March 14, 2018

The controversy over the dwindling ranks of male OB-GYNs, explained

Daily Briefing

    The share of male OB-GYNs has dropped significantly over the past five decades, and some stakeholders fear the trend could have negative implications for the field—while others say the concern carries a sexist undertone, Soumya Karlamangla reports for the Los Angeles Times.

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    Fewer male OB-GYNs

    Women increasingly dominate the field of OB-GYN, according to Karlamangla, although they represent less than one-third of doctors overall. Currently, women account for 59% of OB-GYNs, up from 7% in 1970; 82% of residents training to become OB-GYNs; and—in 2017—76% of OB-GYN residency applications. In comparison, men last year comprised just 17% of OB-GYN residents. Overall, by 2025, women are expected to make up two-thirds of OB-GYNs, Karlamangla reports.

    According to Karlamangla, some stakeholders are concerned men could eventually become excluded from the specialty entirely, which they say is both unfair and has ramifications for care.  

    Jerome Chelliah, 28, is one of three men in his 16-person OB-GYN residency program at Kaiser Santa Clara. Chelliah said he chose the specialty because OB-GYNs "have a front-row seat to life that no one else has," often treating the same patient for several decades—but several patients have told Chelliah they'd prefer to see a female doctor. Some women feel more comfortable with female OB-GYNs, Karlamangla reports, and patients can legally refuse not to see a male doctor.

    According to Karlamangla, male medical students also say it's not uncommon for OB-GYN patients at universities to ask that they not be in the exam room. In addition, some men have said they feel socially excluded from the medical school OB-GYN departments.

    Implications and pushback

    According to some stakeholders, the gender imbalance could hurt the quality of care, Karlamangla reports. For instance, Saketh Guntupalli, a gynecological oncologist at the University of Colorado, said, "If you exclude 50% of people from anything, think about how much you've lost. … You might lose the next person who's going find a cure for cancer."

    Reshma Jagsi, who studies gender issues in medicine at the University of Michigan, added that a group of people with different perspectives is better equipped to solve complex problems. "I really do believe that diversity improves the quality of care," she said.

    However, while there are no national efforts to recruit more men into the field, Karlamangla reports that the gender imbalance may be giving male students interested in OB-GYN an advantage. For instance, some male medical students told Karlamangla that medical school advisors told them they could apply to fewer OB-GYN residency programs than women with similar test scores.

    For his part, Todd Jenkins, an OB-GYN at the University of Alabama at Birmingham, said when two equally qualified candidates are competing for a residency class that would otherwise be all women, the directors may favor a man. "We find our faculty, our residents work better when we have a little mix."

    The field is fine as-is, some say

    But several female doctors and patients pushed back against the idea that the field should recruit more men. For instance, Carol Weisman, a Penn State public health and OB-GYN professor, said, "It seems to me that there's some residual sexism in that view, that we need men to be sure that we're training the best possible people for our specialty. I find that very odd."

    Barbara Levy, an OB-GYN and VP for health policy at the American College of Obstetricians and Gynecologists and other stakeholders say the shift toward a woman-dominated field is driven mainly by patients looking for doctors who are more like peers. As Taylor Ortega, a 28-year-old comedian in New York City, put it, "Even a female gynecologist has been to a gynecologist." She added, "There's a lot we know about each other without knowing each other."

    Separately, Wendy Kline, a history of medicine professor at Purdue University, noted that the trend counters the 1970s, when women faced challenges getting into medical school and female patients had a hard time finding doctors who wouldn't judge their sex lives. According to Kline, activists saw the male-dominated health care system as an instrument of the patriarchy.

    And some men say they don't want to perpetuate a history of men telling women what to do with their bodies, Karlamangla reports. For example, Tanmaya Sambare, 24, enrolled in a class called "Mommies and Babies" in his first year at Stanford University medical school, but began to think he wouldn't be able to empathize completely with pregnant patients. He said, "No matter how hard I try I think it's just capped ... because I don't have a uterus. It's not my fault, it's not anyone's fault."

    Women want a 'good doctor'—regardless of gender, others say

    Meanwhile, some stakeholders say the notion that women prefer a female OB-GYN is exaggerated. A review of 23 studies finds about 41% of OB-GYN patients have no preference when it comes to their provider's gender, while 8% said they prefer a man.

    And several female OB-GYNs have said a focus on gender reduces women's skills to biology and does not account for gender-nonconforming patients. Alison Jacoby, an OB-GYN who is part of University of California, San Francisco's Center of Excellence for Transgender Health, pointed out, "I've never had kids, so what do I know about the pain of childbirth? It has everything to do with communication and empathy, and less on the gender of the provider."

    Separately, Guntupalli said, "We have to do a better job recruiting and dispelling some of the rumors and myths." He continued, "First and foremost, women want a good doctor" (Karlamangla, Los Angeles Times, 3/7).

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