THE IMPACT OF WOMEN IN THE MEDICAL WORK FORCE AND
CONCERNS FOR THE FUTURE FOR PROVIDING CARE FOR OUR AGING COMMUNITY.
The Institute of Medicine predicted an upcoming shortage
of medical professionals by the year 2020 of approximately 75,000 physicians.
Do the increased flexible hours that women physicians demand contribute to this
upcoming shortage of medical providers or as a recent business week article
said, are there just too many women physicians.
You are listening to ReachMD XM157, the channel for
medical professionals.
I am your host Dr. Lisa Mazzullo, a Practicing Physician,
and with me today is Dr. Joseph Flaherty, Dean of Medicine at the University of
Illinois in Chicago and Professor of Psychiatry and Community Health Sciences,
joining us to discuss the impact of women in the medical work force and
concerns for the future for providing care for our aging community.
DR. LISA MAZZULLO:
Welcome Dr. Flaherty.
DR. JOSEPH FLAHERTY:
Thank you.
DR. LISA MAZZULLO:
So do you think that this predicted shortage of medical
providers is really a true statement?
DR. JOSEPH FLAHERTY:
Yeah, I believe there is a true shortage of medical
providers with the increased aging in the population and with the no attempts
to increase it. I do think, however, the shortage could be ameliorated by an
addition to increase in the number of doctors by an examination of the other
health professionals and their role with patients and I think that’s something
not always discussed, the use of nurse practitioners, physician extenders, use
of telemedicine, and monitoring patients in their homes, so there are a lot of
things including human resources as well as technology that may abet the use of
physicians.
DR. LISA MAZZULLO:
I think that you are absolutely right. We are starting to
certainly feel an influx of midlevel providers in an effort to extend the physician’s
ability to watch their patients well. I think we are changing the culture and
patient’s expectation have to change to go with that.
Do you think that the aging baby boomers that are commonly
talked about in the media are part of the impact we are expecting in this
problem?
DR. JOSEPH FLAHERTY:
Yeah, there is no question about it. People are living
longer in general and the boomers in addition to probably going to be a longest
living generation, also have been a generation with fairly high expectations
for service. So, you combine those 2 things and add to that the advent of
newer medications in lowering cholesterol and variety of other things, we are
going to have people that are going to be maintained on fairly expensive
medicines, require monitoring, and have the options of putting in stents in to
their heart,coils into their brain, stents into peripheral vessels to
improve the quality as well as the longevity of life. We can expect the desire
for increased services will be there.
DR. LISA MAZZULLO:
So, do you think going back to this business week article
that there are just too many women physicians, in addition to the things we
have just mentioned, that having women in the workforce that need more flexible
hours are contributing to the concern of a lack of physicians later on.
DR. JOSEPH FLAHERTY:
I really find that argument hard to buy, it’s not asked of
any other profession. The only reason it’s asked of medicine is the expense it
takes to train a physician and the length of time and who is paying for it.
Increasingly, the physicians themselves are paying for that time, that even in
state schools like the University of Illinois, which is largest in the country,
the equation is substantial and so students are facing 150,000-180,000 dollars
of debt after 4 years. They are making the choice just as lawyers make the
choice and lawyers work anywhere from 10 to you know 500 billable hours a week
and no body questions whether that is a good thing to have women in or not. I
think though the <_____> of issue that people are raising is the women
work fewer hours and it is therefore we are going to need more numbers and the
studies in both Europe and the United States show a slight difference, although
not a major difference that what is happening is that young people that are
going into medicine today are making much more lifestyle choices and quality of
life choices with respect to careers in medicine, so that while there are some
that resemble those dinosaurs of us, they work the 80-hour work week. There
are many more that are looking at it as a good career/job rather than a calling
or a profession and I can't help it think that there are good aspects to that,
but the bottom line is you probably need more doctors, because they are not going
to work 80 hours a week and be on call every night and forgo all their vacation
time. Those changes are increasingly non-gender specific.
DR. LISA MAZZULLO:
I think that’s so true. I think, you know, there is a total
culture change going on and we are seeing that in this reduced-work week, it
does not mean people don't enjoy what they doing aren’t dedicated physicians,
it just means they want to have balance to their life, whether they are men or
women.
DR. JOSEPH FLAHERTY:
That’s right.
DR. LISA MAZZULLO:
It's interesting, as part of this business week research
that we were doing, it also was talking about women choosing different
specialties because that was more flexible to their needs for their balance and
with that in mind, they are going into things like primary care and pediatrics
where the shortages may be the greatest.
DR. JOSEPH FLAHERTY:
Unfortunately, that has been one of the hopes. There is not
a great deal of data supporting it. Women are choosing, for example Ob/Gyn
more often than men and that’s a specialty with really demanding hours.
DR. LISA MAZZULLO:
If you are just joining us, you are listening to a
discussion on women physicians and their affect on the workforce in these
shortages that are expected to come in our aging population for medical care.
I am Dr. Lisa Mazullo and today I am speaking to Dr. Joseph Flaherty on these
issues.
We were just talking about some of the questions of whether
the specialties people are picking are really making a difference and I will
tell you from experience with partners who work both part time and full time in
OB, they see almost as many patients as their full-time male counterpart in the
days they are there because of the demand for patients to see them and so I
wonder if they are actually seeing fewer patients, even though they are working
fewer hours.
DR. JOSEPH FLAHERTY:
You know, it is a very good question. It’s very hard to cut
practice back. The specialties that you can do that in are, for example
emergency medicine, so people in emergency medicine full time typically work 12
or 15 shifts a month, there may be 12-hour shifts, etc. So a man or a woman
can say “I would like to work 8 a month” and so you know that’s shift work.
It’s more like nursing, where nurses can say, “I would like to work 60, 40, or
20 hours a week.” If you are running a private primary care practice, it is
very hard to do that. So the issue becomes in part what kind of jobs do men
and women take within each specialty and I don't know US data because I haven’t
a good study, but in great Britain and other European countries, they are
finding more of the newest generation of people and slightly more women are
choosing not to be principles or major physicians in practices versus they are
covering the clinic from 8 to 5, 4 days a week. So again a lot of the issue is
what kind of control do they have over their schedule.
DR. LISA MAZZULLO:
I actually think we are seeing that a lot of ways too in the
extracurricular things people do outside of professional clinic work, for
example, having women in leadership roles and deans offices and in medical
chiefs of staffs and such, they are not taking that extra meeting in the
afternoon or evening because they need to get home to their families.
DR. JOSEPH FLAHERTY:
Yes, that is happening and I have predicted it will happen
also for men, but probably more so with women. The interesting correlation
that is despite the discussion 25-30 years ago that women are cursed both ways,
they are doing more home and they are doing more in the work place as
physicians. A new study shows women physicians are spending about a half hour
a day on housework and about a half hour day on cooking. So they have cut back
dramatically. On that, particularly in every household where the income is
sufficient, they have other people do some of the services, so that has been a
development over the last 10 years that has helped somewhat.
DR. LISA MAZZULLO:
Do you think that regardless of the gender issue that the
more flexible schedule or the increase in life balance is going to have a
negative impact on the care of medical provider?
DR. JOSEPH FLAHERTY:
That’s a great question. I think the simple answer is yes
and the <_____> is unless we can find a more creative way to doing it, we
are running in 2 opposite directions with physicians in naturally,
understandably desiring a little more control over their schedule, not being
bombarded 24x7 and the patients desire for more access to physicians, more
concierge-like services and to be able to call a doctor that knows them when
they are concerned about something whether it be a little pain in their chest
or whatever. So I think we have to look at new models of care that perhaps has
small groups of patients that are pulled together among 4 doctors. The old
group practice methods in some places and countries, they are called firms, so
you have a group that knows each other’s patients reasonably well and provides
that access for the patient for a small group that they know and yet allows a
physician a little more time that they are completely off.
DR. LISA MAZZULLO:
Sounds like the best of both worlds.
DR. JOSEPH FLAHERTY:
Some solution that has to be created, an American has to
come about that otherwise there is going to be a clash of cultures. Part of
this is going to be helped by Internet with all its problems and viability
issues, there is one thing of responding to patients questions and concerns by
e-mail that is a little easier than, you know, the people calling you at 9 on
the phone and your kids, you know, interrupting you and getting you,
particularly pediatricians, they get so much of that.
DR. LISA MAZZULLO:
Well, you known, at 3 o'clock in the morning if I could
answer e-mail while I am waiting for someone to deliver that would be a very
efficient use of time, for sure.
DR. JOSEPH FLAHERTY:
Yeah, that’s right.
DR. LISA MAZZULLO:
Well, medical staffing experts feel women physicians are not
fully responsible for the upcoming medical care shortage. In the last 30
years, women now make up a 50% of medical school classes and 30% of practicing
physicians having life balance; we expect to see result and fewer medical
errors and lower burnout rates. So for now, let say there are not too may
woman physicians.
Thank you to Dr. Joseph Flaherty who has been our guest
as we have been discussing this issue. I am Dr. Lisa Mazullo and you are
listening to ReachMD XM157, the channel for medical professionals. For
complete program guide and podcast, visit reachmd.com or call us for comments
at 888 MD XM157. Thank you for listening.
DOCTOR
Well, hello Nancy.
NANCY:
Hi doctor.
DOCTOR:
How is the osteoporosis medicine I prescribed working for
you?
NANCY:
It’s fine doctor, but you know, I saw this commercial for
something called Evista, raloxifene hydrochloride.
DOCTOR:
Yes, Evista, it's prescription only and it's the one
medicine that treats osteoporosis and reduces the risk of invasive breast
cancer in postmenopausal women with osteoporosis. It's important to note
though that Evista does not treat breast cancer, prevent its return, or reduce
the risk of all forms of breast cancer.
NANCY:
Am I at risk for invasive breast cancer? I don't have a
family history.
DOCTOR:
Well, family history is important, but there are other risk
factors that I need to take into consideration including your advancing age and
personal history, and based on my risk assessment, you may be at risk.
NANCY:
So, you think Evista is right for me.
DOCTOR:
Now, individual results may vary, but I think for you the
benefits of Evista would outweigh the potential risks. Let’s switch you today.
NANCY:
Oh! Thank you doctor. I am glad I asked about it.
DOCTOR:
No problem. Evista increases the risk of blood clots.
Should not be used by women who have or who have had blood clots in the legs,
lungs, or eyes. Evista may increase the risk of dying from stroke in woman at
high risk for heart disease or stroke. Talk to your doctor about all your medical
conditions. Seek care immediately if you have leg pain or warmth, swelling of
the legs hands, or feet, chest pain, shortness of breath, or a sudden vision
change. Do not use Evista if you are pregnant, nursing, or may become pregnant
as it may cause fetal harm. Woman with liver or kidney disease should use
Evista with caution. Evista should not be taken with estrogens. Side effects
may include hot flashes, leg cramps and swelling. For more information about
Evista, contact your Lilly sales representative, visit www.evista.com, see our
ad in good housekeeping or call 188844 Evista.
