The American Medical Association has designated September as Women in Medicine Month to highlight the achievements of women physicians and address remaining career obstacles.

According to Nancy Dickey, M.D, chair of the AMA's Board of Trustees, "Women are succeeding in medicine and are leading the way for others to follow." Dickey is a family physician and the first woman to chair the AMA board.

Women physicians in the U.S. make up almost one-fifth of the profession, a fourfold increase from 1970, and they are expected to make up one-third of the profession by 2,010, according to AMA's report titled Women in Medicine. Moreover, 42 percent of medical school applicants are women.

Psychiatry was the fourth most popular specialty chosen by women medical school graduates in 1994 after internal medicine, pediatrics, and general or family practice. Women make up 26 percent of the psychiatric profession (9,886) and 43 percent of psychiatric residents (2,177), the report also noted.

As women physicians enter the marketplace, many are contracting with managed care organizations, including health maintenance organizations (48 percent), preferred provider organizations (58 percent), and independent practice associations (19 percent), according to the AMA report. Overall participation by women in managed care rose 10 percent between 1992 and 1993, compared with only 4 percent for men.

Cheryl McCartney, M.D., chair of APA's Committee on Women, told Psychiatric News, "Managed care environments offer a structured time commitment, salaries, and the opportunity to concentrate on clinical aspects rather than business issues." McCartney is associate dean for student affairs at the University of North Carolina (UNC) at Chapel Hill, School of Medicine.

Despite their increased numbers in medicine, women physicians on average earn less money than men physicians, according to the AMA report. The average net income for women in 1993 was $124,900, 62 percent of the net income of their male colleagues. Moreover, total annual salaries for women with one to four years of experience in 1993 were about two-thirds that of men and dropped to about half with 10 to 19 years of experience. Women physicians also earned less income per hour and per visit than their male counterparts, noted the report.

Some possible explanations are that women tend to be overrepresented in the lower-paid specialties such as psychiatry and pediatrics and see fewer patients, suggested AMA's report.

Women in medical school faculty positions continue to be underrepresented at the top. Only 10 percent were medical school professors in 1994, compared with 32 percent of men faculty. The majority of women faculty are assistant professors, according to the AMA report.

Further, of 119 deans of U.S. medical schools in 1994, only four were women physicians. The vast majority of women in medical school administrative positions are associate and assistant deans.

"Women in a male-dominated profession such as academic medicine may still suffer from issues of stereotyping that prevent them from meeting the requirements for promotion," remarked McCartney. "Women may not be seen as capable as men, are excluded from information 'grapevines,' and lack mentors and sufficient time to concentrate on research."

Despite these barriers, women physicians in academe are making progress due to a greater sense of entitlement, mentoring opportunities, and networking with other women, noted McCartney.

As evidence of change, she referred to a new association for professional women in medicine at her institution that addresses issues of gender bias and provides lectures by role models. Also, three women have been appointed to positions of acting or full chairs of medical school departments at UNC, noted McCartney.

Both women and men physicians support flexibility during residency training, which typically coincides with a woman's peak childbearing years, to allow time for family and other personal relationships, noted the AMA document. A shared program schedule with another resident--for example, one month on, one month off--is the most common course.

Another positive development is that the Accreditation Council for Graduate Medical Education now requires that residents be given written policies on parental leave and sexual harassment grievance procedures, according to the AMA's document.

The AMA continues to develop and distribute policy statements on parental leave, gender bias, and sexual harassment. Documents are available by calling the AMA's Women in Medicine Services at (312) 464-4392. --C.L.

(Psychiatric News, September 20, 1996)