A Case of Sexual Discrimination
Gynecology is quite literally, the study of women. On a more modern level, it has become the study of the female genital tract and medical and surgical procedures to aid the patient in normal function. As a practicing obstetrician-gynecologist, I dedicated my life to the care and support of females and their health. The road to developing a medical practice in gynecology in a metropolitan area has been a challenge for multiple reasons. One reason for which I was ill-prepared was the fact that I was a male physician entering into a profession where female physicians were in demand. Market pressures were demanding that medical practices hire women, and the all-female practice was becoming a point for advertising.
Gynecology and gynocentrism
Medical schools consist of two years of didactic training and two years of inpatient clinical work. In a student’s third or late fourth year they have to declare a specialty that they wish to pursue after graduation. I chose obstetrics and gynecology because I was enthralled by the fact that one could experience medical and surgical venues. As an obstetrician you treat women for diabetes, and deliver her baby vaginally or by surgical cesarean section. Gynecology presented itself as a medical profession, in the sense that one could treat abnormal uterine bleeding, pelvic pain, and find organic or psychological causes. In cases where true organic pathology was discovered, there is the ability to correct a problem surgically. When I started residency at the University of Oklahoma Health Sciences Center there were ten male residents and ten female residents. Four years later, there were sixteen female residents and four male residents. In a recent phone conversation with my prior program director, I discovered there are two male residents and eighteen female residents (R. S. Mannel, personal communication, December 29, 2008, 2008). Are we seeing gynocentrism in the medical profession? If gynocentrism is defined as an ideological focus on females, and issues affecting them, possibly to the detriment of non-females (Gynocentrism, n.d.), then one might agree that this is occurring in the field of gynecologic practice. The question of gynocentrism is further complicated by market pressures. If patients are demanding female practitioners is this really a case of gynocentrism and reverse sexual discrimination. If a person is “denied a job because that person is male or female, that is an overt act of sexism” (Hinman, 2006, p. 260). In multiple instances, I was denied a job because I was a male; actually I was not granted an interview because I was a male applying for a gender-specific position.
In 1976 only 7.6% of physicians in practice were women; this is compared to 27.8% in practice in 2007 (American Medical Association [AMA], 2008). Obviously, women are still a minority of the applicants and matriculants to American medical schools; there are however two specialties where women are a dominant factor. In 2005, 70% of practicing pediatricians and 76% of obstetrician gynecologists were women (AMA). The main difference in pediatrics is that market factors, in most cases, do not bear out that patients request a female pediatrician.
In 1994 I visited over ten residency programs for interviews. At that time I felt it was more important have done well on the United States Medical Licensing Exam (USMLE) and have excellent recommendations than it was to be male or female. In none of my interviews did I feel that my gender was a part of the selection process. Many of the women applicants that I had exposure to were dressed in the same drab blue and grey suits as the men. I did hear of some of the women being asked how they were planning on caring for their children while maintaining the rigors of a medical residency. I had two children at the time and was not asked that question. Years later, I was witness to these interviews from the side of the interviewer and saw sexist language where women were seen as aggressive while a male counterpart was deemed assertive (Hinman, 2006). In 1998, at the end of my residency I had four years of active duty in the army ahead of me. Towards the end of my fours years in the military, I had a rather na?ve view of the American medical system as I was sheltered in a socialized organization. It was not until the spring of 2002 that my perception of the medical landscape was abruptly changed. Like most physicians looking for employment, I went to the classifieds in journals and multiple websites where physicians are recruited. None of these advertisements or recruiting agencies showed ads that were biased or sexist, but occasionally, I would read an ad that would have the phrase “gender-specific”, or the ad would claim that the office consisted of an all female group looking to add another like-minded physician. In one instance I called one of these offices and asked to speak with the office manager. When she picked up the phone I introduced myself and asked if they were still interested in hiring another physician. Her response was, “you’re not a woman”. Hinman (2006) describes overt job discrimination as “where a woman is denied a job or promotion solely because she is a woman” (p.261). I would assume that the word woman could be replaced by man in the preceding sentence?
I decided to move to Tucson, AZ because of family issues and set three interviews for employment. In each case, I was a finalist with against female applicant, and in each case the woman was hired over me. I called to discuss the interviews after the decisions were made and in each case I was told that the physician groups were afraid that a male would take too long to become profitable. Is this a case of occupational sexism? Is this a case of overt sexual discrimination? The answer may not be so simple. In the area of Tucson where I practice there are sixteen obstetricians; three male and thirteen female. Based on volume of deliveries per year, the three male physicians are within the top six delivering providers. The market does not seem to agree with the concept that medical care should be provided solely by men or women. If one were to look in the yellow pages in many metropolitan areas and look in the gynecology section, there would more than likely be an add for an all-female group with a catchphrase, “healthcare for women, by women”. Does this constitute sexist language? This question is difficult to answer because our language is gendered (Hinman). There is an assumption being made by this ad. The assumption is that there are patients who are looking for a female provider. The reasons are multifaceted, but empathy seems to be a recurrent theme. Female patients feel that there is more comfort in a female doctor (U.S. Army, November 6, 2008). In my current practice, where my wife is the other obstetrician-gynecologist,, there are times where my wife’s patients will not see me as a provider. There are cases where the patient’s culture is an issue, but in most cases there is a general concern with an intimate medical visit and a provider of the opposite sex. Is this a legitimate reason for women’s health practices to deny interviews to male physicians?
Sexual discrimination
As described earlier, the gynocentric model is a newer paradigm in the Western workplace. The work that has been done by females in changing the dynamic of the American workplace is also new in the medical paradigm. In fields such as orthopedic surgery and urology, there are less than five percent of practicing physicians that are female. While androcentrism generally pervades medicine, there are fields such as obstetrics, gynecology, and pediatrics where women are a dominant force in the workplace. In my medical office, of the nineteen employees including physicians, I am the only male employee. This goes against what Hinman (2006) describes as the traditional model of gender, where women are primarily in the home and men are working. Female colleagues will also have their husbands providing the household chores and caring for the children as the wife is the main source of income for the household.
Job discrimination has diminished over the years but it still remains and important issue in American society (Hinman, 2006, p. 261). Job discrimination occurs when one sex is passed up for another, or when one sex is paid an increased amount for the same workload. In the case of a gynecologist, the pay would be similar regardless of gender; it is denial of the same opportunity. I was able to start my own medical practice, but I was not afforded the luxury of starting in an already established practice with access to an increased patient base. This stunted my earning potential for 30 months as it took me this length of time to financially break even, whereas my wife, practicing in an all-female group was financially sound at six months. Comparable worth is one of the more subtle ways in which sexual discrimination occurs when predominantly female occupations are paid less than comparable occupations whose employees are predominantly male (Hinman, p. 262). The ability to measure comparable worth is difficult in many professions. The medical profession and physicians in general are paid on a relatively equal basis. The real question for comparable worth comes when one tries to look between professions. If nurses are mainly female and pharmacists are mainly male, with similar degrees, and female pharmacists are making significantly less than male or female nurses, can this be considered a case for comparable worth? It would be my assumption that comparable worth should be kept to similar professions. Within the scope of medical practice, different specialties provide different income levels. If a female partner in an orthopedic surgery group was making less than her male partner this may be a point for comparable worth. The issue at hand in this case would be that the female partner would also have to show that she is producing the same as her male colleague and that she had similar reimbursement contracts with insurance carriers. As one can see, the case for comparable worth lies within the context of the word comparable.
Maximal choice model
The model that closely fits to the situation for not hiring male gynecologists is that of freedom of choice. Hinman (2006) describes a model that eliminates sexual discrimination by stressing the societal freedom of choice. By asking the public at large to determine what characteristics they want in their medical providers, then you are eliminating gender-based discrimination in the workplace. This model would not only apply to the workplace but could be carried into the home and blur the societal gender roles previously determined by past generations. This is the current model that is utilized in medical practice for gynecologists. There are three arguments I have with this model. The first issue is that of emotion in the decision making process. If a female patient chooses a female provider because she feels that a female provider will understand her pregnancy or menstrual cramps, this is flawed on two levels. What if the female physician has never been pregnant nor has menses that are extremely light and easy. Could this provider empathize as expected? The second issue is that of assumed performance based on gender. If a woman chooses her physician based on gender and her chosen provider has been sanctioned by the state medical board on numerous occasions for violations of conduct, and a male provider with a higher competence is passed over then is this negligent. Finally, there is the projection of the provider’s psychological pathology into the patient. If a patient comes to a female provider with painful menstrual cramps and the provider tends to have easy menses, and the female provider assumes the patient is weak based on her personal experiences, this is not in the patient’s best interests. Do people choose a cardiologist based on how many heart attacks that doctor has personally suffered?
The second sexism
Benatar (2003) describes the second sexism or the neglected sexism where the primary victims are men or boys. In these cases, as with discrimination cases against women, the discrimination does not need to be intentional. In my personal life, outside of employment, I have seen this type of secondary sexism in the judicial system through my divorce. Mothers gain custody of their children in 90% of cases. Some may argue that this is because men do not ask for custody. In my case, my ex-wife desired to move from the state of Oklahoma to Arizona. I vehemently opposed this move based on the fact that I wished to remain a part of my children’s life, and I was in the military and thus not afforded the ability to move. My ex-wife had no financial or physical need to move and was subsequently given the authority to move despite my protests. It was stated in court that I should relinquish to the move since I was a physician and really could not spend time with the children, and the housewife could provide for them throughout the day. This post-divorce disadvantage is possibly due to three prejudicial attitudes: male life is often valued less than female life, there is an acceptance of non-fatal violence against males, and the nature of men to be more violent, aggressive, less caring and less nurturing (Benatar).
Some may argue that the case of second sexism may be simply a side effect of feminism. If there is indeed a movement away from traditional gender roles then this should be as a whole and not open to the piecemeal fashion where it applies to some but not to others.
Conclusion
I am a male obstetrician-gynecologist. It has been jokingly stated to me that this is an oxymoron. I have also been told that one either goes into gynecology because they love women, or hate women; both of these instances do not give me a suitable defense when proposed as such. I have been told by a female psychiatrist that men may go into this field as a means in which to control women. I suppose that this could be the case, but what does it mean about women that go into gynecology. Does it mean that they are wanting to control women or that they may even have lesbian tendencies? It is my opinion that these women physicians are looked upon as nurturing and caring by their patients and that they are good medical providers. Market pressures over the last ten years have driven women to pursue careers in the medical specialties for obstetrics and pediatrics. It is my argument that this market pressure has created a situation where 76% of practicing obstetricians are female and thus this has created an occupational sexism. I have a deep respect for female physicians. My wife is a physician and partner in practice. This is a topic we discuss and are continually perplexed by a patient’s refusal to see a male provider. I have a friend who is an attractive female urologist in a practice with five other males, and she also feels that she is discriminated against based on her gender; although she claims this is more from her partners and not from the patients.
I would like to bring this discussion more openly to the American College of Obstetrics and Gynecology, but this institution is run mainly by male physicians; the irony is deafening.
References
American Medical Association (2008). Physicians by gender. Retrieved January 1, 2008, from https://www.ama-assn.org
Benatar, D. (2003). The second sexism. Social Theory and Practice, 29, 228-243.
Gynocentrism. (n.d.). Retrieved January 1, 2008, from Wiktionary: https://en.wiktionary.org/wiki/gynocentrism
Hinman, L. M. (2006). Contemporary Moral Issues: Diversity and consensus (3rd ed.). Upper Saddle River, N.J.: Pearson Prentice Hall.
U.S. Army (November 6, 2008). Surgeon glad to provide comfort to female patients. Retrieved December 29, 2008, from https://www.army.mil
Retired at None
6 年Sexual Discrimination A decade of racial revolution in the streets of America, prompted the U. S. Congress in 1964 to pass legislation that forbade discrimination by race, religion, national origins, gender and later by age in any employment practice (hiring, firing, paying and promoting). Prohibiting all discrimination in any employment practices in all those areas, in every business across America, is a monumental task, indeed it is impossible. (There are 30 million businesses and 150 million employees in the U.S.) Only rarely is a violation caught and prosecuted; most fall through the cracks. Is Dr. Tassone’s experience in being rejected for a medical position due to his gender, an example of sexual discrimination in employment that was not caught and corrected? Or is it a permissible practice? Can female doctors legally create an all-female clinic? After over 50 years of experience in employment discrimination incidents, most of the kinks have been worked out in defining “what is illegal discrimination” and what is not illegal. When airlines continued to hire only females as stewardesses, this practice was struck down as gender discrimination, despite the fact that passengers expressed preferences for female attendants. Mere customer preference is not sufficient reason to allow gender discrimination. A similar principle would apply in restaurants hiring waitresses by gender. The world of all-female waitresses is gone. On the other hand, in producing movies and stage plays, wide latitude is allowed in the selection of gender for acting roles. And religious educational institutions are allowed to hire teachers and administrative staff from their own faith, without regard to the employment laws. The guiding principle in this is that any exemption to the employment laws must pass a test called “bona fide occupational qualifications,” or BFOQ. Simply defined, an exemption to the law is allowed if the otherwise illegal hiring is proven to be an essential aspect of the job and necessary for the operation of the firm Getting closer to Dr. Tassone’s own experience, can a prison refuse to hire male guards for policing female inmates during intimate moments? – or the reverse? Courts have allowed gender discrimination in most cases due to the extreme nature of the female inmates’ privacy needs. Similarly, a nursing home may refuse to hire male nurses to provide personal care for elderly female patients. Again, bodily privacy needs trump the employment law. Can a hospital reject a male nurse for work in a labor and delivery ward? Many women, during the delivery of their child, object to the presence of a male nurse, although, strangely they may accept a male obstetrician. Hospitals are routinely allowed to bypass the employment law to accommodate patient’s privacy needs in staffing nurses. Now to the issue Dr. Tassone raises. When three female gynecologists form an all-female clinic for no other reason than the notion of female camaraderie, this would be a violation of the employment laws and BFOQ would provide no protection. But if they form an all-female clinic to provide privacy for women, free from the intrusive gaze of any male, and female doctors schedules fill up faster and produce more revenue, BFOQ would provide them protection. Prison guards, nursing home attendants, and labor and delivery nurses can all be selected to accommodate the privacy sensitivities of inmates or patients. Based on these examples, the logical conclusion would seem to be that Dr. Tassone was not the victim of an illegal employment action. All-female clinics are being created all over the country and are generally protected by BFOQ.
Retired at None
6 年My post above have been blocked.? Can someone please tell me what I need to do to change my post to accommodate your requirements.? Don S
President / Founder at Medical Patient Modesty
6 年I am the founder of Medical Patient Modesty, a non-profit organization that works to improve patient modesty for patients and families who feel that modesty in medical settings is important. I wanted to share some thoughts with you. It is not discriminatory when women do not want a male gynecologist. Most women do not question the skills of a male gynecologist. They are simply uncomfortable with a man who is not their husband to examine their private parts. The reason so many women flock to the all-female ob/gyn practices is because they want to avoid male doctors. Thankfully, there are many all-female ob/gyn practices in most major cities now that can give a woman a 100 percent guarantee that her baby will be delivered by a female gynecologist. Most of those women do not mind having male doctors for non-intimate issues such as ear infections, flu, knee problem, allergies, etc. I can assure you that if you were a male ENT doctor that many women who only go to a female gynecologist would not have a problem with you examining their throat, ear, and nose because those body parts are not private. I encourage you to read a well balanced article Dr. Joel Sherman wrote about gender preferences in healthcare at https://patientprivacyreview.blogspot.com/2010/10/patient-gender-preferences-in.html. Male patient modesty (https://patientmodesty.org/malemodesty.aspx) is important as well. Many men are uncomfortable with female urologists and female nurses doing intimate procedures such as urinary catheterizations on them. I also encourage you to read number 3 in Patient Modesty, Values, and Rights (https://patientprivacyreview.blogspot.com/2010/11/patient-modesty-values-rights.html). Two of his paragraphs are very well balanced about gender discrimination. You can see his comments below. "Don’t let someone tell you that your choice of one gender over the other for intimate care is discrimination, in the legal sense of the word. Don’t let them compare it to racial discrimination. A racist is someone who negatively stereotypes a whole race and/or thinks that race is inferior to his own. If, as a man, you believe that all women are inferior to men and can’t do the kinds of procedures you need, then, indeed, you are practicing discrimination. But that’s not what most people believe who request same gender care. Most patients welcome basic care from either gender. It’s only for the most sensitive, intimate care that they prefer a same gender provider. Their assumption isn’t that both genders can’t do the job equally as well. For modesty and privacy reasons, these patients just prefer a specific gender. So -- don’t accept this “discrimination” argument if it’s used." Misty
Facilitator, Educator, Information expert, Proposal Writer
9 年I would not ever willingly go to a male OB/GYN. Also, not to a lesbian or bisexual female one. I am extremely uncomfortable with even the idea of any person, regardless the gender, touching my private parts. It is too sexually intimate for me. I use Trovagene instead of submitting to a pap-smear. I do self-exams on my breasts. My body, my choice. Thanks.