New Feminism and Women in Medicine

A couple of semesters ago, I sat in on an anthropology seminar and learned about the different waves of American feminism over the decades. I thought there was only one feminist movement! It turns out that there have been several. In the 19th century, first-wave feminists sought political power, primarily through the suffragist movement. Second-wave feminists viewed gender discrimination as a result of institutionalized sexist power structures. Third-wave feminists separate themselves from second-wave feminists in their view of femininity, celebrating sexuality as a means of female empowerment. Third-wave debates persist to this day in the 21st century, about the existence of inherent differences between the sexes; or perhaps birth control as a reproductive right and form of sexual freedom; or what I often see championed by female medical professionals: equal pay for equal work, striving to reduce the gender wage gap.

I view these discussions as fascinating, since I find myself to be a member of several referent groups whose majorities have very different opinions about the fundamental nature and roles of women.

  1. An aspiring surgeon, I recognize that women in my dream specialty are in the minority. I certainly would like to see this number increase. As a medical student, I would like to have more female mentors in surgery. In the future, I hope to work alongside many female colleagues and empathize with them given our unique circumstances as full-time working professionals, mothers, and wives. And of course, when the time comes, I would like to be compensated as much as my male counterparts for my work that is just as good if not better than theirs.
  2. As I grow in my faith as a Catholic, I find myself challenging many of my previous beliefs on abortion and gender equity after reading beautiful works of writers like Pope John Paul II, Hildegard von Bingen, and Alice von Hildebrand. My current perspective lies pretty close to this philosophy of New Feminism, which emphasizes gender complementarity. I believe that men and women have different strengths and fundamentally different biologies, but we nonetheless have equal worth and dignity. In this way, I am liberated to chase my dreams in surgery, but I also believe that I possess inherent strengths of empathy, interpersonal relations, and communication as a woman. These strengths prime me for a distinct role in marriage and eventually, bearing the privilege of motherhood.

A new study published yesterday in JAMA Internal Medicine reports that patients treated by female physicians had significantly lower mortality and readmission rates compared with those treated by male physicians in the same hospitals. “Wow, what a potentially convincing new finding” must have been the reaction of many new-age physician feminists. Frankly, my initial thoughts were similar.

In part we can attribute these results to the inherent strengths of women: empathy, interpersonal relations, and communication. These findings make sense because women are naturally more capable of exercising good practices that care for patients on a holistic level. They are also more capable than are men of concession, my thought to explain the finding that female physicians are more likely to adhere to clinical guidelines and evidence-based practices.

But when I read the study’s methods, I found two overlooked but very important things: 1. The patients were hospitalized Medicare fee-for-service beneficiaries, and 2. all physicians were hospitalists.

Number 1 means that all patients were 65+, disabled, or affected by end-stage renal disease. They also pay for unbundled services separately. The fee-for-service model incentivizes physicians to dole out more treatments because their compensation depends on quantity not quality of care. Female physicians may have higher receptivity to clinical guidelines and following rules. But could we also attribute this result to a culture of defensive medicine, which encourages physicians to order more tests to avoid malpractice liability? Maybe women more commonly practice defensive medicine! This may make sense with the statistics associated with number 2.

Number 2 means that all physicians in the study treat patients who are hospitalized. These physicians are internists, who specialize in the diagnosis and medical, or nonsurgical, treatment of adults. It is well-known that women make up a greater percentage of internists than of surgeons in the United States. Whether women choose internal medicine out of personal interest or lifestyle accommodations does not really matter in this case. If there is more gender parity among internists than surgeons, it makes sense that female internists would visibly excel. Internists treat medical diagnoses which more often represent the intersection of biological, psychological, and social factors than do problems necessitating surgical intervention. I digress that the issue of the wage gap is not so apparent when you account for specialty compared to other more commonly utilized factors.

There are certainly valuable lessons to be gained from the study. The most important is that placing emphasis on certain inherent female characteristics will make us all better doctors. However, I find issue with the need for comparison. Why do we need to encourage dialogue that undermines men? In my opinion, these confrontational methods do not elevate professional women with dignity.

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