| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
From the Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Address correspondence and reprint requests to Steven H. Rose, MD, Mayo Clinic, 200 First St. SW, Rochester, MN 55905. Address e-mail to rose.steven{at}mayo.edu.
Abstract
BACKGROUND: The number of women graduating from United States medical schools progressively increased during the 26 yr period from 1978 to 2004. This change was associated with shifts in the gender distribution of residents training in Accreditation Council for Graduate Medical Education-accredited residency programs.
METHODS: We compared trends in the number and gender distribution of residents enrolled in the 10 specialties with the largest national enrollment of residents.
RESULTS: The gender distribution of residents training in different specialty programs varies widely. The percentage of women enrolled in anesthesiology training programs is less than the national average, and the rate of increase is less than that of many other specialties.
CONCLUSIONS: The reasons for this distribution are multifactorial. Contributing factors may include limited exposure to women role models (including fewer women with senior academic rank and in leadership positions), gender insensitivity leading to an unprofessional work environment, limited involvement of women anesthesiologists in undergraduate medical education, misperceptions of the physician–patient relationship in anesthesiology, and practice scheduling requirements that are inconsistent and inflexible.
The total number of physicians and the number of United States medical school graduates (USMG) entering training in Accreditation Council for Graduate Medical Education (ACGME)-accredited anesthesiology residency programs in the United States (US) varied over the 26 yr period from 1978 to 2004. During the same period, the number and percentage of female USMGs has progressively increased, and the number of women training in anesthesiology has grown. The purpose of this review is to examine these trends, to compare them to similar demographic information in several other large medical specialties, to describe the potential future implications of these trends on anesthesiology as a specialty, and to consider issues that may influence the choice of anesthesiology among women medical students.
METHODS
The 10 specialties with the largest national enrollment of residents were identified using data from the American Medical Association on the number of residents on duty in ACGME-accredited specialty graduate medical education programs on August 1, 2004 (1). In descending order by size, these specialties are internal medicine, family medicine, pediatrics, general surgery, anesthesiology, obstetrics and gynecology, psychiatry, radiology, emergency medicine, and orthopedic surgery. Trends in the national enrollment and gender distribution of residents in these specialty programs were reviewed and analyzed over the period 1978–2004 on the basis of the data in the annual medical education issue of the Journal of the American Medical Association (1–22).
RESULTS
The number of women graduating from US medical schools and entering residency training has increased markedly over the past few decades. Only 700 women physicians (8% of all USMGs) graduated from US medical schools and became eligible to enter residency training after the 1969–1970 academic year. A decade later (in 1979–1980 academic year), 3497 women physicians (23% of all USMGs) graduated from US medical schools. At the end of the 1989–1990 academic year, the number of women graduating from US medical schools had increased to 5221 (33% of all USMGs), and 6978 women (45% of all USMGs) graduated from US medical schools after the 2002–2003 academic year (23). As expected, the number of female residents training in ACGME-accredited anesthesiology residency programs increased as the number of women enrolled in US medical schools grew. However, the rate of increase in anesthesiology has not kept pace with that in many other specialties, and it remains less than the national trends. (Figs. 1 and 2).
|
|
On a percentile basis, more than twice as many women residents were enrolled in anesthesiology residencies (19%) as were enrolled in general surgery residencies (8%) in 1978 (24). In 2004, the percent of women training in anesthesiology (28%) was only slightly more than the percent of women training in general surgery (27%) (1). Women accounted for 16% of residents enrolled in US family medicine residency programs and 19% of residents enrolled in anesthesiology residencies in 1978 (24). In 2004, women accounted for 52% of residents enrolled in US family medicine residency programs, but for only 28% of residents enrolled in anesthesiology (1).
DISCUSSION
Does gender distribution among anesthesiology residents matter beyond assuring the inherent benefits of diversity? We believe so, and offer the following argument in support of this position: The future of any specialty is critically dependent on attracting the most talented medical students. As the percentage of women USMGs has increased, the talent pool from which most residents are selected is increasingly limited unless both genders can be effectively recruited. Reviewing these data, it is apparent that anesthesiology may not be fully exploiting the available pool of medical student talent at present and is lagging behind several other specialties in this regard. This trend has the potential to negatively impact anesthesiology if the issue is not considered and addressed.
Why anesthesiology is not a more popular specialty choice among women is difficult to determine. Several factors warrant consideration. Lifestyle issues are often cited as an important consideration in the selection of a specialty for residency training, and anesthesiology is often included in lists of specialties said to be associated with favorable lifestyles (25–32). This group of specialties also includes dermatology, ophthalmology, radiology, and others where it is thought to be easier to sustain a "controllable" lifestyle that includes personal time free of practice requirements and control of total weekly hours spent on professional responsibilities (25). However, data indicate that anesthesiologists rank among the busiest specialists, with an average of 61 hours per week committed to professional activities and an average of 59 hours per week dedicated to patient care (33).
Compensation and incentive programs have recently been described in two academic departments of anesthesiology that address scheduling flexibility and provide options for more consistent work hours (34,35). Implementation of creative compensation and incentive programs could positively influence anesthesiologist recruitment in a competitive academic or private practice marketplace and preserve perceptions of fair treatment among all members of the group. Various scheduling systems, including working more hours on fewer days per week, have been positively reviewed among nursing personnel (36–38).
Although anesthesiology may initially seem well-suited to part-time work or a "family-friendly" practice, this impression may be false. Private practice anesthesiology groups are often rigidly scheduled and may not be economically and liability integrated. Considerable pressure may be placed on junior partners regarding work assignments. In many groups, the junior partners are assigned to a less desirable payor mix, and they are frequently scheduled for later hours, on weekends and during holidays. In addition, the operating room (OR) atmosphere in private practice remains predominantly male, which may lead to less camaraderie or to an imbalance of power for women physicians working in this environment.
Although these issues may be better regulated in academic centers because of university employment policies, several issues in academic anesthesiology should also be considered. The unequal gender distribution of faculty with senior rank (associate and full professors) has been well established, and women are not proportionately represented in the leadership of our national and specialty societies. Women should be encouraged to pursue careers in academic medicine, be supported by strong mentors, and be actively prepared to assume leadership roles in anesthesiology organizations. Such encouragement would promote an atmosphere of advocacy for talented women and encourage them to consider anesthesiology as a specialty.
Several studies have examined factors that influence specialty choice. These factors include an influential mentor or an excellent instructor (28–30,39–41), income expectations (42), and personality factors (43). Gender discrimination and sexual harassment may be important as well (41). Of note, women are most likely to report gender discrimination and sexual harassment during general surgery rotations (44). Assuring professional behaviors in the OR and intensive care unit environments may improve the recruitment of women in anesthesiology and surgical specialties.
We believe some of the factors that may influence women on the choice of anesthesiology as a career can be addressed. These include the following:
Women Role Models/Instructors/Mentors
Having little or no exposure to anesthesiologists during the pre-clerkship medical school curriculum may be a factor in the under-representation of women in anesthesiology residencies (45). As the interaction with role models is known to play an important role in specialty choice (46), particular efforts should be made to involve women faculty as personal advisors, clinical advisors, research advisors, and as mentors. Women faculty and residents should also be supported and encouraged to accept administrative roles in the medical school and should be involved in the resident recruitment process.
Anticipate Issues Important to Women in Selecting a Specialty
Programs should anticipate issues that may be particularly important to women in selecting a specialty. Providing information about spousal employment and day care to applicants of both genders conveys sensitivity to family and parenting issues. Similarly, providing a list of women anesthesiology residents and faculty that includes their personal and professional interests may demonstrate successful integration of personal and professional goals.
Educating Students about the Physician–Patient Relationship in Anesthesiology
The physician–patient relationship may be a particularly important consideration related to specialty choice among women (47–50). We believe this aspect of anesthesiology is often misunderstood by faculty and residents in other disciplines and by medical students. In the OR, anesthesiologists face the challenge of interacting professionally and effectively with patients in a limited period of time. Few outside the specialty are aware of the rewards associated with efficiently conveying a sense of competence, confidence, and compassion during the perioperative period, especially when patients fall vulnerable.
Consider Flexible Scheduling Options During Training and Practice
It may be time to consider flexible training options in anesthesiology on a national level. The American Board of Anesthesiology, like most American board of medical specialties boards, presently prohibits part-time training by specifically requiring "four years of full-time training" to complete the continuum of training in anesthesiology (51). There are recognized complexities involved with administering programs that offer flexible training. However, the pediatrics residency program at the University of California, San Francisco recently reported that a 10-yr experience with a flexible option (part-time) residency training schedule proved to be successful for 24 residents, mostly women, who completed their residency program in this way (52). The availability of various compensation and incentive systems after completion of training may positively impact practitioners who desire greater scheduling flexibility and/or more consistent work hours.
CONCLUSIONS
The number of women graduating from US medical schools and entering ACGME-accredited residency training programs progressively increased between 1978 and 2004. Women remained under-represented in anesthesiology training programs relative to the national population of USMGs throughout this period, and their rate of growth was less than that of several other specialties, including general surgery. Factors to be considered that might promote more effective recruitment of talented women include recognition of the importance of role models in specialty decision making, assuring that gender discrimination does not create an unprofessional work environment, encouraging women faculty and residents to be involved in undergraduate medical education, educating students about the physician–patient relationship in anesthesiology, addressing issues that may be particularly important to women in selecting a specialty, promoting greater flexibility in training options, and establishing incentive/compensation models that allow more consistent work hours.
Footnotes
Accepted for publication July 11, 2006.
Supported solely by institutional and/or departmental sources.
REFERENCES
This article has been cited by other articles:
|
|
 |
|
  C. A. Wong and M. C. Stock The Status of Women in Academic Anesthesiology: A Progress Report Anesth. Analg., July 1, 2008; 107(1): 178 - 184. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
