Intended for healthcare professionals

Rapid response to:

Head To Head

Are there too many female medical graduates? No

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:749

Rapid Response:

Let the job market self-regulate

Nowadays, female outnumber male medical students in most EU countries; nevertheless, equal gender distribution alone does not guarantee gender equality. For example, when it comes to specialty selection or promotion to higher posts, women still do not seem to enjoy the same opportunities as men. Indeed, in their subsequent education, female doctors tend to choose specific specialties, namely paediatrics, anesthesiology, dermatology and general practice, whereas there are far more men holding leading positions.

Admittance to medical education should remain a competitive process regardless of sex or national origin, using objective criteria for choice of students and medical trainees. Antagonism is an inherent element in the function of contemporary societies and successful candidates have to prove themselves daily as scientists and clinicians, rather than blame sociodemographic variants.

With regard to future employment opportunities, we should realise that the job market is a free market, governed by the forces of supply and demand. Once it deviates too much from the optimum configuration, the market forces will automatically tend to correct it. Therefore, any concerns about women crowding certain specialties while other posts remaining relatively understaffed are unfounded since eventually the increased competition and unemployment in the most sought-after specialties will scare applicants away; at the same time, demand for doctors in less preferred specialties will raise wages, generate applicants’ interest and help restore balance. Establishing state controls and putting gender caps on the job market will only strip it of its self- regulating power and inhibit it from adapting to the ever changing needs of healthcare.

On the other hand, apart from purely technocratic issues, one may not overlook the human side of the physicians’ personal life. It would be a fallacy to deny the importance of interpersonal relationships fostered in the work environment. Indeed, physicians tend to marry colleagues; this is well known in the literature and has been described as a mechanism of subconscious spousal support [1, 2]. Let’s envisage the dramatic scenario: in a totally feminized context, what kind of interpersonal relationships may be expected among physicians-colleagues? The question lacks a definitive answer, as no systematic studies have explored the impact of the male-to-female ratio upon professional well-being, self-perception, creativity and role-model behaviours in medical settings. With this in mind can we argue that, despite the free and competitive nature of our society, we should impose gender ratio rules upon this job sector? The answer to this question should be negative, because unless a detrimental effect to physicians’ well being from gender imbalance in their workplace can be adequately demonstrated, the null hypothesis should remain that there is no such effect. After all, there are many other job sectors where there is gender ratio imbalance without any harmful effects to the employees and without any calls for gender balancing rules.

After our inter-unit debate among four male and two female physicians as well as a female psychologist we concluded: while it cannot be denied that men are becoming a minority in medical schools, this realization per se should not be in any way alarming. There is currently no reason to suspect that this gender imbalance will lead to worse healthcare or damage physicians’ emotional stability. The argument that certain specialties might become understaffed is valid but the answer should be to allow freedom of choice to the job market so as to self-regulate to the respective demand. We feel that trying to control this sector at any point – medical school admission, specialty placement – is very complex, and surely not the pertinent way to address the issue.

1. Woodward CA. When a physician marries a physician: effect of physician-physician marriages on professional activities. Can Fam Physician. 2005 Jun;51:850-1.

2. Østerlie W, Forsmo S, Ringdal K, Schei B, Aasland OG. [Do physicians experience spousal support in their medical career?] Tidsskr Nor Laegeforen. 2003 Aug 28;123(16):2296-9.

Competing interests: None declared

Competing interests: No competing interests

12 April 2008
Eleni T. Petridou
MD, Professor of Preventive Medicine & Epidemiology
Georgios Antonopoulos, Giagkos Lavranos, Maria Mpinou, Evi Germeni, Giannis Matsoukis and Theodoros Sergentanis
Medical School, National and Kapodistrian University of Athens, Goudi, 117 25, Greece