Women Have Closed Med School Enrollment Gap; Others Remain

It wasn't a fluke.

In 2018 and 2019, women matriculants outnumbered men. Now, for the first time, women make up the majority of students in U.S. medical schools. According to the Association of American Medical Colleges' 2019 Fall Applicant, Matriculant and Enrollment Data Tables, women accounted for 52.4% of medical school matriculants this academic year.

It's been a long time coming.

Women now make up about 35% of the U.S. physician workforce, compared to 5% in 1970. It wasn't until the 1970-71 academic year that women accounted for more than 10% of a single U.S. medical school class. The incoming class of 1992-93 was the first to reach 40%, but it took more than two decades for women to finally break the 50% mark in 2017-18.

Yet women in medicine still have work to do to reach equity with their male colleagues. According to the AAMC report Diversity in Medicine: Facts and Figures 2019, "medical school faculty continued to be predominantly white (63.9%) and male (58.6%)," and the same holds true for practicing physicians, where the majority are also white (56.2%) and male (64.1%).

According to AAMC 2019 faculty data, women held only 25.6% of full professorships and 15.9% of clinical sciences permanent department chairs.  

Women also face a gap in payment. According to the 2019 Medscape Physician Compensation Report, male subspecialty physicians earned an average of about 33% more than their women colleagues, down from a 36% gap a year earlier. However, the gender gap actually widened in primary care -- according to the Medscape survey -- from about 18% in 2018 to nearly 25% in 2019.

So why am I optimistic that things will change?

As the number of women in medicine continues to swell, so do our numbers in leadership. The presidents of some large national health organizations, including the AMA and the American Academy of Pediatrics, are women.

In family medicine, the presidents of the AAFP Foundation and the Association of Family Medicine Residency Directors are women, and there are many other women in our leadership pipeline. More than half of the AAFP's 55 constituent chapters have women presidents, and women chair three of the Academy's seven commissions.

In 2020-21, women -- including me -- will take on the president's role in six national family medicine organizations: the AAFP, AAFP Foundation, American College of Osteopathic Family Physicians, Association of Departments of Family Medicine, North American Primary Care Research Group and Society of Teachers of Family Medicine.

Many of the women with leadership roles in family medicine have benefited from attending the National Conference of Constituency Leaders, which is the AAFP's leadership development event for underrepresented constituencies: women physicians, minority physicians, new physicians, international medical graduate physicians and LGBT physicians. The annual event is scheduled for April 23-25 in Kansas City, Mo., in conjunction with the AAFP's Annual Chapter Leader Forum.

As I write this post, Black History Month is winding down, and I would be remiss if I did not mention that our health care workforce must grow not only to equally represent men and women but also to address racial disparities. Although the matriculation rate of African Americans to medical schools has marginally increased, we are not yet represented in medicine in proportion with our percentage in the general population. (And neither are Hispanics or Native Americans and Alaska Natives.)

It has been noted that more black men entered medical school in 1978 than in 2014, and the low numbers persist. We must continue to work to inspire and mentor more women and minorities to seek leadership positions within our organizations and in the C-suite to ensure that our workforce reflects our overall population.

The AAFP has set an ambitious goal to ensure that by 2030, 25% of U.S. medical school seniors will select family medicine as their specialty. As we strive to reach that lofty mark, we need to continue to mentor our young black men and women to increase the diversity of our workforce to achieve true health equity.

Ada Stewart, M.D., is president-elect of the AAFP.