Sexual Discrimination: A Case of Occupational Sexism and Gynocentrism
Gynecology is quite literally, the study of women. On a more modern level, it has become the study of the female genital tract and medical and surgical procedures to aid the patient in normal function. As a practicing obstetrician-gynecologist, I dedicated my life to the care and support of females and their health. The road to developing a medical practice in gynecology in a metropolitan area has been a challenge for multiple reasons. One reason for which I was ill-prepared was the fact that I was a male physician entering into a profession where female physicians were in demand. Market pressures were demanding that medical practices hire women, and the all-female practice was becoming a point for advertising.
Gynecology and gynocentrism
Medical schools consist of two years of didactic training and two years of inpatient clinical work. In a student’s third or late fourth year they have to declare a specialty that they wish to pursue after graduation. I chose obstetrics and gynecology because I was enthralled by the fact that one could experience medical and surgical venues. As an obstetrician you treat women for diabetes, and deliver her baby vaginally or by surgical cesarean section. Gynecology presented itself as a medical profession, in the sense that one could treat abnormal uterine bleeding, pelvic pain, and find organic or psychological causes. In cases where true organic pathology was discovered, there is the ability to correct a problem surgically. When I started residency at the University of Oklahoma Health Sciences Center there were ten male residents and ten female residents. Four years later, there were sixteen female residents and four male residents. In a recent phone conversation with my prior program director, I discovered there are two male residents and eighteen female residents (R. S. Mannel, personal communication, December 29, 2008, 2008). Are we seeing gynocentrism in the medical profession? If gynocentrism is defined as an ideological focus on females, and issues affecting them, possibly to the detriment of non-females (Gynocentrism, n.d.), then one might agree that this is occurring in the field of gynecologic practice. The question of gynocentrism is further complicated by market pressures. If patients are demanding female practitioners is this really a case of gynocentrism and reverse sexual discrimination. If a person is “denied a job because that person is male or female, that is an overt act of sexism” (Hinman, 2006, p. 260). In multiple instances, I was denied a job because I was a male; actually I was not granted an interview because I was a male applying for a gender-specific position.
In 1976 only 7.6% of physicians in practice were women; this is compared to 27.8% in practice in 2007 (American Medical Association [AMA], 2008). Obviously, women are still a minority of the applicants and matriculants to American medical schools; there are however two specialties where women are a dominant factor. In 2005, 70% of practicing pediatricians and 76% of obstetrician gynecologists were women (AMA). The main difference in pediatrics is that market factors, in most cases, do not bear out that patients request a female pediatrician.
In 1994 I visited over ten residency programs for interviews. At that time I felt it was more important have done well on the United States Medical Licensing Exam (USMLE) and have excellent recommendations than it was to be male or female. In none of my interviews did I feel that my gender was a part of the selection process. Many of the women applicants that I had exposure to were dressed in the same drab blue and grey suits as the men. I did hear of some of the women being asked how they were planning on caring for their children while maintaining the rigors of a medical residency. I had two children at the time and was not asked that question. Years later, I was witness to these interviews from the side of the interviewer and saw sexist language where women were seen as aggressive while a male counterpart was deemed assertive (Hinman, 2006). In 1998, at the end of my residency I had four years of active duty in the army ahead of me. Towards the end of my fours years in the military, I had a rather naïve view of the American medical system as I was sheltered in a socialized organization. It was not until the spring of 2002 that my perception of the medical landscape was abruptly changed. Like most physicians looking for employment, I went to the classifieds in journals and multiple websites where physicians are recruited. None of these advertisements or recruiting agencies showed ads that were biased or sexist, but occasionally, I would read an ad that would have the phrase “gender-specific”, or the ad would claim that the office consisted of an all female group looking to add another like-minded physician. In one instance I called one of these offices and asked to speak with the office manager. When she picked up the phone I introduced myself and asked if they were still interested in hiring another physician. Her response was, “you’re not a woman”. Hinman (2006) describes overt job discrimination as “where a woman is denied a job or promotion solely because she is a woman” (p.261). I would assume that the word woman could be replaced by man in the preceding sentence?
I decided to move to Tucson, AZ because of family issues and set three interviews for employment. In each case, I was a finalist with against female applicant, and in each case the woman was hired over me. I called to discuss the interviews after the decisions were made and in each case I was told that the physician groups were afraid that a male would take too long to become profitable. Is this a case of occupational sexism? Is this a case of overt sexual discrimination? The answer may not be so simple. In the area of Tucson where I practice there are sixteen obstetricians; three male and thirteen female. Based on volume of deliveries per year, the three male physicians are within the top six delivering providers. The market does not seem to agree with the concept that medical care should be provided solely by men or women. If one were to look in the yellow pages in many metropolitan areas and look in the gynecology section, there would more than likely be an add for an all-female group with a catchphrase, “healthcare for women, by women”. Does this constitute sexist language? This question is difficult to answer because our language is gendered (Hinman). There is an assumption being made by this ad. The assumption is that there are patients who are looking for a female provider. The reasons are multifaceted, but empathy seems to be a recurrent theme. Female patients feel that there is more comfort in a female doctor (U.S. Army, November 6, 2008). In my current practice, where my wife is the other obstetrician-gynecologist,, there are times where my wife’s patients will not see me as a provider. There are cases where the patient’s culture is an issue, but in most cases there is a general concern with an intimate medical visit and a provider of the opposite sex. Is this a legitimate reason for women’s health practices to deny interviews to male physicians?
As described earlier, the gynocentric model is a newer paradigm in the Western workplace. The work that has been done by females in changing the dynamic of the American workplace is also new in the medical paradigm. In fields such as orthopedic surgery and urology, there are less than five percent of practicing physicians that are female. While androcentrism generally pervades medicine, there are fields such as obstetrics, gynecology, and pediatrics where women are a dominant force in the workplace. In my medical office, of the nineteen employees including physicians, I am the only male employee. This goes against what Hinman (2006) describes as the traditional model of gender, where women are primarily in the home and men are working. Female colleagues will also have their husbands providing the household chores and caring for the children as the wife is the main source of income for the household.