Physician Specialties

Occupational sex segregation is a persistent feature of the organization of work and contributes to gender inequalities in pay, status, and power. For physicians, intraoccupational sex segregation by medical specialty remains entrenched despite the rapid influx of women into medicine. Women physicians tend to be overrepresented in primary care specialties and underrepresented in surgery and surgical sub-specialties. Explanations range from those focused on women's gendered choices to those emphasizing structural and external barriers. Equalizing women's status in medicine necessitates parity within medical specialties and more equity across specialties in terms of pay and prestige.

Medical specialization emerged in most Western countries in the 19th century as the separate fields of medicine and surgery began to merge. With the rise of other medical specialties in the middle and latter parts of the 19th century, surgery and internal medicine were relegated to specialty status. While some argue that the advent of an information age and new technologies forced rapid specialization in medicine, others contend that the transformation of intellectual perspective—especially an emphasis on organs and specific areas of the body—was behind the shift. During the 19th century, a more complex division of labor emerged in society generally—setting the stage for highly specialized occupations. Furthermore, as bureaucratization and administrative rationality became dominant forms of organization in the professions, people were increasingly classified and categorized. Medical associations devoted to individual specializations emerged, and specialty training and licensure soon followed.

In 1875, the International Medical Congress listed eight medical sections. In the United States, a 1933 meeting of physicians led to discussion on the education and certification of medical specialists. This discussion sparked the formation of the American Board of Medical Specialists (ABMS), whose mission is to oversee certification of physician specialists in the United States. In short, a national qualifying board determines who is competent to practice in any given specialty. Currently, there are 24 approved ABMS Member Boards that certify in 145 specialty and subspecialty areas. Accordingly, the number of doctors who specialize has risen dramatically, and recent research indicates that fewer than 20 percent of all U.S. medical students are choosing a primary care specialty such as family medicine, general internal medicine, and pediatrics.

In 2009, the Council of Graduate Medical Education advocated for health reform that would provide financial and educational incentives to produce more primary care physicians. The letter outlines five changes recommended by the Council on Graduate Medical Education, including training in non-hospital primary care settings, reducing the income gap between primary care and subspecialty physicians, and providing support for an infrastructure to coordinate patient care and reduce administrative burden. In addition, since growth in specialty areas [Page 1098]is largely driven by the workforce needs of teaching hospitals, realignment requires monitoring and regulation by the federal government.