Book Review

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

N Engl J Med 2009; 360:1795April 23, 2009

Article

The Changing Face of Medicine: Women Doctors and the Evolution of Health Care in America
(The Culture and Politics of Health Care Work.) By Ann K. Boulis and Jerry A. Jacobs. 266 pp., illustrated. Ithaca, NY, ILR Press, 2008. $35. ISBN: 978-0-8014-4446-3

The number of women entering medical school and residency and practicing medicine in the United States has grown steadily over the past four decades. The Changing Face of Medicine is an exploration of multiple aspects of this change, including societal developments, immigration, economics, and the women's movement.

The authors, Ann Boulis and Jerry Jacobs, artfully debunk the myth that the number of women who are applying to medical school and practicing medicine has increased because a decline in the status of the medical profession has led fewer men to apply to medical school. Using multiple statistical studies, they clearly show that the number of women physicians has increased not because medicine has become a less desirable profession, but because more girls are taking an interest in the areas of biology, math, and chemistry at younger ages, and because the number of slots that are available for medical students has increased. All this has followed on the heels of legal reforms for women.

In addition to discussing the increase in the number of women who are entering medical school, the authors explore the subspecialties that women tend to choose. They offer explanations for the changes in these choices, such as selection bias in residency programs, the reduction of stereotyping by sex, how academic and research experiences may be different for women, and the differences in the growth rates of certain specialties. This section is enriched by anecdotes from women who experienced sex discrimination during their training.

Boulis and Jacobs explore special issues for women, including marriage, pregnancy and child-rearing, and dual-career couples. Informative data on employment rates, parenting and work hours, and the effect of these work hours on family life — including divorce and finances — are all included.

An important part of this book is an exploration of how sex role is related to the nature and the quality of care that is provided to patients. This topic has been the subject of much speculation and several publications. Interestingly, many of the qualities that are attributed to women who practice medicine are most often strongly shared by their male counterparts. In addition, the authors point out some troubling trends regarding the exodus of both male and female physicians from primary care settings. The clinical vignettes are a highlight of the book, and they include comparisons of the treatments proposed by male and female physicians.

That female physicians have stronger empathic skills in dealing with patients is strongly supported by extensive research literature. But does this mean that their patients are more satisfied with the care they receive? There appears to be conflicting information in this area, despite the advantages of the styles of communication that women tend to use. Finally, although the number of women in medicine has grown dramatically, the authors underscore their belief that medicine has been feminized “incompletely and unevenly.” They summarize their findings and hazard a prediction that female medical students will represent a majority of incoming medical students in the next decade. They also propose a bright future for the face of women's health research.

The Changing Face of Medicine not only provides discussion of these issues in readable language, but it is also full of charts and tables that illustrate the reams of data. It is unlikely that this book will be read by many, but its availability in such a usable form will allow educators, administrators, reformers, and representatives of funding sources — as well as future physicians — to understand how American medicine came to be as it is now.

Bonnie J. Dattel, M.D.
Eastern Virginia Medical School, Norfolk, VA 23507