Big Swing to Female Trainees in Endocrinology

Marcia Frellick

January 13, 2016

Endocrinology is on track to become the most female-predominant internal medicine subspecialty, say the authors of a new literature review.

Elaine Pelley, MD, from the division of endocrinology, diabetes, and metabolism at the University of Wisconsin School of Medicine and Public Health, in Madison, and colleagues note that about 70% of current endocrinology fellows training in the United States are women, which signals a future swing to a heavily female endocrinology workforce from one that is currently 44% female.

They performed a PubMed search using the terms "female physician" and "physician gender" covering the years 2000–2015, with the goal being to highlight the potential impact of this anticipated gender shift on endocrinology.

Their findings were published in the January issue of the Journal of Clinical Endocrinology & Metabolism,and they conclude that the specialty of endocrinology needs to take "a lead role in advocating for changes that support the success of female physicians."

Number of Male Trainees Dropping Rapidly; Overall Shortfall Projected

Dr Pelley and colleagues say that 46% of medical residents/fellows are currently women, but there are large differences in gender composition between specialties: for example, more than 80% of trainees in obstetrics and gynecology are female, whereas the proportion is less than 10% for vascular and interventional radiology or interventional cardiology.

"Even within the subspecialties of internal medicine, wide gender differentials exist. Women are highly represented in endocrinology, rheumatology, and geriatrics fellowships, while they remain a minority of cardiology and pulmonology trainees."

The shift toward female physicians in endocrinology partly reflects decreasing interest from men in the field, they note.

Data from the Electronic Residency Application Service show that the proportion of female endocrinology fellowship applicants has risen over the past 4 years to 75% in 2014. In the same period, the number of male applicants decreased by 43%.

However, the number of female applicants has also declined (by 12% in 4 years), adding to a projected shortage for all endocrinologists at a time when obesity, type 2 diabetes, and thyroid cancer rates are rising and the patient population is aging.

The projected shortfall of endocrinologists is expected to be 2700 by 2025, the paper notes.

"If we're thinking we need to train more endocrinologists, we need to look at the fact that we may not have people in the pipeline willing to do it," Dr Pelley told Medscape Medical News.

Shift to Female Trainees Has Implications

Studies included in the review referenced reasons people choose a particularly specialty.

For men, financial potential is among the biggest consideration, whereas women weigh time for family and nonwork activities and desire for long-term patient relationships higher.

Therefore, the coming gender shift has implications for the future of endocrinology.

Specialties with predominantly female physicians tend to have lower pay overall. That may create a vicious cycle, where all salaries in the specialty rank low among physicians, and men in particular become even less interested because of the lower pay, Dr Pelley noted.

Dr Pelley reasons that men are seeing that the earning potential for endocrinology is comparable to that for general internal medicine and therefore perhaps isn't worth the additional 2 to 3 years of training.

Medscape's 2015 Physician Compensation Report found the average salaries for internal medicine and diabetes/endocrinology were the same: $196,000.

Endocrinology ranked lowest of any subspecialty, with salaries ranking above only family medicine and pediatrics.

Professional satisfaction did not vary significantly by gender but was low to average overall compared with other specialties. Only 45% of endocrinologists reported that they would choose the specialty again, the review found.

Ensure Leadership Roles for Women

Burnout may also become a more prominent issue in endocrinology, Dr Pelley said — studies in the review found burnout is higher for women, and work/life-balance issues will be magnified with the changing gender mix. The Medscape 2016 lifestyle survey bears this out, with more female physicians (55%) reporting burnout than their male peers (46%), slightly up on the 51% and 43% of women and men, respectively, reporting burnout in 2015.

If this translates to women retiring early or reducing practice hours, that could significantly affect the future workforce, adding to the challenges posed by the already projected shortfall, Dr Pelley said.

Reversing the decline will take a combined approach, including a review of salaries, she noted.

And endocrinology will have to examine flexible work schedules and find ways of ensuring that pay doesn't differ because a physician is female. Paths to leadership in medicine, including high-ranking mentors, will also need improvement.

"If women aren't in leadership, endocrinology won't be in leadership. Specialties that are becoming female predominant — and we're not the only one — need to strategize to make sure their future workforce is successful," she concluded.

J Clin Endocrinol Metab. 2016:101:16–22. Abstract

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