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August 2001
Volume 65 |
Number 8
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WHAT'S NEW IN...
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| …Anesthesiology
Demographics: Woman Physicians’ Changing Specialty Choices
and Implications for Anesthesiology’s Workforce Shortage |
Selma H. Calmes, M.D.
The increasing number of women physicians since 1970 represents
one of the most dramatic changes in American medicine. There were
25,401 women physicians in 1970 — 7.6 percent of the total
physician population. In 1999, the most recent data year, there
were 186,606 women physicians — 23 percent of the total physician
population.1
This is a staggering increase of 635 percent. This trend will
continue because women medical students now make up 45 percent
of the medical student population, and women applicants to medical
school continue to increase yearly. 2,3
Obviously, the specialty choices of women physicians will now
be an important factor in specialty worker output. This article
briefly discusses this situation and some factors that may be
important.
This increase in total women physicians is reflected in anesthesiology
as well. When I finished anesthesiology residency in 1969, only
1,516 women were practicing anesthesiology, representing 14 percent
of anesthesiologists at that time. Now, there are 7,080 women
anesthesiologists, or 20 percent of the anesthesiology workforce
4 [Graph
1]. Numerically, it might seem there are plenty of women anesthesiologists.
But as is so often the case, things are not what they seem. There
could actually be many more women anesthesiologists if women had
continued to choose anesthesiology as frequently as they did in
the past.
The April 2001 ASA NEWSLETTER article “Where
Have All the Anesthesiologists Gone? Analysis of the National
Anesthesia Worker Shortage” on the current and future
anesthesiology workforce, by Gifford Eckhout, M.D., and Armin
Schubert, M.D., led me to reanalyze data on this subject. The
percent of this increasing pool of women who actually enter our
specialty is falling. (See
Graph 1, especially the information under “Percent of
all women M.D.s in anesthesiology”). The falling percentage
of women physicians choosing anesthesiology has been noted previously.
5,6 The decrease continues at the low level
of 3.8 percent as predicted. The percent of the male physician
population found in anesthesiology has increased and, for the
first time since 1970, exceeds the percent of women physicians
entering anesthesiology [Graph
2].
| “ …there are now more
women residents in general surgery… than in anesthesiology
(1,097 in 1999)!” |
It was also predicted that women in all surgical specialties
would exceed women in anesthesiology in 2000 if these trends continued.
7 This has indeed happened, with 8,849 women physicians in
surgery and its subspecialties in 1999, compared to 7,080 women
in anesthesiology. 4 Even more striking news
is that there are now more women residents in general surgery
(1,640 in 1999) — a field that has traditionally had very
few women — than in anesthesiology (1,097 in 1999)!8 This
situation (the attractiveness of other specialties, even surgery,
to women compared to anesthesiology) has important implications
for our ability to meet worker needs. This situation needs attention,
analysis and action if we are to meet our future growth needs.
From the earliest times of professional anesthesia, anesthesiology
attracted a surprising number of women.8 Even after World War
II, when large numbers of men entered anesthesiology, it continued
to be a relatively popular choice for the small number of women
physicians available, ranking as the fifth most common specialty
choice in 1970. Anesthesiology now ranks sixth in female specialty
choice, well below the fifth choice, psychiatry (1999 data: 11,266
women physicians in psychiatry; 7,080 in anesthesiology). 4
The recent NEWSLETTER article by Drs. Eckhout and Schubert
on worker needs based predictions on a 1-percent increase per
year in women’s entry into anesthesiology. Clearly that will
not happen, and the shortage will be worse than projected. We
need to ask why anesthesiology is not as attractive a specialty
choice as it was in the past, and we need to try to fix this.
The increasing pool of women physicians represents our best and
largest potential workforce reserve source to meet the situation
described by Drs. Eckhout and Schubert.
Possible actions include, most importantly, tracking residency
matching data by gender. By tracking at the entry point into the
specialty, we can detect changes more quickly. Also, it is especially
critical to look at international medical graduates (IMGs) by
gender during residency. Female IMGs represent an important but
often overlooked part of the increase in women physician population.10
Have female IMGs been filling anesthesia residency slots, while
U.S. female graduates are not even applying? Surveys of residents
might be possible to determine why anesthesiology is not as popular
a choice for women as it has been. Previous surveys found that
male and female residents had similar reasons for choosing anesthesiology,
but perhaps this area has changed. 11
Drs. Eckhout and Schubert documented a serious workforce gap
in the future. If we are to fill at least part of this gap, we
need to have more women physicians choosing anesthesiology as
their specialty — as they did in the past.
References
1. Women in Medicine Data Source. American Medical
Association. Table 1-Physicians by Gender. (American Medical Association
Web site). [American Medical Association data were used because
they include all anesthesiologists and because data have been
kept by gender since 1970.]
2. Women in Medicine Data Source. American Medical
Association. Table 3-Women in U.S. Medical Schools Over a 20-Year
Period. (American Medical Association Web site).
3. Women in Medicine Data Source, AMA, Table 2-Women
Medical School Applicants (American Medical Association Web site).
4. Pasko T, Seidman B, Birkhead S. Physician Characteristics
and Distribution in the US, 2001-2002 edition. (AMA Press, Chicago),
2001. Table 1.14.
5. Calmes SH. More data on women in anesthesiology.
ASA Newsl. 1993; 57:32.
6. Lucas LF, Thomas MH, Rigor BM. Women and specialty
choice: Why not anesthesiology? J Am Med Womens Assoc. 1992; 47:54-57.
7. Calmes SH, Coombs RH, Coombs CJ. Entry of U.S.
women physicians into anesthesiology and surgery, 1970-1996. Anesthesiology.
1999; 91:A1144.
8. Women in Medicine Data Source. American Medical
Association. Table 4-Women Residents by Specialty. 1999. (American
Medical Association Web site).
9. Calmes SH. The women physician anesthetists
of San Francisco, 1897-1940: The legacy of Dr. Mary Botsford (1865-1939).
In: Atkinson RS, TB Boulton, eds. The History of Anaesthesia.
The Royal Society of Medicine Services: London. 1989:547-550.
10. Mick SS, Sutnick AI. Women in U.S. medicine:
The comparative roles of graduates of U.S. and foreign medical
schools. J Am Med Womens Assoc. 1997; 52:152-158.
11. Wass CT, Rose SH, Faust RJ, et al. Recruitment
of house staff into anesthesiology: Factors responsible for house
staff selecting anesthesiology as a career and individual training
program. J Clin Anesth. 1999; 11:150-163.
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Selma H. Calmes,
M.D., is Chair, Department of Anesthesiology, Olive View-University
of California Los Angeles Medical Center and Clinical Professor
of Anesthesiology, University of California-Los Angeles. |
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