hospitalist was an evolution for the hospital," Dr. Papageorge explained. "There had been no such thing, and we faced a lot of adversity. However, once the system was in place, those who were against the idea saw that the arrangement actually benefited patients."

Adds Dr. Weber, "Dr. Momin cares for patients around the clock at the hospital and can admit or discharge them directly. After the patients leave the hospital, he refers them back to us for continuing care. Some of the physicians who were so against the idea have now asked him to be their hospitalist."  

The Balancing Act  

When asked to name their primary challenge, they are quick to use the term "balance." Dr. More points out in her book that "the theme of 'balance' winds through the entire history of women in medicine. For more than a century and a half, American women physicians have grappled with the dilemma of how to be a woman and a physician, how to be different from, yet equal, to their male colleagues."

Dr. Weber says she and her colleagues struggle "to define this hybrid of physician and motherhood. We are all trying to maintain both roles successfully. We cannot compromise our work as physicians. I can't afford to stay up late doing personal stuff because I have to come into work alert and ready to provide the best possible care for my patients."    

Erica W. Swegler, MD, a Keller family physician and immediate past president of the Texas Academy of Family Physicians, admits that the balancing act is difficult. She has a framed print of the Chinese character for "balance" in her office as a visual reminder. A mother of two, Dr. Swegler believes the key is for women physicians to recognize they can have the lifestyle they want, while still providing the best possible service to their patients.

Today there are so many options of practice settings and situations. Young women are growing up to see that they have choices," she said. "I'm in a small group practice. There are five other physicians to share calls with, which has been terrific. Medicine will always have the 24-hour component and the commitment that goes beyond what most other people do for their jobs. What's important is for physicians to look at their options. They can make their lifestyle as easy or as difficult as they choose."

An article in the July 1, 2001, issue of American Family Physician says, "There is no right time to have a child in medicine." It adds that women with children and families sometimes face a more difficult dilemma because they struggle with child care issues, working-mother guilt, and isolation from their spouses.

El Paso County Medical Society President Kathryn Zerbach, MD, knew she was meant to become a physician. The first female surgeon in her residency program, she had not thought of herself as a pioneer. "Practicing in El Paso has been a terrific opportunity for me. The community was definitely ready for a woman physician specializing in breast care, even if some of my colleagues were not.   Many initially assumed I was an obstetrician, especially if I was in scrubs. That was the only surgical field with which they had any prior experience with female physicians." 

She adds that the most painful consequence of her career was missing a significant portion of her daughter's childhood. She still feels the regret 22 years later and admits she often does not know how to advise medical students or residents regarding practicing surgery and having a family. She knows how different their situations are from her own.

"In the beginning, I was subsequently met with only negative reactions from would-be mentors. They told me becoming a surgeon was impossible. I was too old, a woman, and a single parent. Most women go into medicine prior to starting their families. The rigors of surgery training and a surgical career make decisions regarding the timing of family matters difficult to sort out. I was older, as was my child. We made it work for us, but it certainly wouldn't work for many women. That's probably why, despite the large increase of females in medicine, the percentage of women surgeons continues to remain fairly low."  

Academia … the Final Frontier  

AAMC reported that in 2003, women made up 30 percent of medical faculties. Although surgery and orthopedic departments continued to have low proportions of women faculty, obstetrics and gynecology, pediatrics, and public health and preventative medicine had more than 40 percent women in faculty positions.

Regarding academic leadership, the February 2005 issue of the AAMC Reporter  said only 14 percent of senior faculty and 10 percent of medical school deans in 2004 were women. The numbers represent progress (there was only one female dean in 1990), but the percentage is low when compared to the overall academic population. 

Reasons why women physicians are not as involved in academia as their male counterparts vary. A 2002 study printed in JAMWA  explored the challenges facing medical school department chairs, paying particular attention to issues confronting women in such leadership positions. The study's findings said barriers to the women's advancement ranged from the constraints of traditional gender roles to a lack of effective mentors.

The JAMWA study also says women physicians without children achieved the rank of professor as frequently as men, but women with children did not. Additionally, physicians with children reported the lowest levels of satisfaction with their academic career. It concluded that institutional changes must occur and that targeted initiatives supporting women, especially those with family responsibilities, are needed.

Women must be taught how to negotiate equitable contracts; there needs to be a demand for equity in academic appointments," said Dr. Dickey, the only woman president of a Texas health science center. "Women physicians also need to mentor their female colleagues so they have the formal and the informal skills for advancement. Medicine will only become more challenging as we deal with more and more complex science, and we need to assure that whatever their gender, those who have a desire to become physicians are given the opportunity to do so. In all likelihood, it will take the best of both men and women for medicine to be its best."

Unquestionably, women in Texas medicine have made great strides in past decades. Their rising numbers have not only caused them to revaluate what is best for both their practice and personal life, but it also has caused their male colleagues to reconsider their own lifestyles.

Said Dr. Valdez, "Last week I was talking to a recent graduate who has noticed how women have positively influenced both the work hours and concept of balance within medicine. I think that since women physicians have learned to balance their lives, men are also considering how to do the same for themselves. It's a whole new concept that we have brought to the field."

In Sugar Land, Dr. McKelvey experienced a personal result that neither she nor people like Dr. Waggener could have predicted.

My 5-year-old said something, and I realized she had no idea that men could also be physicians. I am a woman physician. My colleagues are all women physicians, as is her pediatrician. She had only encountered women physicians. As for men, she thought they could only be nurses because that was all she had come across."  

Erin Prathercan be reached at (800) 880-1300, ext. 1385, or (512) 370-1385; by fax at (512) 370-1629.   

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