General Reflection

Gender Application Gap

Gender stereotypes are pervasive in medicine. Last year, JAMA reported on the gender pay gap in medicine, and I found myself wondering if other stereotypes in medicine were true. I have seen some of it and heard more of it – from Scrubs, to blogs, to my own preceptors – ortho-bros, Ob/gyn girls, etc. According to a report using 2015 data from the AAMC and a study in the Journal of the American College of Surgeons that used the same data, these stereotypes seem to fit. The top male-dominated specialties by resident in the GME class of 2013-2014 were orthopaedic surgery (87%), radiology (73%), anesthesia (63%), emergency medicine (62%), and general surgery (59%). Women made up 85% of Ob/gyn, 75% of pediatrics residents, 57% of psychiatry residents, and 58% of family medicine residents. What I was really interested in, though, was whether there is any sort of advantage or disadvantage in being a male or female applicant in a sex-dominated field.

Luckily, this must have been on the minds of the ERAS stats department beacuse one of the headline charts on their FACTS web page is a table of specialty application data broken down by sex. The table includes the total number of applications per specialty and average number of applications per specialty broken down by sex. The data included all types of applicants – IMGs, DOs, and MDs. In working with the data, I chose to focus on Family Medicine, OB/gyn, Urology, Orthopaedic Surgery, General Surgery, and Family Medicine based on the AAMC data for sex-dominance as well as the stereotype of the field. I’ll admit that the latter is not a scientific method, but I don’t think I’m going out a limb here to say that there are (rightly or wrongly) generally agreed-upon stereotypes in medical fields. The modified table can be found below:

Specialty Female Applicants Mean Number of Female Applications Male Applicants Mean Number of Male Applications
Anesthesiology 1268 28.5 2524 30.9
Family Medicine 7168 49.4 7260 51.8
Obstetrics and Gynecology 2019 47.7 758 41.1
Orthopaedic Surgery 193 79.2 1116 74.8
Pediatrics 4576 36.7 2490 33.6
Surgery-General 2606 37.2 4871 37.7
Urology 110 64.2 383 62

Nothing shocking here. Male-dominated specialties like urology and orthopaedic surgery have more male applicants, female-dominated specialties like OB/gyn and pediatrics have more female applicants, and more evenly distributed fields have about an equal number of applicants.

What is more interesting is the average number of applications submitted per applicant by sex to the different specialties. Urology and orthopaedic surgery, probably the two specialties most culturally male-dominated both have higher number of applications submitted per female applicant. This seems to fit. Perhaps female applicants, knowing that the culture is male-dominated, feel pressure to submit more applications in order to be more certain that they will secure a residency in the male-dominated field. Ob/gyn, though, is the opposite. The most female-dominated specialty (both culturally and by AAMC data) has fewer applications per male applicant than female applicant. Even though 85% of the residency class of 2013-2014 was female, and even though far more women applied to OB/gyn than men, men do not seem to feel the need to overcome any sort of cultural disadvantage like women do when applying to male-dominated specialties.

This trend of male advantage in overcoming residency stereotypes holds true among other female-dominated fields like pediatrics where there are likewise more female applicants, but men submit fewer applications per applicant. I should note that this data does not include matriculation – only applications – so it is possible that men submit fewer applications and then do not get residencies. Also, this trend is not universal. Anesthesia is a male-dominated field where women submit fewer applications per applicant, though culturally it is not stereotyped to the same level as orthopaedic surgery or OB/gyn.

The New York Times wrote about this trend in 2001, noting that while men still made up the majority of practicing OB/gyns, upwards of 80% of residency applicants were female. But, according to the article, female OBs were taking a stand. They did not want OB/gyn to become a women-only field with some even supporting the reverse sex-descrimination argument that a few male OBs had taken to the courts. What is amazing in this scenario is that in spite of patient preference being the driving factor in making OB/gyn female-dominated, residencies see this as a problem and appear to be giving male applicants an advantage for residency positions. Meanwhile, male-dominated fields do not appear to have a problem with their male to female ratio. What does it say when women physicians are advocating for more men in their field over the preference of their patients?

Photo Credit: European Parliament