Where have all the men gone?

The number of men choosing to become doctors is dwindling. Karen Herbert considers why

During the past few years many of you will have noticed that the number of male medical students has been steadily diminishing. Although most medical schools try to widen participation among people from ethnic minorities and disadvantaged socioeconomic groups, little attention is paid to the dwindling representation of men. Not only does this have implications for medical students but also for the future medical workforce.

In 1996, 46% of UK university medical and dentistry students were men. In 2002, this had decreased to 39%, according to the BMA's equal opportunities committee. In 2001, more than a third of general practitioners in England and Wales were women, and more than three fifths of general practitioner registrars were women.¹ In the same year, a third of all hospital medical staff in England and Wales were women. However, a greater proportion of junior doctors were women. In 2001, 43% of registrars, senior house officers, and house officers were women.²

Anecdotal evidence seems to agree.

Charlotte Allan, a medical student from Leeds University, estimates "the female to male ratio is about 60:40. However, this is probably more like 40:60 among hospital doctors and 10:90 among consultants. More women are going into medicine because more girls are studying science A levels. I think that medicine is seen to bridge the gap between hard science and a caring role or interest in people that women in society are expected to have."

The international perspective

Portugal

Tiago Viallaneuva is a final year medical student at the University of Lisbon. He estimates that women there make up about 70% of medical students, 50% of hospital doctors, and virtually no consultants. He explains, "It has to do with the political situation of the time when Portugal was under a dictatorship, and the dictator was ultraconservative and believed that a woman's proper place was in the kitchen... so women, except for a minority, were not encouraged to study."

Turkey

Women and men are about equally represented in medical school in Istanbul, Turkey. Ozge Tuncalp, a student at Istanbul University, explains that the ratio is different in private hospital doctors and teaching academics depending on the nature of the specialty: "For example, there are fewer female obstetricians or gynaecologists in academia, while there are more female residents in private training. This may be related to the fact that demand for females in this field is so huge; most of them don't bother to stay in academia. In my faculty there is only one female consultant."

India

The situation is different in India. Sanjit Bagchi, a medical student at the Calcutta National Medical College, explains, "In my college there are approximately two males to every female. Here, in each year, the total number of students is around 150, and amid those students there is an average of about 50 females." He explains that the ratios of men to women vary among hospital doctors depending on the department. "For junior doctors and consultants, the ratios of men to women are roughly 6:1 and 10:1. In surgery, the ratio of men to women for junior doctors is roughly 7:1. In my alma mater, we have only one female consultant in surgery, whereas the number of male consultants is around 12. So, the ratio becomes 12:1. But in the department of paediatrics the scenario is quite different. Here the ratios of men to women in junior doctors and consultants are 1:1 and 1:2. The department of obstetrics and gynaecology has more female medics--junior doctors 1:2 and consultants 1:1."

Romania

Irina Haivas is a medical student in Romania. Although she is not sure of exact figures, she estimates that a fifth to a quarter of her year are men and that this fraction is decreasing each year. The ratio of men to women is also changing among hospital doctors: "In the older generations there are many more male doctors. In surgery, for instance, senior doctors are mostly men, but for the young junior doctors the ratio favours women. In internal medicine, the ratio in the older generations is roughly equal overall, but again among junior doctors there are more women."

Irina feels that this change is in accordance with the changes that have occurred in the country: "Firstly, I think that medicine is more accessible to women now than it was 20 years ago in Romania. The new vision of women's roles in society makes women more self confident, more career oriented, and therefore more likely to choose more difficult careers like medicine. Secondly, in Romania's case, men prefer to go more towards computer science, engineering, or business, as these professions earn much more money with less work and less study (the salary of a Romanian young doctor is incredibly small--less than a100 (£67; $125) a month). Women are less attracted by technical careers, probably because they prefer the more human side of medicine. Thirdly, I think that more women go to university than men."

Why?

"A progressive erosion was found in the level of participation of men in postsecondary education over the past 25 years, and a parallel decline was observed in the percentage of baccalaureate men who sought further education at the doctoral level, including medicine. These dynamics have occurred alongside rising levels of achievement of girls in early education and high levels of interest among college women in medical education", says Richard Cooper, professor of medicine and health policy at the Medical College of Wisconsin.³

Women are growing up wanting careers and believing that they can be whatever they want to be. Girls are working hard, achieving high grades, applying more to medicine, and doing well at interview. Experts also suggest that women are more attracted to medicine whereas men are more inclined towards technical careers.

Implications

People who work the hardest and achieve the most should justifiably be admitted to medicine. However, widening access already proves that for a truly diverse medical workforce these cannot be the only admission criteria. In a society which steadily increases its consumption of healthcare services, we need correspondingly to increase our medical workforce. Some people argue that a predominantly female workforce will imply a lot of flexible and part time doctors due to family commitments.

The causes and implications of the changes in the ratio of the sexes among medics is up for debate. Could white male doctors one day go the way of the dodo and the dinosaurs?

1. Department of Health. Statistics for general medical practitioners in England: 1991-2001. London: DoH, 2001.
2. Department of Health. Hospital, public health medicine and community health service medical and dental workforce statistics for England. London: DoH, 2001.
3. Cooper RA. Impact of trends in primary, secondary, and postsecondary education on applications to medical school: gender considerations. Acad Med 2003;78:855-63.