Tuesday, March 3, 2009

Women in Medicine

Okay, I said I was going to hold off for a few weeks pending some urgent work, but I couldn't resist.

Billy has of late become a fan of the Bioethics Discussion Blog, thoughtfully led by Dr. Maurice Bernstein. A long-standing blog, one can literally scroll through several hundred discussions on various ethical issues involving modern medicine. The most recent post concerns the shifting gender demographics in the medical profession and references an op-ed in the February 25 edition of JAMA ("The Feminization of Medicine and Population Health," by Dr. Susan Phillips and Emily Austin). Dr. Bernstein provides a long quote where the authors discuss matters such as the differences in proportion of women physicians in primary care fields versus subspecialties, and concludes that this may have an impact on overall health care given that primary care fields are much more likely to be "longitudinal" in nature. (For the lay-readers, that's fancy medical terminology for "you have a long-standing relationship with your physician.") The authors conclude:

"Either way, as women increasingly enter medicine and become generalists, rather than being a liability by not working excessively long hours or abandoning parenting, the quality of the care they provide may result in improved population health.”

Billy, being the good card-carrying let's-all-sing-kum-ba-ya liberal that he is, poses no objection to the massive influx of women into the ranks of physicians. However, he does want to take issue with the reasoning that the authors use here.

Though not quite explicit, they seem to imply an argument from utility: we should all be appreciative of the "feminization of medicine" since it may result in improved population health! And Billy disdains mixing arguments about moral rightness with those involving utility. To wit: "the government should be utilized to improve the genetic stock of its people." This was one of the most common refrains heard 100 years ago by prominent eugenicists, of both progressive and conservative political leanings, and that bedrock utilitarian notion formed the basis of mass-sterilization campaigns of people who at the time were thought to be "genetically inferior" but would now be described with one very simple word: "poor." Similar utilitarian arguments have formed the basis of many if not most of the mass slaughters perpetrated on various populations throughout the 19th and 20th centuries (slavery, the Holocaust, Stalinism, the Cultural Revolution, the Khmer Rouge...have I missed anything?). Of course, no such ugly intent can be imputed to the authors of this article; my point is that the rhetoric of utility is the wrong approach to take.

Additionally, the problem that a utility-based argument poses for their cause is if it turns out that large numbers of female physicians (whether primary-care or otherwise) do not improve overall population health. Assuming this could be studied at all (of which Billy is highly skeptical), should we abandon female applicants to medical schools if we discover in study after study that female physicians provide either no benefit or even a decline in care? (In the comments section of the link, "obdoctom" asserts the latter, arguing that the takeover of OB/GYN by women in the past decade has only made patient care worse.) Billy would argue "no," that the reason why you have just as many qualified women as men admitted to medical school is because it's the right thing, and not because of some possible population benefit down the road. There may well be positive effects wrought by the change--indeed, how could there not be?--but such changes are merely a happy consequence of, and not the reason for, that change.

UPDATE: A follow-up to the know-nothingness of George Will and his poorly-reasoned articles on global warming takes place over at The Daily Howler (March 2), but if you want the aw-shucks defense of the editorial staff as to how an influential columnist could be allowed to print pure fantasy, feel free to check out the WaPo's ombudsman's column.

1 comment:

  1. I agree with Dr. Rubin's comments and want to add that in my field (architecture and construction) we see a similar trend to that which is described in the article referenced. Design is becoming as specialized as medicine. And while there are very few licensed women in architecture and even fewer work in construction, a large percentage are attracted to the area of residential design (what I would call the "primary care" specialty of architecture). Women who want to balanace family and work find the flexible hours and work location (often being one's own home) of residential design the right fit.
    Does this mean that women do not have important contributions to make in healthcare design and construction? institutional? higher ed?
    Specialization is opening the doors for women in fields previously male dominated. The more women who can enter the field in any area, the more the field will open and the more it will improve as women do have an important and perhaps different contribution to make.
    It is dangerous to draw conclusions about how women in one specialty will make a difference as this implies that women should not enter other areas or their contributions may not be significant. We should leave the observation to just - specialization is opening doors for women and this alone will make a huge difference to the people being served.