Review the history of firsts for women and notable ironies pop out. Before women won the right to vote, they were legally practicing medicine. The story of women in medicine today is the story of modern medicine — a fascinating, complex, rapidly changing narrative that continues to be rewritten.

Dr. Marion Primomo’s story started in 1944 at the Loyola School of Medicine in Chicago, Ill. Out of a freshman class of 100 in her medical school, only five students were female. “Interestingly, all the girls who started graduated, but we lost some of the boys along the way — only 75 of them finished,” she recalls.

The only instance she can remember when her gender was pointed out was in her first year of medical school. At the beginning of a lecture, the professor announced they would be talking about the male genitalia that day and requested all the women leave the lecture hall. “And we actually did! It was the first time I was embarrassed like that. I never really learned much urology as a result,” she laughs. “We weren’t even allowed to perform male catheterization. We were told that we were women first and doctors second. Can you imagine that happening today?”

Dr. Primomo’s early years of practice came at a time when the number of women in medicine had declined significantly. According to Mary Roth Walsh, a psychologist and author of a history of medical education, there were fewer women physicians in Boston in 1950 than there had been in 1890. Women became a rarity in medical schools when a review of the educational system closed many medical schools that had served them.

Women doctors became more common with the feminist movement and affirmative action in the 1970s. Medical schools once again altered their admissions policies and encouraged women to apply. The number of female physicians in the United States quadrupled between 1970 and 1990, from 25,400 to 104,200, according to the American Medical Association. By 2002, women accounted for more than 25 percent of the total physician population. The number of female physicians continues to climb as the percentage of women enrolling in medical schools (45.7 percent in 2001-02) and earning their M.D. degrees (44.1 percent in 2001-02) gets closer to 50 percent every year.

Physicians in practice acknowledge the natural progression resulting from the increase of women completing medical school. “Now women regularly enter what were previously seen as ‘male-dominated’ specialties,” says Amy Lang, M.D., a medical oncologist at South Texas Oncology and Hematology. “For the most part I think the pressure for women to go into traditionally ‘female’ specialties, such as family practice and pediatrics, is gone.”

Cynthia Villarreal-Taylor, M.D., agrees with Dr. Lang’s assessment. “The future for the male/female physician ratio is equivalency,” says Dr. Villarreal-Taylor, who holds board certifications in three medical specialties — internal medicine, pediatrics and critical care medicine. She sees no obstacles for women in medicine and intends to continue learning and growing personally. In addition to running her own practice and serving as chief of staff at Southwest General Hospital, she may pursue a master’s degree in public health and is entertaining the idea of a medical spa and center for women.

There seem to be few, if any, boundaries that exist for women in the medical profession. Today, physicians like Dr. Villarreal-Taylor chart their own careers and are limited only by their own choices, time constraints and family responsibilities.

As for earnings, reports of women doctors earning less overall is true, but not because of discrimination. Rather, it is more likely due to a combination of complex factors. For instance, family medicine specialties that attract many women practitioners, such as internal medicine, pediatrics and family practice, offer a better lifestyle than, say, vascular surgery, but earn significantly less money. Another contributing factor — children. Two-thirds of practicing women physicians have children. Although they have broken many of the traditional barriers, women remain the family caretakers in most instances. “The gap will probably always be there as long as women are the primary caretakers of the family,” says Janet Bickel of the Association of American Medical Colleges.

In addition, there is some evidence that women physicians may not value a high salary as much as men do. Bickel says that surveys of medical school applicants show differences in men’s and women’s goals. “Ask men why they’re entering medicine, and they say ‘prestige and salary.’ Ask women why they’re entering medicine and they say ‘helping people.’”

Medical miracles — balancing career and family
As obvious as it may sound, doctors are people, too. They struggle with the same conflicts and time constraints, joys and pressures that everyday life brings to the rest of us. For women in medicine, the basic struggle of balancing family and career hasn’t changed much over time. Indeed, many acknowledge the wisdom in the old saying, “Women can have it all [career and family], just not all at once.”

When she was raising her family, Dr. Primomo says she lived in an environment that is probably hard to find in today’s fast-paced world. She and her husband owned the hospital where they worked, so there was inherent flexibility. They lived in a small, supportive community — Dilley, Texas — where her children could walk to school. Because she did “ladies and babies,” she could schedule her appointments around her family, whereas her husband never knew from one minute to the next when he’d be called to surgery. When the kids were toddlers, her parents would visit and help out; later on they had support from a great housekeeper. When her children became teenagers, she quit working and stayed home for a few years.

Now in her early 40s, Dr. Arie Scribbick chose to go to medical school two decades ago because she had an interest in science and in pursuing a financially secure career. She has now forged a balance between her family and career with the help of specialty choices and shared priorities with a supportive husband. “When I first got out of medical school in 1986, I did a year of general surgery,” says Dr. Scribbick. “After that, I switched to emergency medicine because it offered better hours and a more flexible lifestyle.”

As a member of EMANON, a large emergency physician group in San Antonio, she works 10 12-hour shifts per month and serves as the medical director for the emergency department at Northeast Methodist Hospital. Her husband is an ophthalmologist at Brooke Army Medical Center. They have three children ranging in age from 5 to 9, two of whom she home-schools. Dr. Scribbick’s other daily responsibilities mirror those of most parents — coordinating piano and diving lessons in between staff meetings, Boy Scouts and church activities. With families far away, Dr. Scribbick says she couldn’t manage it all without her husband of 15 years. “We share the household and parenting responsibilities equally. We are true partners, working toward a shared purpose. “I enjoy the fast-paced aspects of my job, the gratification of being able to help patients immediately, and the diversity of the medical problems that present to the ED,” says Dr. Scribbick. “I consider myself lucky to have found a career that allows me to maximize the time I spend with my family and still practice medicine.”

For Laura Tamayo, M.D., balancing career and family continues to be a challenge. She graduated from medical school at the University of Texas Health Science Center at San Antonio in 1999 and went on to specialize in pediatrics. Last November she and fellow graduate/pediatrician Dr. Wendy Gideon went into private practice and business for themselves when they opened Helotes Pediatrics. Divorced and the mother of two children ages 5 and 2, Dr. Tamayo feels she’s in survival mode most of the time. She also works part-time as an attending physician at University Hospital. “It’s definitely a lot of juggle, but having my own practice adds enormous flexibility for me as a parent,” she says. “I also get a lot of help from my mom, who lives with me.”

Now in her early 30s, Dr. Tamayo is looking forward to the day she’ll be able to cut back on her 60-hour-plus workweek and pick up her kids from school. Eventually she wants to become more involved from a policy perspective and advocate for children socially and politically. “But for right now, I consider it a victory to get to the grocery store once a week,” she laughs. Balance — it’s all in the eye of the beholder.

What women bring to medicine
For one thing, women bring longevity. At almost 84 years of age, Dr. Primomo continues to teach and practice medicine. As the medical director of the first San Antonio hospice program in 1978, she still works with the 15 palliative care centers throughout San Antonio. She is also a clinical professor in the Department of Family Medicine at UTHSCSA and teaches a regular course in palliative medicine. According to Judith Lorber, author of Women Physicians: Careers, Status and Power, women may work fewer hours, but they work more years because they live longer.

Call it what you will — genes, evolution, hormones, the environment — but women and men emphasize different human traits. “I don’t think you can generalize about every woman and every man,” says Janet Realini, M.D., M.P.H., medical director of multiple programs at the San Antonio Metropolitan Health District. “Nevertheless, I like to think that women bring particular potential for nurturing to their relationships and often an ability to talk about feelings with patients and co-workers.”

At the end of the day, women bring choice to medicine. Their rising numbers mean patients with any kind of disease or problem can choose from a wide variety of interpersonal styles, perspectives, experiences and education — whatever and whoever suits them best. And that’s a valuable contribution in and of itself.

Author: Kelly A. Goff

Photographer: Greg Harrison