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Since starting medical school, I have been harboring a not-so-secret resentment towards the simplicity of men’s professional clothing. Button-up shirt and a tie, slacks, dress shoes, white coat and you’re done. Sure, there are variations on a theme and I’m sure there are men out there who put a lot of thought and care into their outfits, but even if you’re just falling on the basics it’s hard to go too wrong.

I don’t know anything about this dude, but I already trust him to save my life or take all my money.

It’s not that I don’t like getting dressed up. We had med school prom last weekend (I know, right?) and picking out a dress and accessories was an enjoyable distraction from academics. But that’s the thing about women’s fashion: it’s fun because it’s complicated. There are choices to be made, and choices mean a certain level of success and failure. Great for a night out when you want to make an impression. A pain in the neck when you’re running on four hours of sleep with an exam hanging over your head.

Let’s start from the ground and work our way up. Flats or heels? And if you go for heels, how high is appropriate and comfortable to walk around in? When and where are open-toes, open heels or sandals acceptable? Socks? Stockings? Tights? Bare legs? Dress, skirt or pants? And how short a skirt is acceptable? How tight a skirt is acceptable? How loose and flowing a skirt is acceptable? How large a belt? Is your skirt see-through? Is your shirt see-through? If it is, as is the case with most women’s clothing, what sort of undershirt should you wear?  Is it too low cut? Should you wear any jewelry? How much make-up?

The answer to any of these questions varies drastically depending on the person you ask. If you get it wrong there can be serious consequences. I’ve already written about the trials of wearing the wrong shoes, but there can also be more subtle types of pitfalls. For example, studies show that wearing exactly the right amount of make-up will help a women be taken seriously in interviews, but too much or too little will leave a negative impression.

There is this fine line between being attractive, but not too attractive. There can be absolutely no sign that you are attempting to look sexy, but it can be equally damaging to be perceived as “mannish” or plain. There are few solid rules to follow; the fabric of a shirt or the shape of the woman wearing it can push either extreme. And because of the subjective nature of these judgements, you may never know when or how you transgressed.

Clothing stores and designers are not helping either. There is no clear delineation between the different tiers of professionalism and fun dress when you walk into a department store. Watch any television show and the going standard for professionals seems to be six-inch stilettos and a carefully calculated cleavage-to-neckline ratio that defies most Newtonian laws of physics.

At least the skirt covers her knees?

I don’t mean to imply that all of the women in our class are walking a razor’s edge every time we’re expected to look professional for a patient. Still, it does take time and energy and attention to detail that I don’t expect the guys in our class experience in the same way. It is also starting to get expensive, not only because women’s clothes tend to be pricy but also because each outfit is distinct enough that repeats are noticeable even to the less observant. I’m sure the boys all change up their clothes regularly, but I’m paying pretty close attention if I even spot a repeat tie pattern.

Of course much of this stems from larger, systemic issues regarding the treatment of women in the workplace and the double standards we set for professional behavior. I could go on for days. In the end, though, I wish we could dispense with the whole mess and just all wear scrubs to work every day. How can you go wrong?

Okay, fair enough.

I’m terribly behind in updating, and this hardly counts as a legitimate post, but this article about the discrepancy in doctor salaries based on gender was a depressing enough way to start out my Wednesday that I thought I would share.

It’s a good article; the study and the author don’t just accept the numbers and leave us readers to try and sort through the reasons. No, it isn’t just the differences in specialties. No, it’s not just because all these women doctors are off having babies. They even ruled out different income structures or salary negotiating techniques which are causes that didn’t occur to me right away.

As an idle thought, I wonder if the custom of never asking or talking about income might not be hurting our country’s efforts to equality. Are most of these women, who I imagine are by and large intelligent, driven individuals to have made it through medical school and residency, aware that their male counterparts are making more money? It’s one thing to look at statistics in an article, and quite another to know you’re being held to a different standard by an employer.

This is all the more disturbing in light of my last post on women in medicine, in which Canadian schools were having to select moderately qualified male students over extremely qualified female students in order to keep the gender balance from tipping too far off center. Are we paying less qualified doctors more simply because they are male?

By the time you’re making 200K a year, it’s hardly good manners to complain about your income. Still, income equality is important not because of a number in a bank account, but rather because it represents a mindset about what we believe women are worth; right now that seems to be less than men.

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.