Hannah Douglas

	Equal numbers of men and women are entering medical schools, yet the majority of doctors are male, a finding reiterated by 

Medical residents angered at extended work hours

	According to the latest findings, 69% of physicians were men. This aligns with similar studies, including national statistics for 2016 by the Kaiser Family Foundation which puts the number at 66% male physicians of a pool of more than 926,000 MDs and DOs.

	Health policy experts say that even with more women entering medical school, it is still 

 female physicians face throughout their careers-such as the pay gap, returning to medicine and burnout-to keep them in the profession.

	There is no concrete data, however, to indicate when women are leaving medicine- just that they are leaving at some point due to stressors as well as to raise children, pursue different career paths and other reasons. 

	It will take time for the numbers of physicians in practice to equalize, considering that medical schools in previous decades have been mostly male, says Kim Templeton, MD, president of the American Medical Women’s Association.

	“Now that we’re half of the medical school class, it just takes a while, but that’s assuming that everyone is going to stay in healthcare, and that can be a bit of challenge,” Templeton says.

	In the Physician Report, when asked “what do you consider to be the biggest issue(s) facing primary care right now?” 71% of female practicing physicians cited physician burnout, compared to 64% of men. All physicians experience burnout, but Templeton says it is more common for women.

Marriage, children cause more burnout for female physicians

	Burnout happens for a number of reasons, but if a woman also starts out making less annually for doing the same work as her male counterparts, she starts to question the situation, explains Theresa Rohr-Kirchgraber, MD, executive director of the Indiana University National Center of Excellence in Women’s Health and a practicing internist. 

Burnout increases if a woman doesn’t feel as well respected,

 she says, which includes financially. According to research published in

 last year, there is a gender pay gap of roughly $20,000 on average for academic physicians.

	One of the most common causes of burnout occurs when someone feels they lack control over their work environment, Templeton says, and that’s a major complaint among female doctors.

	Burnout can also lead to depression and substance abuse in some cases, Templeton notes, and sometimes even to suicide. Research published in the journal 

 in 2009 indicates that suicide rates are higher among female physicians than male physicians. 

	“This is not an insignificant issue,” she says. “So I would say for an individual woman experiencing burnout, seek help, find help. Talk to other people because half the other people around you are feeling the same way.”

	In addition to the pay gap, Rohr-Kirchgraber says, female physicians, like most women, take on additional work at home. “Whether you’re a mom or whether you don’t have kids at all, the majority of the household chores are usually done by the woman and that’s on top of everything else, and so burnout increases because we’re trying to do everything,” she says. “It’s just not possible sometimes.”

	As for the job-related obligations, female doctors aren’t impervious to the burden all physicians face to do more and see more patients, Rohr-Kirchgraber says. 

Black female physicians face challenges just doing their jobs

	“At the end of the day, the one who’s spending the longest time there is me,” she says. “When the computer doesn’t work properly, when the electronic medical record doesn’t work properly ... I’m the one that’s there answering those phone calls-not those administrative bean counters who are telling me see more, do more.”

	For female doctors who take time off from medicine for a life event such as childbirth and raising young children, the transition back into the field can be daunting, Templeton explains.

	The re-entry process “isn’t as easy as ‘I’m going to raise my child, get them through four or five years of life, and then go back and get my medical license and jump right back in where I left,’” she says.

	While laws vary from state to state, the returning physician will likely be required to take a skill, safety and competency evaluation after approximately two years out of practice, and could then need to be monitored by another practicing physician for a period of time. “This is not an easy thing to go through,” Templeton says, citing the time and money needed to travel to the testing centers and pay the fees, estimated anywhere from $7,000 to $20,000.  

	“At times, it can be prohibitively expensive,” she adds. “Especially if you’ve been out of practice, you might not have the financial reserves to be able do this.”

Why do women physicians experience burnout more than men?

	Women might leave practice entirely following childbirth, but Templeton notes that they also pursue other health industry professions such as medical writing or working for an insurance company.

 Physician Report, when asked “if you could go back in time and choose your career again, would you choose the same specialty, a different medical specialty or a different career,” 25% of female physicians responded they would choose a different career, compared to 18% of males. 

	In addition to leaving medicine, job dissatisfaction can also lead women to work part time, she says. “I think we definitely lose a lot of great potential by not developing that potential and not seeing it for what it is,” Rohr-Kirchgraber says.

	Recent research published in JAMA Internal Medicine shows that women provide a higher quality of care than males, with 32,000 fewer mortalities a year among patients under female care.

	Templeton sees issues like burnout and re-entry into medicine as fixable. Figuring out how to tackle these problems should take place at a national level, within professional groups and locally within institutions.

	The American Medical Women’s Association is focusing on burnout and re-entry into medicine at the annual meeting as well in future projects.  

	Joining a women’s group, finding a mentor, and reaching out to women colleagues are some possible avenues for finding support in confronting these issues, Rohr-Kirchgraber says. 

	For the future, she says she is hopeful for the outlook of women staying in the profession. “I think is helpful because we learn from each other so much,” she says.  

Articles

The physician field remains largely male despite equality in medical school numbers

Why are women leaving medicine?

-Physicians in New York state have put away their pen and paper method of prescribing in exchange for

-many just in time to meet the state requirement.

	The number of New York providers set up for electronic prescribing of controlled substances (EPCS) increased by 28% since March 1, according to Surescripts data reported by Business Wire.

	The shift comes following the Internet System for Tracking Over Prescribing (I-Stop) mandate that aims to tackle prescription abuse and fraud. The law, which took effect on March 27, establishes New York as the first state to require electronic prescribing of all medications, and it slaps prescribers with penalties if they don't comply.

, but it doesn't penalize providers who don’t e-prescribe.

	For providers without a waiver for e-prescribing, possible penalties include fines or professional discipline, a New York State Department of Health spokesperson said.

	So far, the Department has issued about 4,400 waivers, representing approximately 17,300 prescribers.

 of March 27, 2015 had to be extended because vendors weren't in compliance with Drug Enforcement Administration (DEA) requirements for electronic prescriptions of controlled substances (EPCS), says Joseph Maldonado, MD, president of the Medical Society of the State of New York.

	In addition to using software that follows the federal requirements - whether a third party audit or DEA certification - EPCS prescribers also have to adhere to an identity proofing process as well as a two-factor authentication. That EPCS software also must be registered with the Bureau of Narcotic Enforcement.

	When New York City internist Andrew Lyons, prescribes electronically, he uses an application on his iPhone that generates a code every 30 seconds. Then he enters that security token provided by the phone into the device he’s using to prescribe, such as a computer.

	“You have to put in your password for the prescription as well as the number that is currently generated on your electronic token, and if they both match, then the prescription goes through,” Lyons explains. “If they don't, then someone might be trying to prescribe in your system without that proper security clearance.”

Are female physicians leaving money on the (operating room) table?

	There were more than 79,000 New York practitioners e-prescribing as of March 31 compared with 52,000 actively e-prescribing as of March 31 last year, according to a spokesperson for the New York State Department of Health,

	Maldonado said inappropriate narcotic prescriptions due to “doctor shopping” have already decreased by about 90% in New York under the I-Stop mandate, which requires that most prescribers review the Prescription Monitoring Program registry of a patient's prescription history before prescribing a schedule II, III, or IV controlled substance.

	“You have a decrease that came about solely by physicians checking the registry and not by e-prescribing,” Maldonado says. “So the question now is, will e-prescribing make any significant dent on the remaining 10%? And many of us are a little bit skeptical on that.”

	However, some modifications to the new law are being pursued, and some have already taken effect. In a March letter, the state health commissioner 

 under which physicians can use paper, such as for prescriptions in nursing home settings.

	Maldonado explained in the letter that a doctor isn't going to give his or her secret codes to a nurse over the phone, and if he or she sent it to the pharmacy directly, the nursing home wouldn't have a record of it. Other electronic prescription exceptions include those with “long or complicated directions” or those for compound drugs, the letter states.

	Additionally, Maldonado said that any time a prescriber faces a power failure and therefore has to write a paper prescription, he or she has to report the incident to the state health department.

	“If my computer system goes down, and I have 45 patients in my office that are going to require prescriptions, I have to notify (the?) state on all 45 of those patients,” he said. “That's an incredible burden to put on an office that is dealing with the burden already of, 'why did my computer system go down, how quickly can I get it going?' Now on top of that, I have to notify the state on each and every one of those patients?”

Physicians demand answers from presidential candidates

	In the meantime, the Medical Society of the State of New York, is asking that prescribers instead document the issued paper prescription in the patient's record, according to the group’s letter.

	MSSNY is also pursuing legislation to exempt from the requirement prescribers who write 25 or fewer total prescriptions annually. That way, those physicians wouldn't need to apply for waivers every year.

	Despite the bumps in the implementation road, e-prescribing has benefits, says Lynbrook gastroenterologist Larry Good, MD, who describes electronic prescribing as the “stepchild” of the electronic health record, but with far fewer flaws.

	He says the law will improve accuracy in filling prescriptions because it will eliminate the problem of  pharmacists misinterpreting prescribers’ illegible handwriting.

	“I really am an advocate for this program,” Good says. “I think it will be successful. I think it will result in better safety for patients and better communications between patients, physicians and pharmacies.”

Physicians in New York state have put away their pen and paper method of prescribing in exchange for electronic scripts-many just in time to meet the state requirement.

Author | Hannah Douglas

Articles

Why are women leaving medicine?

NY doctors scramble to adopt e-prescribing to combat abuse, fraud