THE STRIKING increase in the number of women physicians in America may be the answer to the accusations that doctors are arrogant, exclusivist and selfish and that medical care has become too expensive. In fact, a profession made up largely of women may be exactly what is necessary to provide the kind of health-care system that the government and the public seem to be clamoring for.
Last fall, according to the Association of American Medical Colleges, 33.9 percent of those entering medical school were women. In 1969, the figure was only 9.1 percent. In some schools, the percentage of women medical graduates will soon approach 50 percent.
This is happening at the same time as the legal crisis in which three out of four doctors can now expect to be sued for malpractice during their professional lives. Doctors who entered the profession in simpler times when neither their fees nor advice was questioned are increasingly asking themselves why they should continue to expose themselves to litigious patients. These older doctors -- almost by definition male -- are wondering why they should not simply retire and devote their time to managing their investments or other interests.
Meanwhile, I think I detect that students entering medical schools today differ markedly in their personality and motivation from those of only a few years ago. Put at its baldest, the profession seems less attractive to individuals -- men or women -- who possess a strongly independent or entrepreneurial streak.
With few exceptions, the medical students that I come into contact with look forward to practicing in a group, or working as members of a prepaid health plan or as a salaried employe of a large health-care corporation. In such circumstances, they have all their overhead, insurance and fees taken care of. And they can make, on average, as much as $90,000 a year. Whenever I suggest that they are still free to open up a practice of their own, as I did a little over a decade ago, thus sparing themselves the interference of "bosses" and work schedules imposed by others, they look at me as if they've encountered a person from another planet.
I believe the implication of these changes is that medicine will shift in the next decade from a male-dominated profession towards a female-dominated profession, and this might well be a very good thing.
For instance, medical costs can be more easily controlled as additional women enter the medical profession. Some authorities believe that as few as 25 percent of doctors will be solo practitioners by the year 2000. Others estimate that by the end of the century, 50 percent or more of the nation's physicians will be working at straight salary. These preferences make especially good sense for women in light of the desire of many to have time off for families. In a group practice, such arrangements are easily made. In a solo practice, however, time off with one's family is a much more difficult feat to manage.
On the whole, this preference for salaried over private practice will keep health care costs down. This is because, in general, a doctor stands to make more money in solo private practice than in any other arrangement. Further, this reduction in income won't have the devastating effect on women doctors that it would on their male counterparts. Most married women physicians that I know have chosen husbands who are professionals of one type or another and who earn respectable incomes. The traditional "doctor marries nurse" arrangement, it turns out, is extremely rare when the doctor happens to be the woman. Women doctors, as with professional women in general in our society, tend to "marry up."
Even more important than income, however, is autonomy. Traditionally, doctors have set their own hours, determined what patients they will see and when they will see them and, within limits, even what they will charge. A physician of the recent past ruled his fiefdom with near-total autonomy. But all of that must now be changed if our health-care system is to be more "responsive."
The emphasis is now on molding physicians who are flexible, cooperative, capable of understanding and working with group process and labor-management arbitration. (There are now over 10,000 physicians who have joined labor unions.)
Women physicians have an advantage over their male counterparts in adapting to this lessening of power and authority. This is not something that the health-care profession should be proud of, but it is a fact nonetheless: traditionally, women within the health profession (primarily nurses) were trained for docility and the taking of orders from superiors (primarily doctors and other nurses). These female health-care workers didn't expect to make a great deal of money over their lifetime nor garner much in the way of prestige. A similar situation is now developing for women doctors.
As in all other professions in the society, female physicians can be expected to earn less than their male counterparts, on average. And since women doctors are more likely to practice in a group or clinic, their autonomy is limited in regard to such things as how much they will earn, how long and hard they will work, and how much time they will take off.
Of course, there are benefits to be gained by the entrance of more women into medical careers. For one thing, patients will benefit from an increase in humanism within the profession. This is not to say that all male doctors lack compassion. In general, however, I have observed that a woman doctor is more sensitive to a patient's anxieties and fears. She is also more capable of acknowledging and dealing with her patients' emotions.
If you combine a woman physician's natural intuitional and emotional assets along with her willingness to work for less income and her willingness to settle for less autonomy, health care planners are provided with a means to achieve several important goals.
Health-care costs can be lowered, since doctors will be earning less.
Medical care will be more readily accessible. Women doctors will work according to schedules convenient to the patient.
Most importantly, physicians -- both women and the dwindling number of men for whom the profession remains attractive -- will be transformed from independent entrepreneurs into, simply, salaried bureaucrats. Such an arrangement has tremendous "management" advantages in the event of conflict between doctor and patient or doctor and employer. The "unruly" physician can be managed the same way one manages any other bureaucrat who steps out of line: Write to the boss, register a complaint, get her fired or, at the very least, soundly chastised. No longer will it be necessary to deal directly with "arrogant" physicians or the "unresponsive" medical societies.
Ironically, many of the directors and officers (more often than not, males) of the corporations who will be employing women physicians possess the kinds of skills and attitudes that, a decade or two ago, would have attracted them into a medical career. They want to be on the cutting edge of new and exciting ventures. They want to feel important. They want to earn a lot of money. They want, in short, to be independent, pioneering, wealthy and influential -- goals that not too many years ago most physicians set out in search of. But now all of that must be changed as we develop a new health-care system.
Nothing less is required than a remolding of the collective psyches of those who enter the profession. There's no longer a place within American medicine for the Ben Caseys of the world. Individuality and independence -- often in the past combined with a measure of arrogance and a dash of the temperamental -- must be replaced with a mindset that values cooperativeness and malleability, traits that, feminists' claims notwithstanding, come more easily to women than to men.
An increase in the number of women doctors can reasonably be expected to provide for additional role models who can facilitate the entrance into the profession of even more women. As the numbers increase, so too should the benefits of even cheaper and more available medical care. With this influx of women into medicine we can probably expect within not too many years a female-to-male ratio among doctors such as one finds in, say, Russia.
Will there eventually be a point of diminishing returns in all of this? I don't think so. In fact, it's just possible that within a decade the typical American doctor will be similar to a nurse in terms of income, power and autonomy.
At this point, of course, such a dramatic gain must remain speculative as we as a nation mold a more responsive health-care delivery system. But we can be reasonably assured that we are at least on the right track if we encourage more women to enter the medical profession.
Indeed, if we are serious about our desire for more compassionate and cheaper medical care along with a compliant and easily regulated medical profession, then we could hardly improve on present trends.
If anything, what's needed are even more women doctors.
Richard Restak, a Washington neurologist, is the author of "The Brain."