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Warning: The following may contain content that some might find to be “feminist.” Read at your own risk.

So here is an interesting article. Apparently in Canada, and I believe in the United States as well, medical schools are seeing a drastic drop in the number of males entering their programs.

Reading this article, I found myself asking the obvious question: why do we care? I don’t mean this flippantly by any means; clearly we do care or we wouldn’t be writing articles about it, and these schools would not be changing their admissions standards to address it. We care about having a gender balance in our medical schools and in our population of doctors.

As the article points out, the concern behind this has to do with our belief that our doctor demographic should reflect our patient demographic in certain key areas. If all of the physicians out there are one gender, race or religion, we assume that people who seek care and do not fall into this demographic will be neglected in some way. This is a well-founded fear given the history of women’s health being very much neglected when medical care was provided primarily by men. It would not behoove us to reverse the situation simply because the numbers of qualified male applicants to medical school have dropped off.

My next question, though, is how big a difference does that gender bias make? Is a well-qualified female doctor a better choice than a moderately qualified male doctor? Because the issue here isn’t bias toward women; far from it. The article points out that between two equally qualified applicants, one male and one female, the male still has the advantage. The problem is that we’re seeing a drop-off of high caliber male applicants and a rise in the number of female ones. The guys aren’t getting overlooked, they’re just not there.

The same is probably true of men’s health; it’s not going to be suddenly ignored because the face of medicine has become a bit more feminine. Sure, having an equal distribution of male and female doctors would be ideal, but does anyone really think that passing over high-scoring female students in favor of fairly good male students is really going to improve the overall medical care being provided? Apparently Canadian schools do, because their response to the high percentage of females in their first-year classes has prompted a lot of schools to change their admissions requirements.

Now don’t get me wrong; there’s a lot more to being a good physician than just high test scores, and I support admissions standards that reflect this. But it does smack a bit of poor sportsmanship that as soon as the girls start to play the game better than the boys, we up and change the rules.

What I really find funny and a little ludicrous about this move, though, is that the issue here isn’t discrimination. As I said, we’re not choosing women over men because they’re women; the boys still have the advantage in this field. They just don’t seem to want to play. I mean, as much as I would like to take this as a sign that women are just plain smarter than men and are finally given the level playing field to prove it, the issue here probably has a lot more to do with lack of motivation than anything else.

Why are men less motivated to become physicians? I have a couple of theories. Doctors aren’t quite as revered in our society as they once were. Nor do doctors, particularly in Canada, which has a single-payer healthcare system, if I’m not mistaken, consistently make buckets of money. A few specialties are lucrative and a few allow normal working hours, but they are highly competitive for those very reasons. Medical school is expensive, residency is long and arduous; it’s not surprising that many top male students might set their sights toward different fields.

As for women, the same barriers exist, but in recent years the profession has become more welcoming to female practitioners. It’s no longer unheard of or even that frowned upon (except in the most competitive specialties) for a female doctor or resident to go on maternity leave. Some specialties, such as gynecology and obstetrics, often require female practitioners for the comfort of their patients.

On top of all this is the fact that women are starting to dominate college and postgraduate institutions everywhere. I remember reading articles like this one about undergraduate institutions when I was first applying to college. I remember fuming when I discovered that male classmates of mine, with equal high school accomplishments, had received nearly full academic scholarships to attend the same institution that was spotting me a fourth of tuition.

Admissions standards are absolutely not the problem with the changing face of medicine in Canada or the United States. Affirmative action makes some sense if there is a history of discrimination against a group or if the background of that group puts them at a disadvantage. But the male students who are applying to medical school are not in this situation; right now everything is in their favor except for their drive. So the question we should be asking ourselves (or at least the Canadian medical schools should be asking themselves) is how do we motivate the next generation of male students into wanting to be physicians? Pushing out exceptional female candidates in favor of decent male ones is not going to create a stronger physician population down the road.

 

Note: the article also acknowledges that there are more scholarships available for women applicants, and that surely has some effect on these statistics. I didn’t mention that in this commentary because I don’t think it is the major factor in the gender balance. But if motivation is a factor for men, I think more scholarship aid for them is a reasonable way to go.

There are a couple of students in my program who are considering PA (physician assistant) school instead of medical school. For anyone interested in primary care and, oh I don’t know, having a life outside of work this is a pretty practical option. The requirements to get into school are slightly different (no physics, for example, which right now sounds like a magical possibility where candy grows on trees and unicorns carry your books to class for you) and, unlike the physician path, the time/money commitment is not as intense. All in all I see the appeal.

Yet for some reason the option of PA school makes me profoundly uncomfortable. I think this is because it’s forcing me to confront the reasons why I’m not choosing to go that route.

I’m an intensely logical person. I’d like to think that is a good trait in someone planning to be a doctor, yet somehow I keep coming back to the unsettling fact that becoming a doctor is not a logical process. The system is archaic; there’s been little change to medical school and residency structure since medical schools first became standardized. The time commitment for training is unreal; even if I condensed all of my future schooling into the shortest time period possible I won’t be a practicing physician until I’m thirty-two. Not to mention the financial commitment is extremely long term and I can probably expect to be paying off student loans most of my foreseeable future.

Why then, I keep asking myself, would any logical person put themselves through all of this when there are dozens of other health service positions that require less time, effort and money?

In an earlier post I mentioned that in biology, the function of most molecules follows from their structure. If you look at the structure of the medical training system, it’s not hard to see why we have a dearth of primary care physicians. It’s not that the interest isn’t there; I think the problem has far more to do with cost benefit analysis. When you sit down and weigh your pros and cons, I imagine a lot of students wonder if maybe they wouldn’t like time to have family someday or start earning a decent living before they hit thirty. I can’t blame them.

So once again I ask myself, why am I not going that route? And uncomfortably I have to answer that some of it just comes down to pride. For a long time I didn’t believe myself capable of being a doctor; medical school was something that really smart people did, not people like me. Even now that I’ve had a taste, there’s a little part of me that just doesn’t believe I could ever be worthy of the Dr. title and I desperately want to prove that part of me wrong.

Is that a good enough reason to eschew the practical path and to subject myself to a second glorious semester of physics problems and MCAT prep? Well, on its own, no, probably not. I do want to help people, and I do crave knowledge for knowledge’s sake. And for all that the prospect of facing a semester and a half of bewildering physics equations fills me with a very special kind of dread, I welcome the thought of immersing myself in the practice of medicine in the coming years. I never want to look back and wonder if maybe I could have done it.

Perhaps addressing my own doubts, naming them as an old psychology professor used to say, is a good thing. No, I’m not going to go to PA or nursing school, and not because I think it’s an impractical choice. Rather, it’s a little too practical for me right now. Just because I’ve put my dreams of living big as the next great American novelist on hold doesn’t mean I’ve stopped dreaming. And if that dream involves a long white coat and more student loans than any sane person should accumulate, then it’s worth it. Logical or not.

The day after the two exam double header (physics and bio) will henceforth be known as Oh Yeah, Life Day. The day in which all of those vital little maintenance chores that I’ve been putting off all week in favor of studying, cluster together into a single day at which point they can no longer be ignored. Yesterday I restocked an empty refrigerator and pantry and washed pretty much every item of clothing and flatware that I own. Everything is reset and prepared to decimated in the coming week as the normal academic schedule resumes.

Sadly, there is not much to write about other than the all-consuming exams. I’m still trying to hammer out a volunteering gig, and I haven’t pursued any shadowing since my stint in the Neurology department ended. Aside from a brief but much needed trip to my parents’ over fall break, my life has become a great big neon sign that says EXAMS. I’ve become the least interesting conversationalist known to mankind.

It’s reaching the point where my own internal monologue is frighteningly scientific. Driving on wet roads I think about static friction coefficients and centripetal forces. I mentally imagine the chemical makeup of the plastic bags from the grocery store. I’m out nerding myself, and I didn’t even think that was possible.

I’m contemplating tackling fiction again; nothing serious, maybe just picking up the pieces of a few stories I left behind when I started focusing on medicine. I’m not sure if I’ve waited the requisite amount of time post-writer’s block to feel ready to take another crack at it or if the recent flood of science classes has left my creative side hungry. I’m thinking I’ll make an effort to defy as many laws of physics as possible in whatever I write next; air resistance will overcome gravity and frictional forces will cause objects to move the opposite direction of where they’re pushed. It will be glorious, ridiculous chaos.

Gen Chem: Step 1; get organized.

Stoichiometry is the foundation of most experimental calculations done in general chemistry; it’s a way to figure out how much product you’ll get if you mix two chemical reagents together. Over the summer we did it a lot. Our professor had a three step outline for approaching problems like these, and every time we ran across one he’d pull us up short and ask the class, “What’s the first step in stoichiometry? Get organized.”

As it turns out this is a pretty good approach to life in general. I have since inherited a little voice in the back of my head that pulls me up short when things start to feel a bit overwhelming. “What’s the first step? Get organized.” I’ve used this to sort out everything from physics problems to vacations to making sure I don’t forget anything when I leave my house for the day. There’s very little in life that can’t be helped by taking a minute to make sure you have all the information spread out in front of you before proceeding.

Biology: From structure follows function

If you want to see how something works, don’t look at what it’s is supposed to do, look at how it’s put together. In biology, the secondary, tertiary and quaternary structures of proteins all follow the original arrangement of amino acids. If a single amino acid is out of place, the structure changes and the protein will no longer function the way it should. This is the core of genetic dysfunction. It’s an interesting exercise to turn this perspective onto larger structures in the world. We’ve been taking a great deal about health care in America for the past few years, but it’s only as I’m starting to learn how the system was put together that I can see why it functions the way that it does.

Physics: It’s not the gun, it’s the bullet.

Ie: momentums being equal, the smaller object can will cause the most damage. It’s a good reminder that the things in life that can hurt us the most, can often seem the most inconsequential from the outset.

Organic Chemistry: Things that are unstable are harder to form and quicker to react

Manipulating organic molecules is all about creating a transition state that is unstable enough to finish the reaction, but stable enough to be created in the first place. Keep everything where it’s comfortable and nothing will ever happen; try to push the molecule into a state that is too volatile and your experiment could literally blow up in your face.

Most of our lives are spent trying to achieve the same kind of balance. How can I put myself just off center enough to keep things interesting without taking a risk I can’t recover from? Psychology classes teach about finding “flow;” a state in which your challenges are exactly matched to your abilities and interests. For me, the postbac program and the future to which it leads is all about finding that match; putting me in a transition state just unstable enough to successfully reach the desired products. Preferably without blowing off my eyebrows in the process.