INCREASING REPRESENTATION, MAINTAINING HIERARCHY: AN ASSESSMENT OF GENDER AND MEDICAL SPECIALIZATION

Abstract

AbstractDespite increases in the number of women entering the medical profession during the past four decades, female medical students remain more likely than their male colleagues to enter less prestigious medical specialties. Data from the Association of American Medical College's 2004 Graduation Questionnaire are used to test both supply- and demand-side explanations for this pattern among a recent cohort of graduating medical students. Controlling for educational debt, type of medical school attended, and race/ethnicity, women are less likely to enter the prestigious fields of surgery and anesthesiology, radiology, and pathology. Although none of this study's hypotheses account entirely for the effect of gender on medical specialization, results reveal that concerns about work and family balance and experiences of mistreatment in medical school affect all medical students' career decision making, albeit in somewhat unanticipated ways.IntroductionAlthough women are increasingly gaining access to occupations historically dominated by men, processes of internal segregation often occur within occupations following the entry of significant numbers of women (Reskin and Roos 1990). The medical profession is no exception, as women are disproportionately represented within less prestigious specialties such as pediatrics, psychiatry, and obstetrics and gynecology (Colquitt 1994; Hinze 1999, 2004). Gender segregation in the medical profession also has consequences outside the workplace. Research shows patients prefer to be seen by physicians of similar backgrounds; thus, a diverse physician pool serves patient interests (Laveist and Nuru-Jeter 2002; Menees et al. 2005; Saha et al. 2000). For example, women's reluctance to be screened for colon cancer has been attributed to the low number of women gastroenterologists (Menees et al. 2005). Women are willing to delay colon screenings in order to see a female gastroenterologist, as they feel more comfortable with a woman performing the exam (Menees et al. 2005). Because women may delay medical care to see physicians who are demographically similar to them, a lack of diversity across medical specialties has implications for women and women's health throughout society.In this paper, we examine the gendered hierarchy of the contemporary medical profession. Why, we ask, are women disproportionately located in less prestigious medical specialties?1 What factors contribute to the gendered hierarchy of the medical profession? We explore two possible explanations for this gendered pattern offered by recent literature. What we refer to as the supplyside explanation argues for the importance of individual preferences and goals. Here, women's location within less prestigious medical specializations relates primarily with their unique goals and desires. This gendered goal development is thought to result largely from the differential socialization of men and women, and women's resulting concerns about balancing work and family life. In contrast, what we term the demand-side explanation holds that experiences during medical school shape male and female students' career trajectories in very different ways. This perspective locates the source of men and women's divergent medical pathways firmly within medical and educational institutions.These two explanations are not mutually exclusive, as students bring a priori intentions and goals to their medical training, which affects future career plans. Although we discuss these two explanations separately given debates in the literature about the relative merits of each, they are tested concomitantly in our analysis.The Gender Hierarchy of the Medical ProfessionMirroring the success of the women's movement by opening up opportunities for women in previously male-dominated fields, the 1970s marked the first entrance of significant numbers of women into medicine (Boulis and Jacobs 2008). As of 2005, women comprised close to half of medical students, an increase from 11 percent in 1970 (Boulis and Jacobs 2008:2). …