While everybody has been cheering the narrowing gender gap for medical school enrollees, they've overlooked a related development: Every year fewer men choose to become physicians.
The reason is no secret to Emilie Osborn, M.D., a family practitioner at the Palo Alto (Calif.) Medical Foundation.. "My opinion is, as income goes down, women rise, and men go down proportionately. It's the pink-collar effect on medicine."
Think of schoolteachers, she said. "If it's a service thing, and you're only going to make $110,000 a year, heaven forbid, then men are going to go into business, computers and technology."
In fall 1998, there were 41,004 applicants to the nation's 125 medical schools, according to data from the Association of American Medical Colleges. Of the applicants, 56.6% were men and 43.4% were women.
Of 16,170 people who actually entered medical school that year, 55.7% were men and 44.3% were women.
That's a sea change from just 10 years earlier, when 63.1% of the 15,969 entrants were men and 36.8% were women.
The 7,162 women entrants last year represented the largest number of women ever in an entering class, while the 9,008 men represented the smallest number of men in an entering class since 1968.
The numbers suggest that the profession of medicine may be losing its appeal to men.
Ed O'Neil, director of the Center for the Health Professions at the University of California-San Francisco, said there's a link between a profession's salaries cresting and the proportion of women entering the field.
"Look at veterinary medicine," he said. "It's close to 70%-plus in female composition of the entering class. If you look at salaries, they've been stagnant since it tipped from male to female."
Another possible explanation, according to O'Neil, is that medical schools are choosing a different kind of applicant. Cognizant of the nation's need for more primary-care doctors, they are admitting more students who want to be generalist caregivers rather than medical subspecialists.
"Clearly women show a preference for pediatrics, family practice, and general and internal medicine. They show a preference for employment situations, not owning their own practice," he said. "They eschew the running of the practice. They're selling themselves as wage laborers to a physician organization, a hospital, a managed-care organization. They'd rather be a salaried employee with a predictable schedule than running their own practice."
The decline of men in medicine hasn't attracted much attention at the Washington-based AAMC.
In fact, the AAMC doesn't break out applicant statistics for men. One must derive them by subtracting the number of women from the total.
The AAMC didn't respond to several requests for an interview on this issue.
At Brown University, in Providence, R.I., famous for producing a strong crop of premedical graduates every year, men seem as interested as ever in medical careers, said Robert Ripley, associate dean and premedical adviser. "I started my job in 1974. I don't see that it's much different from what it always was," he said.
Brown has always prepared an uncommonly high number of women for medical school.
In the mid-1980s, Brown's premedical population was already 44% female. Women were being accepted into medical school in about the same numbers as men.
Since 1991 Brown has had 1,478 medical school applicants. Of those, the aggregate number of women has been 712, or 48%, and the aggregate number of men has been 766.
In the past four years, however, Brown's number of premedical-student applicants has risen. In 1996, 51% of students were female; in 1997, 49% were women; in 1998, 51% were.
The 1999 applicant pool was 56% female, the highest percentage ever.
"I don't see any major thrust," Ripley said. "I'm not struck that 56% is way out of line in either direction. There is no specific thrust to create a huge number of female applicants. They've been accepted in the same proportion as they've applied for the past 25 years."
But, if Brown is a bellwether, then the future of medicine could indeed be in women's hands.
What changes would a feminized medical corps entail?
For one thing, we might need to recalculate physician supply and demand, said Michael Rie, M.D., who teaches medical residents at the University of Kentucky in Lexington.
Some speculate that medicine is becoming more attractive to women as working hours and conditions become more flexible. Doctors can work in a variety of settings, sometimes for shorter hours.
If that's the case, greater numbers of doctors may be needed to cover a defined population.
"The women have families," Rie said. "Right now there is tremendous friction to allow women to work not full time but three-quarter time-or 10 out of 12 months-so they have more time to be at home with children."
O'Neil believes the archetypal nature of women may be more aligned with the future needs of the healthcare delivery system.
"We're changing the definition of the caregiver," he argued. "The independent, lone physician making decisions late at night is heavily identified with the male stereotype. That's an older way of thinking about the physician."
The emerging model sees the physician as a team leader, the facilitator of a group effort that will achieve the best outcome for the patient. That image, said O'Neil, may fit women better than men.
"We might learn something from what happens when women move into the corporate boardroom. This collaborative, team-oriented, population-based individual may have more of the skills we're looking for in our new health system."
That doesn't mean women will actually run the show.
In another 20 years, predicted Osborn, "all the managed-care organizations are going to be run by men. The science, the business of medicine will be run by men. Women will be doing all the work at the bottom," directly interacting with patients. "It will be a hierarchically masculine society for another generation."