Gender Segregation by Specialty during Medical School

Over the past 30 years, the representation of women in the active physician workforce climbed from 6.8% in 1970 to 23.0% in 1997. Moreover, women’s presence in medicine will continue to grow, because 45.8% of all U.S. first-year medical students in 2000 were women. By 2010, women physicians are projected to constitute 29.4% of U.S. physicians. In spite of this dramatic progress, women physicians remain concentrated in relatively few, lower-income medical specialties and are less likely than are men to hold tenured faculty positions. In addition to their effects on women physicians, gender disparities in medicine may have implications for patient care. Patients who desire providers of a specific sex but cannot access them may be more reluctant to seek medical care initially and less compliant when they ultimately end up with providers whom they do not trust. Having providers of a specific sex has been shown to influence the satisfaction of women seeking prenatal care, and satisfaction has been associated with patients’ compliance. It follows that a similar preference for women physicians may exist for women seeking other types of sensitive care, such as treatment for breast cancer or urologic disorders. Although the supply of women obstetricians has grown substantially, the availability of women breast surgeons and urologists remains very low. Further, data suggesting that substantial numbers of women prefer women primary care physicians may imply that some women prefer to see women providers for all of their health care needs. In addition, a number of studies have suggested that women physicians differ from their men counterparts with respect to time spent with patients and attention devoted to preventive health. Women physicians may also treat certain conditions more aggressively. Thus, the presence of women across a broad range of specialties may affect patient care in a number of different ways. There is extensive literature investigating why men and women medical students pursue different specialties. These studies suggest that demographic characteristics, personal values, and/or unique family responsibilities are responsible for gender differences in specialty choice. Surprisingly, little effort has been made to assess the role of academic experience in promoting gender segregation across specialties. Coffin and Babbot found that the gender disparity in interest in pediatrics grew during medical school. Several studies have documented an association between medical school experiences and specialty choices, and at least one study suggests that women and men have different experiences in medical school. In this study, we used the well-established sociologic concept of segregation to describe differences in distributions. We specifically examined how gender segregation across specialties has changed during the past 20 years and how gender segregation changes during medical school. In so doing, we began to assess whether the entry of women into medicine: (1) causes the profession to become woman-dominated; (2) exacerbates the concentration of women in a few, lower-income, specialties; or (3) encourages the equal representation of men and women in the profession. This analysis sheds light on whether specialties are continuing to integrate, as Jacobs found for the 1970s and 1980s, or whether a process of resegregation by gender is occurring in the medical profession, as Reskin and Roos suggest. The analysis also indicates whether the process of gender segregation is fixed at entrance to medical school, or reproduced during medical school. Methods