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Are there too many women in OB/GYN?

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The LA Times recently published a piece on the lack of men in OB/GYN. Only 17% of new trainees (residents) in OB/GYN are men and the male OB/GYN physicians who weighed in worried that this “lack of diversity could weaken the field.” Apparently it sends a “horrible message to men” and with the lack of men we might “lose the next person who is going to find a cure for cancer.”

I have some thoughts.

The first one is 55% of pediatric residents in 1990 were women and currently 75% of pediatric residents are women yet I have never once heard any pediatrician talk about how that might prevent us from the next big breakthrough in pediatrics. I’ve never read an article on how the gender discrepancy in pediatrics or family medicine or psychiatry (the latter two also female dominated as approximately 57% of trainees in both are women) impacts those fields either. Then again those fields tend to pay less than OB/GYN.

Is is just acesss to higher paying jobs that is bad for men? Hmmm.

My second thought is I have not read any think pieces on how the dearth of women in the areas of medicine that are still male dominated, such as neurosurgery, affects advances. No one there seems to worry that the lack of woman brain hampers much of anything.

I could just leave it at that, but I’m me and today is International Women’s Day so buckle up.

There are more medical role models top to bottom for men than women

My medical training was 1986-1996. In medical school the only lectures I received from women were given by basic scientists (Ph.D.s not M.D.s) and pathologists. I was never given a lecture by a female surgeon or cardiologist or even a female OB/GYN. Maybe there was one and I was sick that day. I never had one textbook authored or edited by a woman. A chapter written by a woman was a treat.

When I did an elective in the U.K. in 1990 and heard that they referred to surgeons as “Mr.” I asked a male surgeon what that called female surgeons. His answer? There aren’t any.

In my residency there were three female OB/GYNs out of a department of about 20.

During my 10 years of training I never met one female surgeon. Not one. Most of the faculty in all fields were men. I never heard of a female chief of a department never mind meeting one. Not just of OB/GYN, of any department.

What about now? Are there men in leadership positions so male trainees at least have someone to look up to when they take a break from the textbooks largely written by men? The most recent data tells us that for OB/GYN 79.4% of department heads or chairs, 64.9% of vice chairs, and 71.4% of division directors are men. The American Congress of OB/GYN (ACOG) elected its first female President in 1984. In 65 years they have had 5 female Presidents.

The Royal College of OB/GYN in the U.K. has its first ever female President.

Patient Preference 

Some women will ask to see a female provider and this bias will be greatest against medical students. This is new. When I trained most providers were men so there was no choice. The few times there were women providers the female patients were less empowered to speak up. Women now have more power to say what they want. That is not a bad thing.

If men in medical school or OB/GYN residencies are working a little harder to overcome some biases then I can assure them from my personal experience that it will make them a kinder, better doctor because they will learn how to gain a patient’s confidence that much quicker. I think every woman of my generation who has been called a “little miss” by a patient and been asked to step aside so the man (a.k.a. real doctor) could do the procedure has some empathy for the situation some men in OB/GYN face today. Although at least men are not sexually decredentialed as they step aside.

It is interesting to hear women who have had bad experiences with doctors talk about their providers. In my experience when they were unhappy and the provider was a woman she was “uncaring” or a “bad doctor.”  The men, well, they just “didn’t understand.” That is how systemic our biases are against women.

Sexual Assault and General Demeaning Talk

I’m not sure how many men in OB/GYN have had their scrotum cupped by a female attending in the operating room, but I have certainly been positioned next to a male surgeon so his arm rubbed against my breast for an hour or so. I’ve had more hands run up and down my back and I’ve been corned, literally pushed up into a corner, by a male surgeon trying goad me into letting him drive me home late at night. I’ve also had a tongue stuck down my throat. I know that many men in medicine have been sexually assaulted, but I believe the numbers pale in comparison to the female experience.

Then there were all the times male surgeons and even OB/GYNs spoke about hockey or golf in the operating room in a pointed or “humorous” attempt to exclude me from the conversation. Or the good times when the men in the operating room joked about not knowing how to talk about knitting!

Ha ha.

This not specific to OB/GYN, but just to demostrate some of the additional barriers women experience.

Pregnancy Bias

I have heard story after story of women being turned down or passed over for training positions because they might get pregnant or because they (God forbid) had a pregnancy in residency. A friend of mine wanted to be a neurosurgeon. She applied to a variety of programs in Canada. She was conditionally accepted into what was considered one of the best programs. The condition? She sign a contract stating she would not get pregnant during her residency. This was in 1989. Not 1889, 1989.

I bet not one man in any medical school or residency ever has been asked about his plans for procreation.

Job Bias  

If you thought being a woman in OB/GYN brings bigger bucks you would be wrong.

Male doctors who get awards from the National Institute of Health make $13,399 more per year than women doctors (controlled for specialty, academic rank, leadership positions, and number of publications). It’s not about pregnancy or kids either as women with no children still had lower salaries than their male counterparts.

In academic medicine OB/GYN ranks the 4th worst (out of 18 fields) for a gender pay gap. Women in OB/GYN earn $36,390 per year less than men in an adjusted analysis.

Overall (so not just in a university setting) women in OB/GYN make $48,000 less on average than men. This specific data set didn’t control for number of hours worked, however, looking at all the other studies on gender pay gap in medicine that do control for hours worked and other factors it is very likely the pay gap still exists.

If indeed women are taking jobs away from men in OB/GYN they are only taking away  the lower paying ones freeing men up to stay in the higher paying positions.

It is still harder for women in medicine. Period.

When there hasn’t been a male President of ACOG for 10 years and all OB/GYN textbooks are written by women and no one asks me if I am a nurse or forgets to call me doctor when they introduce me at a professional function and when women out earn men in OB/GYN and have 80% of the leadership positions and when opinion pieces about the dearth of women in surgery and the excess of women in pediatrics fill our newspapers and when men are asked about their procreation plans at interviews I will be concerned that OB/GYN has developed a gender diversty problem. However, as the women I have worked with in medicine tend to be concerned with all stake holdeers equally and support parity because they have been on the receiving end of inequality I doubt we will ever see that kind of bleak, all female future.

It is true that most residents in OB/GYN are women, but a man who wants to go into OB/GYN will never, ever face the systemic oppression and bias and lack of role models that women have faced and still face today. Any man in OB/GYN on graduating residency will likely end up with a higher paying job than the women he trained with and history tells us he won’t seem to mind. After all, if men in OB/GYN minded so much about the gender pay gap we wouldn’t have one because they have always been, and are still, the ones in charge.



*** This post has been updated to reflect there have been 5 women Presidents at ACOG in 65 years, not 4 as originally stated***

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4 days ago
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Congrats! A Voice for Men and Return of Kings have both been designated hate groups by the SPLC

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Paul Elam of A Voice for Men: Now officially a hatemonger

By David Futrelle

A big round of applause for two websites that have featured here on We Hunted the Mammoth from the beginning: A Voice for Men and Return of Kings have both been officially recognized by the Southern Poverty Law Center as hate groups. 

The hate-monitoring group announced the news in its latest “Year in Hate” report yesterday. “[F]or the first time,” the report declared,

the SPLC added two male supremacy groups to the hate group list: A Voice for Men, based in Houston, and Return of Kings, based in Washington, D.C. The vilification of women by these groups makes them no different than other groups that demean entire populations, such as the LGBT community, Muslims or Jews, based on their inherent characteristics.

Both groups have more than earned this long-overdue designation. If you need to be reminded just how, take a stroll through the archives here for literally hundreds of examples of hateful rhetoric and actions by both AVFM and RoK, and/or their respective founders, Paul Elam and Roosh V.

You may also notice, in your stroll through the archives, that both AVFM and (especially) RoK have embraced some of the most noxious views of the racist alt-right directly. Indeed, one of the most notorious participants in the racist Charlottesville march last year — a man jailed for his assault on a counterprotester — was a former contributor to AVFM.

Elam’s response so far to his recognition as a hatemonger by the SPLC has actually been somewhat tame, at least by his standards.

He also retweeted this lovely sentiment from someone whose Twitter handle is a not-very-subtle reference to the c-word.

This dude was even more pissed:

Roosh’s response to his inclusion on the list was a bit, shall we say, ironic as well:

Thanks for proving the SPLC’s point, guys!

The SPLC report also notes a number of other discomfiting facts, starting with this one:

The SPLC’s Year in Hate and Extremism report identifies 954 hate groups – an increase of 4 percent from 2016.

Some of this increase, the report says, was due to a resurgence of fringe black nationalist groups — which the SPLC is quick to distinguish from “activist groups such as Black Lives Matter and others that work for civil rights and to eliminate systemic racism.”

But the real danger comes from the racist right.

[B]lack nationalist groups lagged far behind the more than 600 hate groups that adhere to some form of white supremacist ideology – and they have virtually no supporters or influence in mainstream politics, much less in the White House.

Within the white supremacist movement, neo-Nazi groups saw the greatest growth – from 99 groups to 121. Anti-Muslim groups rose for a third straight year. They increased from 101 chapters to 114 in 2017 – growth that comes after the groups tripled in number a year earlier.

Ku Klux Klan groups, meanwhile, fell from 130 groups to 72. The decline is a clear indication that the new generation of white suprem­acists is rejecting the Klan’s hoods and robes for the hipper image of the more loosely organized alt-right movement.

The overall number of hate groups likely understates the real level of hate in America, because a growing number of extremists, particularly those who identify with the alt-right, operate mainly online and may not be formally affiliated with a hate group.

These groups not only spew hatred; they have helped to spur a frightening rise in racist violence — and murder.

separate SPLC investigation, released earlier this month, found that 43 people were killed and 67 wounded by young men associated with the alt-right over the past four years. Seventeen of the deaths came in 2017.

So AVFM and RoK are in some pretty shitty company here.

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24 days ago
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What did Donald Trump do today?He hears you, he said.Trump held a "listening ses...


What did Donald Trump do today?

He hears you, he said.

Trump held a "listening session" today with preselected victims of school gun violence. The White House event was scheduled against a day of protest in Tallahassee by many of the student-survivors of the Parkland mass murder.

Trump's struggle to show empathy is most noticeable in times of tragedy. He has gotten into nasty feuds with grieving widows and parents of servicemembers killed in action, jovially tossed paper towels at hurricane victims (before blaming them for their misfortunes), and asserted the likely innocence a man his own staff had fired over accusations from two ex-wives that he had beaten them. When he met with first responders to the Parkland mass murder, he offered them "congratulations" and gave a grinning thumbs-up sign for the cameras--a photo he liked so much that he made it his Twitter banner.

Presumably this is why his staff felt obliged to write down talking points for him that included a reminder to say "I hear you." 

Encouraging Trump to practice "reflective listening," as it is known, was good advice. The Complete Idiot's Guide To Clear Communication says that it's especially useful in emotionally charged situations.

Trump did more than listen, though. He spent a considerable amount of time talking about how his audience might have suffered fewer losses if their teachers had been armed. This is not a new position for Trump, although admitting it is.

Why should I care about this?

  • It's bad if the president needs to be reminded of how to act like he's listening.
  • Presidents should not lie about their policies.
  • Presidents should not use tragedies to advance political ends.
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24 days ago
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Trump Calls Democrats "Treasonous" for Not Applauding Him at SOTU

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At a speech today in Ohio, where he was supposed to be promoting his tax bill, Donald Trump went on an extended riff about how the Democrats were insufficiently enthusiastic during his State of the Union address, which he found "un-American" and "treasonous."

So that means they would rather see Trump do badly, okay, than our country do well. That's what it means. It's very selfish. And it got to a point where I really didn't even wanna look too much during the speech over to that side, 'cause, honestly, it was bad energy. No, it was bad energy! You're up there; you've got half the room going totally crazy wild; they love everything; they wanna do something great for our country — and you have the other side, even on positive news, really positive news, like that, they were like death. And un-American. Un-American. Somebody said "treasonous." I mean, yeah! [makes a goofy face and shrugs] I guess, why not? [crowd laughs] Can we call that treason? Why not? I mean, they certainly didn't seem to love our country very much. But you look at that and it's — it's really very, very sad.
Three observations:

1. It's important to remember that Donald Trump is an inveterate projectionist who always accuses other people of doing whatever he's doing.

2. Note the jocular tone he uses to call his ideological opponents "treasonous" for failing to applaud him. That tone is not an accident. It serves to preemptively deflect any inevitable criticism by asserting he was "joking" (and his critics are humorless and over-reacting), while simultaneously diminishing the inherent seriousness of treason, should he ever be charged with it. "Treason" will have become just another incendiary insult that politicians throw at each other, like the president did at Democrats for their lack of clapping. It's not like it means anything. Incredibly sinister stuff.

3. Lest we fall directly into that trap, let us pause to seriously contemplate the gravity of what happened today: The United States president called members of the opposition party "treasonous" — and, even more specifically, members of the Black Caucus, whom his base excoriated for their "disrespect" — because they they did not publicly demonstrate their enthusistic fealty to his satisfaction.

Chilling. And also just another day in the Era of Trump.
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40 days ago
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TV Corner: Murphy Brown Reboot

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image of the cast of Murphy Brown
They were all laughing like this because they just ate salads, I bet.

Does anyone want to talk about CBS bringing back Murphy Brown for a minimum 13-episode run? Because I am pretty excited about it!

I loved Murphy Brown, and I am really interested to see what the show makes of current politics and especially current news media.

I wouldn't be as interested if the show's star, Candice Bergen, weren't reprising the titular role, and if the show's creator, Diane English, weren't also back on board at the helm, but they both are. Yay!

There was a lot I loved about Murphy Brown, but let's just get right to the most important detail: Candice Bergen had the best hair of the '90s. Fight me.

Anyway, let's see if Murphy Brown can drag yet another insufferably sanctimonious vice-president from Indiana into a battle of wits that he will definitely lose!

Relatedly, I'm really digging the trend of reviving old shows for new seasons, as opposed to simply remaking them with a new cast. It's a new trend in the United States, but it's very common on British television, and I like it a lot.

I do, however, hope that, irrespective of how many of the old cast come back, producers diversify the cast in the new season.

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43 days ago
Ooh. I loved Murphy Brown. I'm glad she'll be back.
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Trump, Baby Hope, and What Wasn't Said

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[Content Note: Reproductive coercion; addition.]

If you were disturbed by the "uplifting" story told by Donald Trump about the Holets family, who were his guests at the State of the Union, you are not alone.

Here is the story Trump told to the nation, as the camera lingered on the young white parents and the white baby being cradled in her adoptive mother's arms:
As we have seen tonight, the most difficult challenges bring out the best in America. We see a vivid expression of this truth in the story of the Holets family of New Mexico. Ryan Holets is 27 years old, an officer with the Albuquerque police department. He is here tonight with his wife, Rebecca. Thank you, Ryan.

Last year, Ryan was on duty when he saw a pregnant, homeless woman preparing to inject heroin. When Ryan told her she was going to harm her unborn child, she began to weep. She told him she didn't know where to turn, but badly wanted a safe home for her baby.

In that moment, Ryan said he felt god speak to him. "You will do it, because you can." He heard those words. He took out a picture of his wife and their four kids. Then he went home to tell his wife Rebecca. In an instant, she agreed to adopt. The Holets named their new daughter Hope. Ryan and Rebecca, you embody the goodness of our nation. Thank you. Thank you, Ryan and Rebecca.
This story, when I heard Trump tell it, did not seem like the inspirational tale of people who "embody the goodness of our nation" to me. It seemed like a crass and exploitative yarn that reduced the identity of Hope's birth mother to a nameless, faceless junkie and invisibilized Trump's vile healthcare and childcare policies that leave many pregnant people and addicts without any good options.

(And while I have no idea if Ryan and Rebecca Holets would have been so quick to adopt Baby Hope if her birth mother were not white, I strongly suspect that Trump would not have told the story if she hadn't been.)

Many of us wondered: Was there not a better solution? Would it not have been a greater kindness to secure the help and recovery that Hope's biological mother needed to get sober, instead of (or, at minimum, in addition to) separating her child from her?

Many of us wondered what had happened to the woman who was written out of the story, in Trump's telling.

At the New York Times, Jennifer Weiner answers some of these questions ("Baby Hope's biological mother is named Crystal Champ."), and observes how writing Crystal Champ out of the story — her story, as much as anyone's — acts in service to an anti-choice agenda where women (and other people who can get pregnant) are nothing more than incubators, whose humanity is decidedly inconvenient.
Think of the posters often brandished at anti-abortion marches and rallies, with the image of a fetus in utero, floating free, like an astronaut, with the umbilical cord, untethered, trailing off into the darkness. The spaceship — a woman — was, of course, nowhere to be seen, an important framing. With the woman literally out of the picture, abortion foes can advance the claim that a fertilized egg is just as much a unique human life, deserving of protection as a living, breathing, toddler.

They can argue that the only difference between an embryo, a newborn baby, and a kidney patient on dialysis is age, size, location and circumstance.

In this formulation, a pregnant woman, a living, breathing, thinking person, becomes no more than an environment, or a tool, whose story ends once she's given birth.

Once we put the woman back in the picture, once we insist on seeing her as a person, not a place or a thing, we've got to acknowledge what is, for abortion opponents, an inconvenient truth. ...That embryo requires the support, the partnership and the body, of one specific individual: The woman carrying it.

The way around that is for abortion opponents to simply take the woman out of the story, to erase her from the picture, or to characterize her as nothing more than the place that "pre-born baby" happens to reside.
Trump's erasure of Crystal Champ acted in service to this narrative — the position I frequently describe as fetuses being valued more highly than the people who carry them.

It is an argument unique to anti-choice rhetoric: No one else is obliged to let their bodies be used without their consent to sustain another life. We don't even let organs be harvested to save a life unless the donor, or someone empowered to make decisions for them, consents to it.

That is why anti-choicers, including the president, choose to tell stories designed explicitly to conceal how far outside medical practice in all other circumstances forcible birth is, a central part of which is disappearing people who gestate the fetuses emblazoned on anti-choice propaganda.

But Trump had other things to conceal, as well: The fact that his policies failed Crystal Champ, and Baby Hope, in every conceivable way.

In the very same speech in which he held out this story as an example of "the best in America," he enthusiastically boasted about getting rid of the Affordable Care Act's individual mandate, which makes healthcare affordable for and accessible to millions of people. He wants to restrict healthcare access further still.

He has declared the opioid crisis a public health emergency, but took no action and requested no funds to do anything to address the problem beyond saying the words that got him a day's worth of headlines to make it look like he gives a shit.

He supports no early childcare policies that would help a mother struggling with addiction parent her own child; no policies at all that prioritize keeping families together. To the absolute contrary, he is an aggressive advocate of policies that tear families apart, from his cruel immigration policies to his Justice Department's renewed "war on drugs" that will continue to dismantle families via incarceration.

And his economic policies mean that people like Champ, and her daughter, will continue to be casualties of the class warfare being waged by his administration and Congressional Republicans.

All of these catastrophic failures were concealed in Trump's story, along with the identity and personhood and humanity of Crystal Champ.

He didn't say her name, and he didn't tell the truth about how conservative policy conspired to make Champ's best choice to give away her daughter, to a police officer who shamed her for being an addict in a country that treats addiction like moral weakness.

This story was emblematic of America, all right. But not in the way Trump would have us believe.
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43 days ago
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