What Happened to the American Medical Profession

From the comments section in the New York Times responding to an article "The Manly Jobs Problem" by Susan Chira, in which she described the problem women have doing work which had traditionally been the work of men. The article was pretty predictable in its "feminist studies" way, but the comments section got more interesting, as readers explored not just the effect of putting women in these jobs but the effect on the jobs themselves as women arrived.

Near Lincoln Center

Claudia

Oddly, there is little mention of the sea change in medicine and surgery. There was a riddle presented to medical students in the 1970's about a car crash in which a boy and his father were killed and the surgeon who received them at the Emergency Room says, "My, God! This is my son!"

So how could that be if the father was killed in the crash?

Most students guessed the answer turned on biological vs step father. But the answer was: the surgeon was a woman.

Few thought of that. Because there were almost no American women surgeons, or physicians in those days.
Now slightly more than half of medical students and doctors are female.
In formerly male dominated specialties like gynecology, men have been driven out or simply opted out.
There was plenty of misogyny in medical schools and housestaff training programs along the way, but all that is history now.
The sheer weight of numbers in the workplace changed behavior, ethics, sensitivities.
Not all the changes as women came to dominate medical practice redounded to the benefit of the patient, as many physicians and some surgeons said, "I'm a mother first, a doctor second." But overall, the sea change as been a positive force.
Whether that will ever happen on construction sites or coal mines is another question, but it will likely be settled, as it was in medicine, by demographics, the force of numbers, not by studies, commissions, academics or editorials.

Sza-Sza

Alexandria Va

Oh Claudia. If only it were really so. I got out of med school in the 1970s in a class of 6 women and 200 men. Truly there was great prejudice from doctors - and nurses - but medicine at that point was one of the highest paying professions around.
Now medicine is a salaried job, most practices taken over by hospitals or large national conglomerates. You get a salary, do shift work and - importantly - adhere to money producing guidelines or risk being fired.
So of course as it is devalued you see the void left filled by women as men go off to the real high paying fields like finance, where the payoff and prestige are greater. Only few women are found there.

Avarren

Oakland, CA

Not every female physician or surgeon is a mother, just as not every male physician or surgeon is a father. Prioritizing work-life balance is not at all to the detriment of the patient. Happier, more grounded doctors provide better care and result in healthier patients.

Iceland

Of course, Avarren spouts the au currant claptrap of the in-touch-with-her-feelings woman, who recites the line about "work-life" balance benefiting not just the worker but the work, and, of course there is the inevitable, "Happier, more grounded doctors provide better care and result in healthier patients." Where does she get that?

 And what is a "well grounded doctor?" Presumably somebody who makes herself or himself unavailable to his or her patients. 

And why would a happier doctor result in a healthier patient? Is that doctor dispensing herbs and minerals and positive vibes and good Karma? 

Sza-Sza's comment, however,  is in some sense a revelation. She is a doctor, and actually knows what she's talking about.  What she is saying is that a career in medicine is no longer an entry to upper class life, to high end of the scale income. 

Once the hang-out-your-shingle private practice, doctor as shop keeper, independent professional turned into a paid employee of a corporation, salaries steadily, inexorably, if gradually declined. 
Today, for most specialties in internal medicine, pediatrics and family medicine, the salary averages $85 thousand.

This is not a bad wage, but not a good deal, considering the doctor has medical school debt (in the USA) and does not start earning this until 10 years after high school at the earliest, typically full earning power does not begin until age 30-35.

By that time the kid who went to work as the power line man, or the plumber or electrician has been earning for 15 years and may be only 15-20 years away from retirement, depending on whether he has a union or company pension.

Ennis, Ireland

In a sense, this may simply be the regression to the mean. In the 1930's and 1940's doctors were upper middle class, for the most part. It was only when health insurance and third party payers emerged that doctors could charge more and make upper class incomes. But, after half a century of prosperity, financial forces drove doctors out of self employment and into salaried positions and their incomes declined.

Doctors have not been the only profession to decline in income and status. Ironically, airplane pilots who during that same halcyon period of the 1950's and 60's made top salaries, saw their incomes decline and they are no longer earning upper class salaries. Ironically, because just at the time air travel became safer and more dependable and more widely used, the remuneration for pilots crashed. 

Humble Country Doctor

For doctors, the fear was always that the government would take over American medical care and fix salaries and the income and prestige of doctors would tank. As it happened it was the private sector which brought down the proud medical profession--as commercial insurance companies gained control of the companies which employ doctors if not in name, at least in fact.

It's Come to This

Our American medical profession now looks a lot like the British rendition: There are highly paid specialists, few in number, competitive positions, and then there is the great mass of practitioners, humble, paid about what the manager of a McDonalds might make.  

The companies who employ doctors have realized they really don't need to employ doctors at all: Nurse practitioners and physicians assistants wearing white coats, write prescriptions, dangle stethoscopes around their necks and many, if not most, of their patients can't tell them from the folks who earned MD's.