Academic Psychiatry 22:236-239, December 1998
© 1998 Academic Psychiatry
Gender-Related Values and Medical Specialty Choice
Kay F. McFarland, M.D. and
Donna R. Rhoades, Ph.D.
Dr. McFarland is Professor of Medicine, Department of Medicine, and Dr. Rhoades is Traumatic Brain Injury Followup Program Manager, Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia. Address reprint requests to Dr. McFarland, Richland Medical Park, Suite 502, Columbia, SC 29203.
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ABSTRACT
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During orientation, all 74 first-year medical students at the University of South Carolina responded to a survey about their preferences regarding specialty, work hours, leisure-time activities, and the quality they most valued in their own physician. More women than men listed a primary care specialty as their specialty choice. The men indicated a desire to work longer hours than the women, whereas a greater proportion of the women than men chose to spend their leisure time with family and friends. This study suggests that these gender-related values may influence practice choices.
Key Words: Gender • Medical Specialty • Medical Students • Specialty Choice
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INTRODUCTION
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Women and men make different choices regarding the practice of medicine. Research data suggest that the developmental life of women centers on building and preserving relationships, whereas male development focuses on individually based skills, with a greater emphasis on competition and competence. These differing values may influence gender-specific medical specialty selection. For example, women choose primary care specialties more frequently, and a higher percentage of men choose surgical specialties. Men work longer hours, and women place greater emphasis on the physician–patient relationship (1–3).
The reasons for these choices likely result from a complex combination of biological, social, and psychological factors. In a survey designed to study gender-related preferences, we questioned first-year medical students about their choice of specialty, number of hours they would choose to work, their favorite leisure-time activity, and which characteristic—competence or compassion—they value more in their physician. The results yield insight into how men's and women's values may influence the way each gender chooses to practice medicine.
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MATERIALS AND METHODS
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During medical school orientation in 1994, all first-year medical students at the University of South Carolina School of Medicine wrote answers to the following verbally presented open-ended questions.
- What medical specialty is most attractive to you now?
- When you start to practice medicine, how many hours would you like to work? Indicate the ideal work hours per week.
- How do you spend your leisure time now?
- Assuming that your own physician is both compassionate and competent, which of these is more important to you, compassion or competence?
Students did not put their name on the note cards containing their answers. Just before turning the cards in for tabulation, they were instructed to put their gender in the upper corner of the card. Results tabulated by gender were compared by using chi-square analysis. Marital status and number of children determined from matriculation records provided the basis for statistical evaluation. However, the demographic data obtained from these records could not be matched with individual student responses about specialty choice and leisure-time activity. Therefore, when the study was repeated with a subsequent class, the students answered the same four questions and recorded gender, marital status, and number of children on the note cards.
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RESULTS
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All 31 female and 43 male students in the original study answered the four questions. There was no difference between the men and women regarding marital status ( 2=3.809, P>0.05) or number having children (2=0.173, P>0.05). More women than men listed primary care as their specialty choice (2=4.7237, P<0.05), with 84% choosing pediatrics, family medicine, obstetrics and gynecology, or internal medicine, compared with 60% of the men. About 10% of the women chose psychiatry, compared with 2% of the men. See Table 1. The women wanted to work an average of 49 hours per week, compared with 53 hours for the men.
Women more than men preferred spending their spare time with family and friends (2=7.950, P<0.01), followed by interests in sports, reading, and music. Men more than women listed sports activities as their first preference, followed by spending time with family and friends, reading, and music. See Table 2. Based on the assumption that their own physician was both compassionate and competent, when asked to assess which quality they more valued, 60% of the women and 26% of the men indicated compassion. Forty percent of the women and 74% of the men chose competence (2=8.246, P<0.01).
In the second class, there was no statistical difference between the men and women in age, marital status, or number having children. Statistically significant differences still existed for preferred work hours, medical specialty choices, and leisure-time activities when comparing single male and female students. The same was true for married men and women students. These data were not combined with the original data, since the sample was taken a year later.
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DISCUSSION
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A greater percentage of female physicians than male physicians choose primary care specialties (2). Sixty percent of women and 40% of men practice five specialties: family practice, internal medicine, obstetrics and gynecology, pediatrics, and psychiatry (4). In contrast, men are more than twice as likely to choose residencies in general surgery and the surgical subspecialties (5). We found that the women entering medical school already preferred primary care specialties more frequently than their male classmates and that the first-year male students preferred surgical specialties more than the women. Therefore, medical school alone does not train or socialize women or men to select a primary care specialty.
Anticipation of the work hours attributed to each specialty may affect students' specialty choice. Female physicians more frequently than male physicians indicate that the anticipated number of work hours influenced their specialty choice (6). In this study, first-year medical students believed an average of 51 hours per week was the ideal work week, compared with the 55 hours per week that physicians typically work (1). The male students wanted to work 53 hours a week, compared with 49 hours for women.
Not only do women physicians spend fewer hours per week in practice than men, they are five times more likely to practice medicine part-time (7). Here again the desire to practice part-time may influence specialty choice. Part-time work may reduce the conflict between one's professional and family life (6). In this study, the female students chose to spend time with family and friends more than in any other leisure activity. In contrast, half the men selected sports, and only 7% of the men listed spending time with family and friends as their first-choice leisure-time activity. The value the female students place on time with family and friends is consistent with statements female physicians usually make, indicating they make significant career decisions, including specialty choice, based on family considerations (8,9).
Assuming the presence of both competence and compassion in their own physician, the students in this study were clearly divided by gender when expressing which quality was more important to them. More men selected competence, whereas more women chose compassion. This finding is consistent with reports that women place a higher value on relationships and close affiliations (10–12). Also, female physicians indicate that their specialty choices frequently come from their inclination toward greater patient contact and involvement (13). On the other hand, men more than women chose surgical subspecialties that involve less patient–physician contact and longer hours. Women may gravitate toward the primary care specialties for time considerations and because these fields provide an opportunity for longer, more intimate relationships.
This study provides only preliminary data. A longitudinal study would explore actual future practice patterns. Also, the questions in this study may not be applicable to medical students at other locations. Neither did we consider how specialty stereotypes might affect student choices. Further investigation of gender-related values would enhance understanding about specialty and subspecialty choices.
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Surrey JL: The "Self-in-Relation": a theory of women's development, in Women's Growth in Connection, edited by Jordan JV, Kaplan AG, Miller JB, et al. New York, Guilford, 1991, pp. 51–66
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ABSTRACT
INTRODUCTION
