For much of the 20th century, the work of medicine in the U.S. was performed by predominantly male physicians. As women began entering medical schools in larger numbers during the 1970s, some specialties were welcoming to women, others weren’t.

Surgical specialties were particularly resistant to the inclusion of women, with the exception of obstetrics and gynecology. After decades of increasing percentages of women entering gynecology, the field became the first majority women surgical specialty in 2012. This should have been embraced as evidence of the legitimate role for women in surgery. Instead, it led to a devaluation of gynecology as a specialty.

Despite the advancement of women in medicine, traditional gender roles persist. Men and women physicians are still expected to pursue “male” and “female” jobs, where women opt into caring and nurturing positions and men select technical or managerial roles. A surgical field composed mostly of women surgeons defies this conventional separation of physician specialties by gender.

advertisement

Occupational segregation, the unequal distribution of workers across and within professions by gender, defines and drives professional status. When the percentage of women in a traditionally male field increases, the work begins to be viewed as “women’s work,” which leads to a decline in wages, respect, and status.

The subsequent collective abandonment by men of now female-dominated fields is, at least in part, because of the gender-specific stigma and wage penalty associated with working within a “feminine” occupation. A tipping point, when approximately one-third of a field becomes women, leads to a precipitous decline in men employed in the field. In gynecology, this point has passed: Women comprise 58% of practicing OB-GYNs and 84% of trainees.

advertisement

Gender segregation across occupations drives much of the gender wage gap. As the share of women in a field increases, wages go down, even when controlling for education and skill. A documented negative correlation exists between the percentage of women working within a specialty and the mean salary. For OB-GYNs, salaries are currently lower than for any other procedural specialty. Similar work on women’s reproductive tracts is reimbursed at lower rates than on men’s reproductive tracts. For example, a surgeon is paid 45% more for a biopsy of a penis than of the vagina.

The attrition of men has resulted in lack of attention to the traditionally masculine, surgical side of the specialty. Obstetrics and gynecology is a unique specialty, the only field where medical and surgical care of an organ system are combined. Obstetrics is care related to pregnancy; gynecology is the surgical care of female reproductive organs. Today, academic obstetrics and gynecology departments are disproportionately led by nonsurgeons who tend to have expertise in obstetrics. These departments center around the labor and delivery units and maternity care, not the operating room.

Within health care systems, the bias and discrimination commonly experienced by individual women surgeons now extends to the group of surgeons who care exclusively for women patients. Gynecologists are no longer viewed as possessing the stereotypical masculine traits of surgeons — bold, decisive, and analytical. This categorization leads to preferential allocation of vital resources such as staff, operating room time, and equipment toward surgical specialties such as orthopedics or cardiothoracic surgery, where practitioners still fit the established perception of what a surgeon looks like. Regardless of revenue generated, increasingly gynecologists get the scraps.

More than 20 years ago, during my medical education, the conspicuous absence of women in surgery factored prominently in my decision to pursue a surgical career through gynecology. In retrospect, I assume there was ambient messaging from faculty and classmates that gynecology was more appropriate for a woman. A generation of women like me have now been trained in pelvic surgery for women as gynecologists.

As women physicians increasingly speak up about gender equity, their voices have arisen predominantly from non-gynecologic realms. The social media phenomenon #ILookLikeASurgeon highlights the widespread experiences of women going unrecognized as surgeons. #Time’sUp efforts now extend to health care. Zero-tolerance policies on sexual harassment are being adopted by health care organizations. Yet women in gynecology have remained remarkably quiet, despite being part of the first majority women surgical specialty.

To retain the value of our field, we must acknowledge that “women’s work” or not, medicine is medicine and surgery is surgery.

Sarah M. Temkin, M.D., is a gynecologic oncologist who works in Maryland.

  • As a gyn doubly boarded as you probably are I have tried to organize for practitioners thru my state’s district Acog .No one cared . Not the Acog district or the practitioners . Especially not the hospital , employers of most of the practitioners .When ob/gyns start caring about their own rights as much as they do about patients rights then , things might begin to change .In Bellevue the rate of appointment “no shows” in the ob/gyn clinic is between 30-40 % . This shows total disrespect for doctors & the institutions that pay the costs of the visits. We are a “punching bag” willing to take abuse from all sides . As far as I am concerned the midwives should manage all deliveries , and let the public be damned .

  • In my Otolaryngology career I was a general doctor ” for my patients with medical ENT problems and a surgeon for their surgical problems
    I think this was fairly comm for specialty doctors in my practice era of the 60,s to the 90s so obstetrics and gynecology was not the only area where a doctor…
    treated the whole patient I saved many patients from unnecessary surgeries by
    I listening to their problems, examining them and then giving them a treatment plan
    Too bad we dont do that anymore

  • Yikes is right. Although the article is about underpaid women, most of the comments I read were from defensive men which appears to support the premise that there is a bias.

    • More than yikes.

      I feel so bad for all these little men who are crying and complaining and crying and complaining because someone else…in this case women…are speaking up. Finally.

      And these same little men feel so threatened and are terrified of someone having a louder voice.

      But oh wait…it’s all right when the louder voices are from white men.

      Like Leonard…poor baby had to stay silent and awkward while women dished about a younger, cuter guy. So sad…so terrible. It must have ruined your life to still cry about it today. But it’s all right that women go through that…all the time. I can not think of a woman who has not been made to feel uncomfortable because of men around them dishing about “that hot girl over there” or that attention aimed at them personally.

      So why so awkward? Because you were a minority there? Because your ego got bruised and they weren’t talking about you? Because you found the young guy attractive too? Who knows and who cares. Big deal. It makes no sense.

      Or George? Are you pissed at your boss? Are you mad you didn’t progress in your career and a woman did? Do you hate your mommy? Who knows and who cares. Big deal. I don’t get it.

      George apparently also missed that historically medicine had gender parity between physicians and nurses in the first place. Men were only believed to be capable of being doctors as they were more “logical and rational”. Women were relegated to nursing because of the belief they were not suited to medicine due to emotions and only suited to be caregivers. Those are the same reasons women were shut out of the sciences as a whole. How did you miss that…

      The truth is it’s the person is better suited to being a doctor or nurse individually. I have met some amazing female doctors who blow their competition out of the water because they are smart, well read, and talented. I have met some amazing male nurses who blow the competition out of the water with their own talents, knowledge, and empathy/care. I’ve seen plenty of mediocre to poor male doctors (in all fields) and mediocre to poor female nurses. It’s just the way it is in a competitive field.

      And I guess according to David men can’t fight insurance rates! So powerful! Those insurances…with a lot of men at the top. How does that make sense?

      Welcome to real life guys. Welcome to logic. Now please stop crying and whining. That’s definitely not attractive…

  • It seems an overstatement that men have opted out of OB/GYN. There have been powerful forces at work against men, including insurance rates. The movement for “Equality” has gone well past the 50% point and your stat shows it’s past 80%. Are we on the eve of affirmative action for male students?

  • Yikes! The comments from the men. I had a colleague 30 years ago who completed a urology residency. I think her experience in a male dominated surgical field was a bit different than the male posters here would like to think. As for my $0.02, I do not think women entering gynecology caused reimbursements to drop, I think it is the gynecological flirtation with the label “primary care”. After all, every internist in this country can tell you about the degradation of a specialty and it happened long before women made up a majority of medical students. I made have started out in a general surgery residency, but, a mandated side trip as a military doctor and a medicine residency later, I work in an ED as an internist. Because I couldn’t make enough as a solo practitioner to afford a house.

    • You had a colleague that applied to a urology residency 30 years ago? Why would you think that experience is relevant 30 years later? I have a family friend who started a urology residency 2 years ago – in interviews with multiple programs they all expressed an interest in encouraging female medical students into the field. ‘

      Very serious question: Can men survive anywhere, but women need to be coddled? When a field is majority male, we worry whether women will fit in. But when it is majority female we assume men will be fine. In reality, we all need support, encouragement, and representation to thrive in any community – whether it be majority female OBGYN or majority male Orthopedics. I’ve been in a majority female work environment before and stood awkwardly and silently as the women discussed the attractive young new male intern – I promise you – it’s no less awkward and exclusionary as a man. It’s only less acceptable to complain about it.

  • Is the proportion of women in a medical specialty correlated with the total supply of candidate physicians in that specialty? Or conversely, are specialties with fewer practitioners more male-dominated?

  • Great article, except it’s clear that men don’t join OBGYN because it’s “women’s work” – they don’t join because it’s not hospitable to men. The residents are almost all female and the patients increasingly insist on female-only providers. What’s the point in going into a specialty where half the time you will be sidelined and told to step out because of your gender? In some cases, you will even be constrained in your job search due to implicit preferences for female providers, as a plaque in the office of one OBGYN group read: “Women’s Care. For Women by Women.” And every year that graduates an 84% female class makes it worse. (Interestingly, women don’t have nearly the same problem in Urology.)

    • I agree with Leonard.
      A lack of male participants would indicate that that particular discipline is possibly unwelcoming toward men.
      Men were not initially welcomed into the female dominated nursing profession and still only comprise 6% of the nursing profession in the 21st Century. Nursing is a respected profession with salaries and opportunities for advancement that are way above average, so, why wouldn’t men want to join that profession in equal numbers? Why is that not considered?
      Why is it celebrated when women dominate a discipline, but there is somehow something untoward/wrong if a discipline is dominated by men? Why is there no escalated concern that males are now heavily underrepresented in OB/Gyn profession as stated in the article and that this is a long standing trend for males not to enter OB/Gyn?
      If there is a lack of females in a particular discipline the “go to” reason is that that discipline is not welcoming towards women.
      Women in the top hierarchy of any profession can be just as oppressive as men and are quite capable of being oppressive/dismissive/unwelcoming toward men.
      If you’re looking for gender parity in every profession then study the reasons as to why either gender is misrepresented in a profession, I suspect the reasons are just as numerous and varied and a lot more complicated than just blaming it on gender stereotypes.

Comments are closed.

A roundup of STAT’s top stories of the day in science and medicine

Privacy Policy