Gifty Dominah cannot remember a time growing up that she did not think about becoming a doctor.
"When I was 5 years old and my dad would ask me what I wanted to be, I would say, 'A doctor,' " she said. "It was one of the only careers that I knew about, but I knew that I liked it."
In August, the 24-year-old from Montgomery County entered the George Washington University School of Medicine.
Historically, medicine has attracted fewer women than men because of long working hours associated with the profession and the rigorous academic background required in advanced science and math — subjects that women have been less likely to pursue. Three decades ago, just over a third of medical students were women.
But this year, Dominah joined a class of medical students that for the first time is majority female nationwide, according to a new report by the Washington-based Association of American Medical Colleges. After making steady gains since the 1960s, women have hovered close to the 50 percent mark nationally for the past 15 years. The number of male applicants was slightly higher in 2017, but since 2015, male applicants declined while female applicants increased.
Many advocates of the profession credit the increasing number of women in medical schools to a growing emphasis on so-called pipeline programs that encourage girls to pursue math and science from the time they are in grade school.
"Many of these programs show that women are just as talented and capable in the sciences," said Geoffrey Young, senior director for student affairs and programs at the AAMC. "We are pleased to see this increasing diversity in what has been a white male-dominated profession."
The association is hopeful that the increasing number of women, along with a rise in the numbers of underrepresented racial minorities, will help fill a projected shortage of physicians needed to serve the nation's growing aging population.
Several medical schools around Washington long ago surpassed the 50 percent mark for women, and some have far surpassed it.
In 2017, women represented 54 percent of entering students at the Howard University College of Medicine and 53 percent at Johns Hopkins University School of Medicine. At the Georgetown University School of Medicine, 48 percent of entering students last fall were women, but Stephen Ray Mitchell, dean for medical education, said women constituted a majority for the first time in 2002 and that classes since then "generally run about 53 percent women."
Matriculants at the University of Maryland School of Medicine in Baltimore were 59 percent female in the fall, and women have been in the majority for 19 straight years, said Sandra Quezada, assistant dean for admissions and assistant dean for academic and multicultural affairs. That includes years when men represented most of the applicants, she said.
At George Washington University's medical school, the entering class in 2017 had the highest percentage of women in its history at 62 percent.
Yolanda Haywood, senior associate dean for diversity and inclusion and associate dean for student affairs at the school, said that women have made up about half the school's enrollment since the 1990s.
In addition to a cultural shift in which educators and families are more encouraging of women pursuing science-based careers, she said, there is also more acceptance of working mothers, she said.
Haywood recalled her own experience in medical school in the early 1980s. She had three children and was often questioned by colleagues about how she could spend so much time on her career, she said.
"People thought that was an unreasonable choice to make," she said. "There is not as much stigma anymore."
While women are making strides in medical schools, barriers remain in the field.
Women overpopulate the lower rungs of academia in medical schools, and they remain in small numbers in some high-paid specialties, including orthopedic surgery and cardiovascular disease.
There is concern about a high rate of burnout, particularly among female physicians.
With more women entering the field, more people are talking about these issues and looking for solutions, said Kim Templeton, former president of the American Medical Women's Association and a professor of orthopedic surgery at University of Kansas Medical Center in Kansas City.
Templeton is conducting research about female physicians who are advanced in their careers and balancing work with caring for children and older family members.
"Even as busy professionals, women are still the ones in the family who are expected to take care of all these things at home," she said.
In focus groups, she said, women talk about feeling guilty that they are always in the wrong place: at work when they should be taking care of someone at home and vice versa.
"There is constant concern and self-doubt," she said.
For younger doctors, as with most professions, child care remains a big issue, she said. In June, the governing body of the American Medical Association voted to launch a study of leading hospitals to look at what kinds of child-care services they provide to help physicians with young children.
Dominah said she felt encouraged to pursue science studies from a young age. Her parents, immigrants from Ghana, were supportive, and her mother worked as a nursing assistant, which gave Dominah some early familiarity with health care.
At Paint Branch High School in Montgomery County, she got to explore the field more closely through a medical careers program. She was certified as a nursing assistant while still in high school, and during her senior year she volunteered in the emergency room at Holy Cross Hospital.
The teachers in that program were registered nurses who encouraged her to pursue medicine and set up opportunities for her to shadow doctors.
They would say, " 'I think you should be a doctor; I see you as a doctor,' " she said.
Now as a medical student, she said she does not notice any barriers to success. "I think I have the same opportunities as my male counterparts," she said.
She is fascinated by the brain and is thinking about specializing in neurological surgery, a field with a very low percentage of women. It involves a seven-year residency and the demands and long hours that come with working as a surgeon. She anticipates it would involve some challenging decisions.
"The biggest issue is knowing when to start a family, and doing it without putting your career in jeopardy, particularly when you are competing with people who seemingly don't have to take time off," she said.
Entering a field that has been male-dominated can be attractive to some female doctors, offering a chance to bring a different perspective.
Jaspreet Bahia, 25, a second-year medical student at Georgetown, said she wants to become a cardiologist at a women's heart health clinic.
She said much of the research about heart disease has been done on men and that she wants to help advance understanding and treatment of this disease in women.
"The field is changing now," she said.