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Why don't more women go into EM?

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  • #16
    Female non-EM PGY-1 here.  I agree with wideopenspaces - I think a large part is the lack of predictable daytime hours.  I think young female docs most value predictable daytime hours in their 30s when they have young kids; that's also when they're the least senior and very unlikely to be able to hold the reasonable 6am-2pm or 7am-3pm etc shift regularly.  As a med student, I'd see my attendings (both male and female) do a seemingly random assortment of 7am-3pm, 11pm-7 am, 3 pm-11pm shifts all within the span one one week.  After experiencing those terrible Circadian rhythm shifts myself, I realized quickly that was not for me, despite the perks mentioned above (shift work, relatively low total number of hours per month for a doc, etc).   Female docs are also way less likely to have a stay at home spouse than male docs, so that plus the varying shifts makes childcare a real pain to find.

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    • #17
      I think there is a perception among medical students that the burnout rate among EM MDs is above average. That does seem to give them, especially the female students I encounter, pause. Whether or not this is true is beyond me and my desire to research.

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      • #18




        Female non-EM PGY-1 here.  I agree with wideopenspaces – I think a large part is the lack of predictable daytime hours.  I think young female docs most value predictable daytime hours in their 30s when they have young kids; that’s also when they’re the least senior and very unlikely to be able to hold the reasonable 6am-2pm or 7am-3pm etc shift regularly.  As a med student, I’d see my attendings (both male and female) do a seemingly random assortment of 7am-3pm, 11pm-7 am, 3 pm-11pm shifts all within the span one one week.  After experiencing those terrible Circadian rhythm shifts myself, I realized quickly that was not for me, despite the perks mentioned above (shift work, relatively low total number of hours per month for a doc, etc).   Female docs are also way less likely to have a stay at home spouse than male docs, so that plus the varying shifts makes childcare a real pain to find.
        Click to expand...


        Excellent points, doesnt sound fun even now. Wonder how long one does that on average and whether or not its because they absolutely have to or just feel they should, end result same obviously.

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        • #19




          I think there is a perception among medical students that the burnout rate among EM MDs is above average. That does seem to give them, especially the female students I encounter, pause. Whether or not this is true is beyond me and my desire to research.
          Click to expand...


          It is true. EM is ranked highest on the burnout scale, Derm is lowest.
          Helping those who wear the white coat get a fair shake on Wall Street since 2011

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          • #20
            How does one explain that ob/gyn is now primarily female.  The hours and "overnights" are much more numerous.

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            • #21




              How does one explain that ob/gyn is now primarily female.  The hours and “overnights” are much more numerous.
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              Are you kidding me? Have you been on an OB/GYN rotation in the last 20 years? I've never felt so unwelcome as I felt on the labor deck. And that was my second choice specialty at the time (now it would probably be anesthesia.)

              The patients don't want men, the patient's S.O.s don't want men, the staff doesn't want men, the other doctors don't want men....it's a generalization, but I bet if you poll medical students 80% of the men got the same vibe I did. Same reasons women come to the ED and request a female provider, it's just more comfortable for all involved for cultural reasons even though logically it may not make all that much sense.
              Helping those who wear the white coat get a fair shake on Wall Street since 2011

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              • #22
                From my institution, I would generalize a couple different points:

                1) The specialty is perceived as procedure intensive, and while I wouldn't say that women are less likely to want to do procedures, I do think there's a certain "maleness" that contributes to the excitement of nailing a difficult airway under pressure.  And the women I've noticed who are excited by things like this end up in a more surgical field (most specifically, OBGYN).

                2) Lack of strong female mentors.  I would say that not only are men more prevalent in EM, I would say that it is probably skewed even worse in terms of leadership.  Women looking for strong female mentors tend to find them (in my institution) in pediatrics or OBGYN.

                3) Shift work.  Many are willing to work just as much or even more for less because it means no weekends, no holidays, no nights, etc.

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                • #23
                  I'm a female in EM (just finished a shift) and mom/wife with a stay-at-home dad.  I find that the EM schedule is much easier to work around than a call schedule. Yes I work nights - but my young kids are sleeping. Yes I work weekends - but my husband and kids go see family or hang out together.  Yes I work holidays- but the same thing applies.  Schedule wise I think EM is great for working moms (and dads).

                  As for other reasons more women don't go into EM - it can definitely be intimidating.  Drunks, angry people, out of control guys taking swings - I get really friendly with the male nurses and with security first thing (I'm 5/2").  But it's also fun to work in such a crazy environment (3 years out from residency, we'll see how things go) and to get to interact with all sorts of people.

                  Personally, I was one of only 2 girls in my residency class (out of 9), but the years behind me were 5:4 and 7:2 girls to guys so at least at my program the tide was turning.

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                  • #24
                    Yes I have done an Ob rotation in the last 20 years. Duh. I am an Ob/Gyn.  What I meant but perhaps did not communicate well was that several posters had theorized that the reason there are not more female ER docs is the overnights etc and confrontational aspect of the job.  Ob has lots of night work and confrontation. Yes patients and staff like female docs there is no question about that.  I guess my point is the reason there are few female ER docs is more than just lifestyle issues.  Maybe females who can deal with lots of night call choose Ob over ER.  I really don

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                    • #25
                      Continued answer.  Don't know the answer.  I am 58. There were very few female role models at that time.  ER was really an undefined speciality.  I think if I could do it all over again I would consider it.

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                      • #26
                        Just found the "women's issues" subforum and I thought I'd chime in.  I'm a pulmonary/critical care attending (also male dominated) and I think there is a component of gender discrimination in the process of selecting a specialty.  I work full time in a cardiac surgery ICU with a robust ECMO/mechanical support program.  Sick people.  And lots of them.  If there is one skill that I have, it is resuscitating a hemodynamically unstable patient.  Just yesterday I was working to stabilize a very sick patient with biventricular failure in addition to acute raging pancreatitis (Hb went from 10 to 13.3 in 1 hour) and the surgeon, who I had never met, asked THREE times if I wanted anesthesia to come up and intubate the patient.  I politely declined the offer for "help", intubated and lined, alined the patient within 30 min from initial request for the intubating supplies to CXR to confirm placement (I was watching the clock).  This sort of crap happens all.of.the.time.  Subtle undermining of clinical skills, questioning of competency.  Now that the surgeon has worked with me he has asked for my help with several other patients, but that initial gut reaction of - "move aside little lady, let's let the real docs handle this" happens a lot.  I have no doubt that this is an influencing factor for these types of specialties - EM, surg, crit care - despite the awesome pay and great work hours (not surgery obviously!)

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                        • #27
                          I don't know the breakdown, but I am guessing in pediatric EM there are more women compared to general EM.  That's partially because almost all people who do a peds EM fellowship did a peds residency first (it often doesn't make sense for someone who did an EM residency to do the PEM fellowship) so you are starting from a different substrate.

                          Peds EM doesn't always pay as well as regular EM (though it can in some places), but it subtracts out a lot of the negatives that many people in general dislike about EM -- abusive patients, drug users, tons of psych, etc. (though maybe women choose based on that more than men, I don't know).  We see all of that in PEM, but not nearly as much as my adult colleagues.  Abusive parents are actually not that common, and even when the parent is a giant pain I still have significant positive internal vibes from taking care of a child.

                          PEM gives you the same scheduling flexibility as general EM as well.

                           
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                          • #28
                            I've been in EM now for 4 years after training. I love EM for all of the reasons mentioned!  I think that the "personality" of EM, though, doesn't fit everyone.  high pace, critical moments, death, procedures...  But it IS great for being a mom!

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                            • #29
                              As a female ER doc, I would have to say one of the drawbacks of the gig is that since it is predominantly male, I feel like I'm always in the good old boys club. There are countless inappropriate jokes and profanities passed around during shifts amongst male staff. It takes a certain type of female, with a certain type of personality, to survive in this culture. It is also not generally accepted to have an emotional response to tragedy (which can be hard for many women). The amount of grief and tragedy to which you are exposed can make it hard to not have it take an emotional toll on you. Women can absolutely do the job, but given that women for the most part (of course there are many exceptions) tend to be more emotional human beings, it can be hard emotionally. OB/gyn you see babies and bring life into the world, pediatrics you get to see cute kids, family practice you're seeing both healthy and unhealthy individuals. They are different kinds of gigs than EM/critical care. EM is a male dominated specialty, work conversations can get very inappropriate, and you do often see people at their worst and when they're scared.

                              Also, during my training I was often told I was too peppy and it was recommended to me that I needed to be more abrasive at work in order to be taken seriously. I was encouraged to tone down the femininity to be more "serious." I was told this by female EM physicians. I find this to be incredibly sexist, that I have to lower my voice to sound more confident and serious to other ER docs. I doubt pediatricians and OB/gyns have to lower their voices to be taken seriously at work, as it is common for women to have higher voices than men. Alas, it is what it is. I think this culture is a result of it being male dominated for so long.

                              It certainly is not all bad. There are many reasons why I love my job. You do have the privilege and opportunity of making a significant impact on patients during a scary time and truly making a different every day, shift work, good income, no shift is the same/variety, etc.

                              I also agree with the above mentioning there just aren't as many female mentors. A lot of the females that I work with are divorced or never married. There are exceptions, but for the majority, I haven't found a female role model. I hope with more women going into Emergency Medicine, this will change. I'm hoping to be a woman in Emergency Medicine that women can see as a role model (we'll see!) to work on changing this.

                              There is a website called feminem.org that explores a lot of these issues/topics of women in Emergency Medicine.

                              Until there are more women in EM, I suspect the culture of the specialty will not change much, but it is changing-SLOWLY.

                               

                               

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                              • #30




                                As a female ER doc, I would have to say one of the drawbacks of the gig is that since it is predominantly male, I feel like I’m always in the good old boys club. There are countless inappropriate jokes and profanities passed around during shifts amongst male staff. It takes a certain type of female, with a certain type of personality, to survive in this culture. It is also not generally accepted to have an emotional response to tragedy (which can be hard for many women). The amount of grief and tragedy to which you are exposed can make it hard to not have it take an emotional toll on you. Women can absolutely do the job, but given that women for the most part (of course there are many exceptions) tend to be more emotional human beings, it can be hard emotionally. OB/gyn you see babies and bring life into the world, pediatrics you get to see cute kids, family practice you’re seeing both healthy and unhealthy individuals. They are different kinds of gigs than EM/critical care. EM is a male dominated specialty, work conversations can get very inappropriate, and you do often see people at their worst and when they’re scared.

                                Also, during my training I was often told I was too peppy and it was recommended to me that I needed to be more abrasive at work in order to be taken seriously. I was encouraged to tone down the femininity to be more “serious.” I was told this by female EM physicians. I find this to be incredibly sexist, that I have to lower my voice to sound more confident and serious to other ER docs. I doubt pediatricians and OB/gyns have to lower their voices to be taken seriously at work, as it is common for women to have higher voices than men. Alas, it is what it is. I think this culture is a result of it being male dominated for so long.

                                It certainly is not all bad. There are many reasons why I love my job. You do have the privilege and opportunity of making a significant impact on patients during a scary time and truly making a different every day, shift work, good income, no shift is the same/variety, etc.

                                I also agree with the above mentioning there just aren’t as many female mentors. A lot of the females that I work with are divorced or never married. There are exceptions, but for the majority, I haven’t found a female role model. I hope with more women going into Emergency Medicine, this will change. I’m hoping to be a woman in Emergency Medicine that women can see as a role model (we’ll see!) to work on changing this.

                                There is a website called feminem.org that explores a lot of these issues/topics of women in Emergency Medicine.

                                Until there are more women in EM, I suspect the culture of the specialty will not change much, but it is changing-SLOWLY.

                                 

                                 
                                Click to expand...


                                Hi! I am not EM, but are you familiar with FemInEm? I recently heard about it via @CarrieMD's podcast interviewing the founder, Dara Kass. It addresses exactly what you are saying

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