Increasingly, women's health is becoming a woman's profession. 

No Man's Land

The class pictures confirmed everything Dr. Jim Nashed had heard. It was 1997, and Nashed, a recent graduate of the medical school at University of Miami, had just been accepted to the four-year residency program at VCU's Medical College of Virginia, where he would train to become an ob-gyn. In an effort to boost camaraderie among the program's six first-year residents, MCV admissions coordinators had mailed the students' photos to each other. Nashed saw pictures of the six new ob-gyn residents: five "quite beautiful women," Nashed recalls — and him. Nashed and his friends had a good laugh about his situation. In becoming an ob-gyn, he was stepping into what is increasingly a woman's world. Ob-gyn, like most medical specialties, historically has been practiced mostly by male physicians. But it is being transformed by a flood of young female doctors entering the field. In a few decades, if the trend holds steady, ob-gyn will become overwhelmingly female. Though most doctors who currently practice obstetrics and gynecology are male — about 64 percent — most of the doctors entering the specialty are female, according to the American College of Obstetricians and Gynecologists. Of the approximately 4,500 doctors in four-year ob-gyn residencies across the country, more than 3,100 — about 70 percent — are women. That's up from 46.5 percent in 1990. And there are no signs the trend is letting up. Why? "It's all market-driven," explains Dr. John Musich, chairman of the Council on Resident Education in Obstetrics and Gynecology. More female patients are seeking female physicians for women's health services. In response to that demand, most ob-gyn private practices are looking for female physicians to fill their vacancies — and bring in business. That's caused a ripple effect. During the past five to six years, Musich says, a warning has trickled down to medical-school students: Men who expect to enter the field of obstetrics and gynecology had better buckle in for a rough job search — or send their resumes out to the boonies. Some doctors worry that such pressures may discourage good doctors from entering the field because they are male. Already, many men who might be interested in becoming ob-gyns opt out from the beginning, says Musich, who runs the ob-gyn residency program at William Beaumont Hospital in Royal Oak, Mich. "They'll just decide to go into something else," he says. Nashed defied the trend and pressed on. "I kind of knew what I was getting into," he says. "But when you're in medical school, you try to find what you'd like to do most." And Nashed liked the field's variety of surgical and clinical work, as well as the idea of dealing with patients from the time they are born. "You have that continuity that other surgical fields do not have," he says. So he stuck with the specialty, thinking: "I'm just going to get into residency and take it from there." Now that time has come. Nashed faces graduation from MCV's residency program in June. In his search for employment, he finds himself stuck in the middle of a trend that shows no signs of letting up. Across the country, his fellow male graduates are in the same pinch. Things were much different when Dr. Stephen Cohen finished his ob-gyn residency at MCV in 1979. Then, all the residents were men. Today, though, there are a total of two men in all four classes of the MCV program Cohen now runs (one of them is Nashed). The end result, Cohen says: "The women get hired much earlier." You don't have to tell that to Nashed, who wants to remain in Richmond after his residency. He figured he'd have a shot, he says. He's done well in his residency, received good evaluations and great letters of recommendation. MCV faculty even placed phone calls to personal contacts in the area on Nashed's behalf. "I couldn't even get an interview," Nashed says. But what surprised him even more was that the local practices were typically upfront about their preference for women. "I was pretty much told point-blank, 'We're really looking to hire a female associate,'" Nashed says. And while Nashed doesn't call it discrimination, he admits it can be discouraging. "I think it's more of a business mindset — not just based on male and female," Nashed says. For example, he says, it may be that it's the practice's only way of bringing in new patients quickly, or it may be a void in the office: "And so, in the overall scheme of things, it does not matter to me which way it goes. But it still feels like discrimination." Dr. Peter A. Zedler, a co-founder and partner in Virginia Women's Center, thinks market forces are creating an awkward position for the doctors in ob-gyn practices. Now they may feel pressured to hire women merely to build their business quickly. "I think in the extreme sense, you could say this is sex discrimination," he says. But it's difficult to ignore what patients want, Zedler acknowledges. "The perception for women now is that they need to find, or should find, a woman gynecologist," he says. That's truer of younger patients than older ones, he adds. While he says his practice strives to choose the best possible physician, the associates are trying to figure out how to deliver a balance of male and female associates. Eventually these shifts will change the business, Zedler says, as female partners decide to become mothers themselves. He predicts that ob-gyn practices will need to implement time-sharing programs and part-time schedules. Nashed agrees. "A lot of women [he works with] have put off having their children because of residency," he says. That may change during the first two years of practice. Eventually, Nashed says, he thinks things will balance out. He does have two job offers — they're just not in Richmond, where he wanted. He's enthusiastic about one promising position that would take him to the fast-growing Northern Virginia area. And the only other male in MCV's ob-gyn residency, currently in his second year? Nashed says his fellow resident is trying not to worry after watching Nashed struggle through the job search. Still, even more women are coming to MCV's program. Last year, 73 percent of the 335 applicants to MCV's ob-gyn program were female. "We try to play golf," Nashed says, "and forget about

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