When Nancy Hardt attended Loyola University medical school back in the mid-'70s, there were just enough women in her class to fashion a nucleus of close friends who supported and commiserated with each other. "We were," she says, "right at the beginning of being more than token."
Women in medicine are token no more. The ratio of men to women in the profession, 12 to 1 in 1970, shifted to about 3 to 1 by 2000. The balance is even closer in U.S. medical schools, where a continually steady increase in the number of entering women students has yielded a near-equal gender split. As the recently minted director of the University of Tennessee's Institute for Women's Health in Memphis, Hardt sees firsthand how a small corps of female pioneers has multiplied - and, in the process, forced a not-so-subtle change in the way medicine is practiced in the United States.
For decades, the medical field was dominated by one central archetype: the im-perious, job-addicted male delivering rapid-fire diagnoses and rushing from case to case. But now that Type A doctor shares the stage with women who are credited with being more team-oriented than their male colleagues, better at taking time to communicate with patients, better at striking a balance between career and family. And often, just better doctors.
"I think it's creating a softer side of medicine," Hardt says.
Dr. Rodney Meeks knows firsthand that women doctors often possess better one-on-one communication skills than men. He's seen them in action. That makes it easier for him to consult a woman doctor when he's in need of care, because he's confident that women are as capable as men when it comes to practicing medicine.
"On a personal level, I don't have a preference [for women]," he says. "I just like to see a doctor I have confidence in and can talk with. I find it very easy to have women look after me."
So do many others, and perhaps just in time. The 78 million-strong baby boomer generation is edging into their mid-50s, and they are demanding more medical help to deal with aging. As a group, baby boomers aren't satisfied with a prescription and quick advice. They want dialogue. That's not always easy to offer, either, as doctors of both sexes complain that health insurers force them to choose between seeing more patients - and devoting less time to each one - or losing income.
But according to a fresh study by University of California-Davis researchers, women doctors manage to give more time to their patients than their male colleagues do. Conducted by UC-Davis' Health Services Research in Primary Care, the survey of 509 patients and 100 doctors concluded that women doctors are more likely to take time to counsel their patients. They're also more likely, the investigators found, to order preventive screening tests, which lead to advanced warnings of disease.
Meanwhile, a separate study found that women doctors emphasize compassion in their work, while male doctors believe their competence is more important.
It seems that it's this combination of time and compassion that patients desire. In the UC-Davis study, patients of women doctors were 27 percent more satisfied with their physicians than were the patients of male doctors - even after adjusting for the patient's gender, age, and other demographics.
The historical role of women as caregivers might also factor into that preference, says Peter Franks, one of the UC-Davis researchers. If male physicians are perceived as authority figures, then patients may be less threatened by women and therefore more likely to voice their satisfaction with women doctors. "Women have traditionally been identified as having a more nurturing role," he says.
The best male doctors have been quick to imitate their nurturing female colleagues. "Men are more focused on the goal or endpoint of therapy and not necessarily the progress to that goal," Meeks says. "[Women have provided] a different perspective, and I think it has altered the interaction men have with patients."
Though it appears that male doctors have much to learn from their female counterparts - and though more women enter the profession each day - full, professional equality remains elusive.
In fact, women's desire to balance their work and personal lives has cost them in income and advancement. Hardt notes that women are less likely to study surgery or other specialties that still demand grueling workloads. Women are also less likely to be tapped for academic promotions, and their average earnings suffer. The AMA's Center for Health Policy Research concluded that female physicians earned $120,000 on average in 2000, well behind their male colleagues' $195,000 average.
In part, says Hardt, that may just be a reflection of women's hesitancy to sacrifice personal needs for professional advancement. Or it could also be a sign of the old-boy network dynamics at work when male doctors go to the golf course and women go home to their families. "If you don't do things guys do," she adds, "you miss that business opportunity."
At the same time, though, women's insistence on reasonable working hours may be essential to improving healthcare. With an average workweek of 48 hours, women doctors are less likely to push themselves into burnout than men, who clock, on average, 57 hours a week. While medical residents' work hours are now capped by law, the large concentration of women in medical school has helped curb demands for near round-the-clock service from bleary-eyed doctors-in-training.
That emphasis on controlling work hours and balancing work and personal concerns, says Lynn Epstein, president of the American Medical Women's Association, is at the heart of today's efforts to reduce medical errors and increase the quality of healthcare.
Which is a big change for the better for the entire profession, says Meeks. "All of medicine has changed a little bit," he says. "Understanding that working long hours should be tempered is a real positive thing for men and women."
Women doctors also are changing medicine in ways patients don't immediately see. Case in point: In one notable study by Harvard Business School, younger physicians who took extra time to work with teams of colleagues in learning a new method of cardiac surgery mastered the process much faster than their older, more experienced counterparts, who preferred to give orders rather than collaborate.
That accelerated learning was true for everyone, regardless of gender, but for women, the personal approach necessary for teamwork just comes more naturally. "Most people would say that a stereotype of women would be that they take the time to listen, validate what they hear, and make sure there is agreement and understanding of what was recommended," says the AMWA's Epstein. "That's good medical practice. The best doctors do that."
Meanwhile, the growing legions of women doctors have pushed a long-overdue refocusing of medical research, says Dr. Nanette Wenger, a nationally prominent cardiologist and professor at Emory University School of Medicine. "There was so much emphasis on the health of men in this country, that in some respects women's health was neglected," says Wenger, a 1954 graduate of Harvard Medical School. "Women in medicine are becoming the advocates for getting this information."
They're also becoming advocates in the political arena, which could be the acid test of Venus' influence on medicine. The American Medical Association - historically dominated by older, white, male physicians - has long opposed healthcare reform that would create a single source of health coverage for all Americans, under a government-financed model similar to Medicare. But Epstein says that a recent survey of her AMWA members - women doctors - shows their growing warmth for single-payer reform.
If women doctors could push such sweeping change in healthcare, then their power would go far beyond the one-on-one influence they now have on their patients and colleagues. But if more male doctors simply follow women physicians' example of a collaborative, patient-oriented approach to their jobs - as well as spend more time with their families and sleeping, and less in the O.R. - then we might all be better off.