The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America (review)

In The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America (the title may deliberately allude to the similarly named National Library of Medicine exhibition, which is cited in the text as a source), the authors begin with the presumption that medicine has been "feminized" and ask whether this is a good thing for Americans' health care. The answers, of course, depend on one's definition of "feminization." The term used to be a code word for various undesirable occupational traits—lack of professional commitment and ambition, an overvaluation of family obligations, a field's decline in mean wages and status, a consequent lowering of occupational prestige, and so on. Ann K. Boulis and Jerry A. Jacobs, however, sociologists at the University of Pennsylvania, define it merely as an influx of women into the medical profession that has resulted, or soon will result, in numerical equality of men and women physicians.

Their book distills much of the recent historical and, especially, sociological literature on gender and the medical profession, relying as well on large national surveys, Web sites such as MomMD and Student Doctor Network, and a modest number of interviews. They ask the following questions: "(1) How can the feminization of medicine in the United States best be explained? (2) How and why do the career locations and experiences of male and female physicians differ? (3) How are the family lives of physicians changing as the need to balance work and family becomes more salient? and (4) What effect has the feminization of U.S. medicine had on the daily practice of medicine and on the medical profession?" (p. 3).

The first third of the book is taken up with a refutation of arguments that women's entry into medicine in large numbers from the mid-1970s onward was the cause or, at least, the occasion of medicine's decline in prestige in American society. Relying significantly on the work of historians, they show that it was neither true that quantitative feminization caused such a decline nor that such a decline took place at all until approximately twenty years after medicine's demographic shift began. Their larger argument, that changes in the conditions and perception of medical practice responded not to changes in the demographics of the field but to the economics of health care, is persuasive. They also refute the claim that women's numerical rise in medicine depended on "male flight" from the profession. Rather, women's rising social position, not men's declining interest, fueled the larger opportunities open to them in the medical profession. Men did not flee the profession except for the few years during which banking and finance seemed likely to produce higher incomes with a lesser educational outlay. But the declining proportion of male applicants to medical school did not last long enough to have accounted for the increased number of women.

The first portion of the book, therefore, may provide additional data for historians but will not result in rethinking what we have generally known for some time. The remainder of the book is devoted to examining changes in the working conditions and job satisfaction experienced by all members of the medical profession since at least the late 1980s. Here, their supporting data are revealing. For example, they observe that the representation of women physicians among medical researchers actually has declined proportionally to their representation in the profession as a whole since the 1970s. Relying on figures from the Association of American Medical Colleges, Boulis and Jacobs show that the growing presence of women among biomedical researchers is the result of an increase in women scientists with Ph.Ds rather than of women physicians pursuing research. Such statistics could suggest that women's career...