Women's participation in the medical profession has increased dramatically in the past 25 years. The number of all allopathic women physicians in the United States more than quadrupled between 1970 and 1991, and current trends indicate that this will continue. The number of osteopathic women physicians increased 36% between 1989 and 1992. Women comprised only 7.7% of all physicians in 1970, whereas by the year 2010 they are expected to represent 30% of the total physician population.
This physician demographic shift has important ramifications for the health care system in the United States. It parallels two other trends in American health care - the demand by consumers and policymakers for increased attention to women's health issues and the health reform effort to increase the number of generalist physicians within the United States. Women in medicine bring a unique perspective to women's health concerns and are more likely than male physicians to choose a primary care specialty. Therefore, these women can substantially influence the shape and direction of changes in the health care system.
Despite the contributions that women can make to the future of medicine, there continues to be evidence that women are not attaining their fair and appropriate place within the medical profession. By most measurements of professional success and accomplishment - income, academic rank, leadership roles, and participation in scientific research - women lag behind men to a degree disproportionate to their smaller number and relatively recent entry in numbers into the medical profession.
Bias against women in the medical profession not only denies women a chance to realize their personal potential, but also denies medicine the contributions that women could make to the field. the link between the status of women physicians and the quality of women's health care, for example, has attracted the attention of policy makers, government agencies, and other organizations. There is also evidence that women generally bring special skills in communication and patient care that could help to set new standards for the profession.
The Congressional Caucus for Women's Issues, a coalition of women members of Congress, included initiatives on gender bias in medicine in its 1993 omnibus package of women's health bills, the women's Health Equity Act. In addition, both the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH) and the Society for the Advancement of Women's Health Research held forums in 1992 on how to increase the role of women in biomedical fields. Many of their recommendations are cited in this report.
The Historical Context
The acceptance of women into mainstream medical practice is a relatively recent phenomenon in the United States, and medical institutions are still adapting to the dramatic increase in the numbers of women in the professional workforce. The gains represented by the influx of women into medicine and the medical system's response to the needs of women physicians are best evaluated in a historical context.
Ventures by women in the medical field were initially successful during the last quarter of the 19th century when there were 16 women's medical schools and several traditional schools accepted women. However, this "first wave" of women's involvement in medicine was followed by a long period of decline. By 1910, all but three of the women's medical schools had closed or merged with a traditional school (e.g., the University Medical School in 1900). Integration did not necessarily bring greater opportunities for women, however. Whereas 70 women had entered Cornell University Medical School in 1900, by 1903 the number had dropped to only 10. One-half of all medical schools in the United States did not accept women in 1910. As a net result, the ranks of women physicians declined during the first part of the century, resulting in an even smaller proportion of medical students being women in 1930 (4%) than in 1900 (6%)
Women also faced hardships in finding residency training. The American Medical Association (AMA) reported that, in 1921, only 8% of U.S. hospitals with training programs accepted women as interns. In 1925, one-half of all U.S. women physicians trained at only nine hospitals, most owned and operated by women.
Although the situation for women seeking entry to medical school had improved somewhat by midcentury, until the mid-1970s, women continued to be admitted to medical schools according to an informally established but acknowledged quota system. Prior to World War II, only one to three qualified women were accepted into a class. After the war, a quota of roughly 6-8% women students was believed to exist; in 1946, the dean of one eastern medical school admitted to limiting female admissions to 6% of each entering class. Expectations for women graduates were that they would enter a limited number of fields, primarily general practice, pediatrics, and psychiatry, and that a certain percentage who chose to have families would cease practice either permanently or temporarily.
Only after medical schools began changing their admission practices in the mid - 1970s did barricades for women in medicine begin to fall. In many ways, however, vestiges of a discriminatory system linger, and the current system is still adapting to a changing medical workforce.
The Council on Graduate Medical Education (COGME) believes that the involvement of women in clinical and academic positions in medicine will promote better care for all patients and lend needed diversity to the field. The following findings outline the current status of women in medicine and identify areas in which reforms are needed.
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