Eyeworld

EW NEWS & OPINION 24 July 2016 by J.C. Noreika, MD, MBA leadership is not limited to General Motors, Facebook, Hewlett-Pack- ard, and CERN. Women chair 15 ophthalmology programs around the country and lead 2 of America's most respected institutions, Wills Eye Hospital and Massachusetts Eye and Ear Hospital. My point? I don't think this subject is gender-driven as much as generational. Regardless of profes- sion, the road to the top always compels painful choices. In a recent Wall Street Journal article, Dr. Toby Cosgrove who heads the Cleveland Clinic with 2015 operating revenues of $7.2 billion reflected that, "you don't get to be a CEO—certainly not a successful CEO—unless you're giving a big percentage of your time. You make your choices, you can never look back." I expect this applies equally to both X and Y chromosomes. You, dear reader, are invited to draw your own conclusions. EW Reference 1. Kletke PR, et al. The growing propor- tion of female physicians: implications for US physician supply. Am J Public Health. 1990;80:300–4. Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio since 1983. He has been a member of ASCRS for 35 years. Contact information Noreika: JCNMD@aol.com Christmann: kindes.auge@gmail.com Simon: lauren@theeyegroup.com work." Citing Sheryl Sandberg's Lean In, he acknowledged "the conflict between professional success and domestic fulfillment." Linda Christmann, MD, is the president of Women in Ophthalmol- ogy. She reported that, "ophthalmol- ogy trainees are nearly 50% women now, which means the profession will change. Having said that, we only comprise about 23% of practic- ing members of the AAO." She wrote that women secure "limited lead- ership positions." In a 2015 online posting, she said that when women self-identified to AAO their special- ties, they comprised 13% cataract and IOL surgeons, 14% retinal sur- geons, and 8% refractive surgeons. Glaucoma, cornea, oculoplastics, and pediatrics were more frequent choices. Lauren Simon, a principal at the EyeGroup, an ophthalmology recruiting firm in Boca Raton, Flori- da, stated that, "there is definitely a different mentality in today's work market. There is a strong slant to- ward work/life balance." But she said that this is not unique to females. The millennial male also seeks life- style harmony and embraces more responsibility at home. Ms. Simon stated that, "today, men do not work like their predecessors." She added most are hard-workers but priorities differ from earlier generations. First the ASCRS in 2002 and then the AAO in 2005 chose women as their presidents. Although fewer women ophthalmologists identify as cataract or refractive surgeons, ASCRS' 36 committees have above- average female participation. Female more women doctors and lawyers than ever. A hockey-stick curve, the inflection point began in the early 1970s when fewer than 10% of medical degrees were conferred on women. Today, about 1/2 of medical school graduates are women; 1/3 of doctors in the U.S. are female. The significant statistics? Licensed female physicians less than 40 years of age in the U.S. account for 30.4% of all women physicians. The same cohort shows that males make up only 15.7% of their gender's num- ber. Between ages 40 to 49, the percentages are similar with females accounting for 30.5% of their co- hort, males 22%. More than 60% of all women physicians licensed today are younger than 50 years old. Only 38% of all male physicians are 50 or younger. The largest male cohort at 37.3% is age 60+ years. The future of medicine belongs to the distaff gender. The tricky part? How does this impact health care, ophthalmology, patients, and society? Politically, it is a third-rail discussion. It engenders disputation of gender, bias, dis- crimination, equality, wages, work/ life balance, and, ultimately, tough choices. In 1990, The American Journal of Public Health 1 published Phillip Kletke's article studying the impli- cations of a proportional majority of female physicians. Recent articles support his findings: Female phy- sicians work fewer hours per week, have higher retirement rates, favor specific specialties, and earn less money. In 2015, female residents were underrepresented in general surgery, orthopedics, emergency medicine, anesthesiology, and radiology and dominated pediatrics (75% of all residents) and OB-GYN (85%). International socialized health systems are troubled. The U.K.'s National Health System subsidizes the training of its workforce. A controversial article by Professor J. Meirion Thomas appearing on DailyMail.com in 2014 impugned if, after spending at least £500,000 to train a physician, "taxpayers were getting the best return on their investment?" Dr. Thomas, a distin- guished cancer surgeon, maintained that, "in many cases, the wife is the secondary earner. This also en- courages less demanding part-time The number of female physicians is growing. Choices will be made and medicine and ophthalmology will change O n a recent Saturday, I paged through a section of the paper devoted to the 2016 high school gradu- ates. There are 7 public high schools in the county boasting several hundreds of newly minted grads. The schools' top 5 students ranked by GPA were pictured, each wearing their "shining morning face." Curiosity soon gave way to inquiry. Of the 34 scholars (1 school cited only 4 students), 24, i.e., 71%, were female. Correlation is rarely causation, but something is afoot. A random occurrence or a trend? If the latter, what does it mean? Educators and psychologists tell us that females mature earlier than males and apply themselves to education more rigorously through adolescence. The result? A majority of college, law, and medical school students are female. This is a tidal change from prior generations when women graduating with advanced degrees are remembered as "pio- neers." Randy Olson, a postdoc- toral researcher at the University of Pennsylvania, studied trends in bachelor's degrees by major con- ferred upon women between 1970 and 2012. Four top fields remained constant: health professions, public administration, education, and psy- chology. Health profession degrees including nursing, veterinary, and dental assistants are overwhelming- ly popular; women capture 85% of the baccalaureates. Even science, technology, engineering, and math, the STEM curricula, show that the science/math gap is closing. Women captured 58% of biology degrees in 2012. Engineering lagged, technolo- gy waned. In 2012, The Atlantic ran an article reporting that there are Insights Medicine and the X chromosome J.C. Noreika, MD, MBA

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