Today in the United States, the majority of incoming medical students are women. And in future years, female matriculants will continue to outnumber men.

Yet in spite of the increase in female physicians, female and male doctors have not as yet reached a level playing field. Issues such as compensation disparities, sexual harassment, persistence of "traditional male" attitudes among some male physicians, as well as the challenge of combining practice and family continue to play a role.

A number of studies and articles have been devoted to assessing the feelings of female physicians about the practice of medicine. Just about all of them reflect opinions not obtained anonymously and so those opinions may have been tempered by external influences.

Indeed, female physicians have strong feelings about various gender-related issues. We learned their opinions while interviewing many for a previous article on gender ratio published in Medical Teacher in 2004. Female doctors also have a desire to make their true feelings better known. Therefore, we undertook earlier this year an anonymous survey of 200 randomly selected female physicians. In order to assess the possible effect of American rules and regulations, we chose to survey 100 Dutch physicians and 100 Californian physicians.

The selection of Dutch physicians was based on the fact that The Netherlands and the United States are comparable in terms of medical sophistication, while California's general and physician populations are about double those of Holland.

Even though the number of physicians surveyed is not very large, we believe that the answers to 11 questions-given in strictest privacy-do reflect the honest opinions of these individuals and can be viewed as indicators of the whole group. Of the 200 questionnaires mailed, 91 were completed, 51 from Holland and 40 from California.

By and large, except for one question, the answers are very similar. The only significant difference observed is about full-time vs. part-time practice.

It is striking to see that the numbers in California and in Holland are reverse: In The Netherlands, 67 percent of the respondents practice part time, while in California essentially the same percentage (65 percent) practices full time. The different social and economic safety net for physicians in The Netherlands permits women to more readily combine the tasks of family and practice. Dutch policies, such as a mandatory pension plan for all physicians, undoubtedly play a role.

Issues such as difficulty in reaching high levels in the profession ("breaking the glass ceiling"), obstacles in academic careers and personal ideas continue to plague the female physician, whether it be in California or in The Netherlands. See the chart with survey responses, below.

Drawing Conclusions
In spite of the small number of individuals surveyed, some trends and impressions can be observed. The number of women in medical schools and in practice has grown significantly and will continue to increase because the number of female medical students exceeds the number of male students. Since the personal and professional goals of men and women are generally not identical, differences are found in their practice of medicine as well. For reasons such as wanting to combine practice and family, and trying to circumvent discrimination, women have sought out medical specialties that facilitate satisfying their goals, namely general practice, internal medicine, pediatrics and obstetrics. The data from this survey confirm the presence of these as well as other attitudes and perceptions in the majority of individuals surveyed.



Leo van der Reis, MD, is adjunct professor in healthcare mangement at The University of Alabama and the director of the Quincy Foundation for Medcal Research in San Francisco. Qian Xiao is a doctoral student at The University of Alabama and a fellow of the Quincy Foundation for Medical Research. Dr. Reis can be reached at 415/661-8865 or lvanderr@cba.ua.edu