Female (OB-Gyns) Only - Discrimination?

From todays NY Times. Some excerpts (I hope not too much.)

So the questions are out there. I think everyone agrees that a woman can chose to see a female doctor. But what about hiring only women?

I would say that’s what the market wants, and that’s the breaks. But what then about hiring only men if that’s what the market wants? Or only whites? Does a distinction require a value judgement - that we agree that a woman wanting to see only women has a reasonable basis so we honor it, but a preference for men or whites is bigotry?

For that matter, can a man walk into the general practitioner’s office and announce that he will not see any women? Or blacks? (As a practical matter he can specifiy Doctor X - the question is if the office can accomodate a direct request).

Have at it.

Like you said, women wanting a woman OB/GYN has a reasonable basis to it, and the market is the market. It might be a reasonable argument in court that a woman is more qualified than a man simply because she has gone through the standard procedures, and has experienced the common maladies that the specialty deals with. I’m not saying that a man cannot be a good, even brilliant OB/GYN. But he can never have the same insight or share the same rapport that his female counterpart can.

I think the desire of some women to see a female rather than a male OB-GYN is perfectly reasonable and should be accomodated where possible. The flip side of the coin would be the male patient who wants a male urologist to do his prostate exam.

As the article you quoted indicates, increasing numbers of women are moving into OB-GYN. Males will still have a place in the field, and in fact there are a number of women who prefer having a male OB-GYN. The problem would come if residency programs start discriminating against otherwise qualified men. Filling job vacancies is also a touchy area.

There’s probably a line that should not be crossed when medical practices are trying to accomodate patients’ preferences in doctors. A patient who wants a male/Christian/Caucasian/heterosexual family doctor is free to seek one out. But if that patient wants to see another doctor in a group because of such a preference, I can think of a limited number of scenarios in which the group should grant the request.

There was a recent case in which a patient needed surgery for a serious heart problem. Her husband requested that no one in the O.R. be black, as he had a hangup about African-Americans seeing his wife in a state of undress (!). The first doc turned him down. The second surgeon agreed to the request, citing the urgent need for the surgery, and asked a black anesthesiology assistant not to participate in the operation. The surgeon later regretted that decision - as he should have.

I don’t believe that’s what it is about. I think it’s a privacy issue. But I’m not sure if this has a bearing on the matter. I would imagine that any “genuine” reason would suffice. It would seem that though “customer preferences generally do not justify discrimination in hiring or employment”, this is only true where those customer preferences are motivated by bigotry alone.

But this gets to a new layer of judgementalism. The wife of a friend of mine “does not trust” female doctors, and prefers men. Is this something that may be accomodated? Suppose a clinic had years of experience and noticed that doctors of a specific gender were more popular. Must they undertake an analysis of the motivations of the people before deciding if they may use this as a factor in hiring?

See Fair Play by Steven E. Landsburg for a chapter that shows why anti-discrimination laws are bad: There is a moral equivalence between the two sides (seller/buyer of a service). If it is ok for buyers of a service to discriminate (Most people would think it ridiculous for a male doctor to sue a woman who did not come to him for OB/GYN treatment; it is not a violation of law for a tennant to reject a lease because the landlord is gay, reverse the situation and it probably is), why can’t sellers do it?

Um, because a buyer discriminates with the implicit knowledge that he or she can go elsewhere for the service, and because a seller can usually adapt to meet a buyer’s demands (not, obviously, talking about gender or race here).

If ALL sellers discriminate against a particular type of buyers, then that buyer has no where else to go and simply cannot obtain services, and can do nothing in terms of adapting his or her self that will compel the seller to sell to him or her.

Hm… IMHO the sex of an OB/GYN has nothing to do with capability of providing appropriate care for a patient. The only real issue here is one of “patient comfortableness” or preference. It is hard to try to defend the position that a patient should not have a preference as to the doctor they see, just as it would make absolutely no sense to tell all those Pepsi-Cola fans out there that they need to start drinking Coke. On the other hand, when people are allowed to make decisions solely based on matters of superficial relevance (ie, “I don’t want a male/female/black/white doctor”) then we end up with environments that breed discrimination and mistrust. The solution: the same as it has always been in the past. Education and awarness. And yet, maybe I don’t want a black doctor because I don’t think he will understand my “whiteness” as it applies to my physical condition (I don’t buy that a woman would make a better OB/GYN just 'cause she has the relevant anatomy).

The key is to see the symmetry: Why does an Albanian seller of apples get no sympathy when he says “Some people may not buy my apples because I am an Albanian. Therefore I need laws to protect me”, but an Albanian buyer of apples saying “Some people may not sell me apples because I am an Albanian. Therefore I need laws to protect me”, get laws passed for him?

It is true that if there was no one who did not share prejudices against this Albanian, no one who would re-sell (re-buy) apples to him (from him), no one who would interact with him at all, he would be a “one man island” and in as much trouble as any Castaway. However, a seller seems to face as big a chance of this as a buyer.

People are not like this. Even if some White sellers don’t want to serve lunch to Blacks at their Diners, if there is free entry into the Diner market, and Blacks want to eat, someone who cares more about profit than bigotry will come into the market to sell to them.

I’m not old enough to have been there, but from what I’ve seen/heard this wasn’t the case in the south (U.S.) prior to the civil rights movement?

From what I understand blacks were often denied service or they could only chose a notably inferior service (again, this is secondhand to me, I wasn’t born yet so if I’m mistaken please be kind).

We could argue that things have changed and it would be different today if we did away with all anti-discrimination laws prior to the 1960’s but I don’t think we can know that for sure. I would be willing to agree that in larger, more diverse cities your statement would probably hold true but I’m not so sure for small, isolated communities with a relatively small population of minorities.

What percentage of the difference in attitude and practices today is from education/realization that bigotry is wrong and unacceptable and what percentage is purely a result of the anti-discrimination laws?

If ALL buyers discriminate against a particular type of seller that seller is in as bad shape as the buyer.

I think the real difference is in that the discrimination laws don’t govern private conduct. The buyer is not running a “buying business” he is making a private purchase for himself. The seller, by contrast, is running a business. This is considered a public matter, and this makes government interference more justified.

There I was. I had no moral obligation to you to create a restaurant. But, I saved up my money, bought equipment and opened my restaurant. What is it about the act of providing you with a restaurant, which may be of a different type (you might call it lower quality) of restaurant than you desire, since I ohh, … what… don’t allow people who smell like they have not bathed in a long time to come in and sit at my tables; refuse to hire a person with a long beard and a pierced septum because I don’t like his looks; don’t build a ramp so that people in wheelchairs can come in; don’t provide menus in Braile; don’t allow Irish in at all: why is it that before, I had no obligation to provide you with any kind of restaurant, but when I DO create something, it becomes public and you get to tell me what I must do with it?

Federal anti-discrimination laws do not require the sexes to be treated completely equally. IIRC, they make exceptions for tradition, physical differences, and, well, lust. Employers can require women to wear skirts and men to wear pants; accomodations because of pregnancy are allowed, and strip clubs can hire only women. Why wouldn’t there be an exception for modesty? I see no problem with all-female OB/GYN practices, or all-male practices specializing in male urology. Now, an all-female heart clinic or GP association would be pushing it, I think. But when the practice by its nature serves one gender, why can’t the patient’s preference for someone with the same equipment be accomodated?

Why can’t people’s bigoted preferences be accomodated?

I have a friend who can’t put a in a classified ad for a housemate that states he is a Christian (the paper thinks it is discriminatory). If I were to say “Beware, in the future the Government will require proof that you dated equal-opportunistiaclly before proposing marriage”, I would probably be acused of fear-mongering/making straw-men. But how many people in 1920 would have believed that some day they would be require to install wheelchair ramps, hire transvestites etc.

A patient who wants to see a female OB/GYN has every right to do this. As a male, I will never fully appreciate having a painful period or becoming pregnant. Does this matter? Yes and no. I am expected to support and monitor patient swith thousands of diseases that I will never (god willing) have. That does not mean that I cannot be sympathetic, or provide appropriate treatment and referral.

This matter does affect male medical students and residents. I don’t buy the counter “urology” argument – lots of urologists are female and from my experience males don’t mind receiving prostate exams from a female as much as females dislike receving a pelvic exam (from anyone). Patients who see me occasionally say they prefer a female to do these exams but that it really doesn’t make much difference – an uncomfortable exam is always uncomfortable and if you do it slowly and more sympathetically it will be better regardless who does it. Female OB/GYNS make a much bigger deal out of this than their patients do for reasons which are indeed sexist and territorial. The patients really don’t mind, the OB/GYN calls herself a “Woman’s health expert” and makes a bigger deal out of it than warranted.

There is no question females are permitted to do much more duirng their OB/GYN rotations and that they generally receive much higher grades without having more skills or knowledge. On the other hand, I think this is a storm in a teacup. Lots of male students hate OB/GYN (I like it) and the matriarchy of nurses and clinicians that go with it. Most of the males I know who really wanted to do OB/GYN did get spots – just more women want to, which suits the consumer well too.

The women I know who prefer a female OB/GYN (not me) don’t have this preference because a female has gone through the same thing,or will provide better treatment, or because the exam is more physically comfortable, but because it’s more mentally comfortable. They simply prefer not to have pelvics, etc done by a man for much the same reason as I would prefer not to use a fitting room staffed by a man.

Interesting you should mention that, Dr. P.

One of the Family Practice doctors at my school just did a study comparing the number of OB/GYN procedures done and scores on the in-service exams between the male and female residents in that department.

As you might expect, the female residents did, on the average, a lot more OB/GYN procedures than the males did. However, on the OB/GYN portions of the in-service exam, the males and females did about the same.

Interestingly, when he compared the scores on the other sections of the exam, the men averaged somewhat better than the women. The thought, then, is not that the women are gaining anything in OB/GYN, but that they’re losing in everything else.

This makes sense, when you think about it–most of those OB/GYN procedures are pap smears, which don’t offer much in the way of learning. You’ve done one, you’ve pretty much done them all. It’s hard to argue that the women benefit from “more experience” in the procedure–I can do a pretty good pap/pelvic, and I’ve only done about 15 of them.

He’s going to publish the data eventually. Hopefully it will help programs realize that female residents would have everything to gain by spreading out the paps a little more equitably.

Dr. J

I’m sure that every OB/GYN department is different. At the school where I did my clerkship, females got to do more Pap smears and cervical exams; and males and females did about eqiually well on the written exam. However, per capita, females got four times as many Honours as males. This sort of thing does not bother me personally, have been in school too damn long to get worried about marks, would rather develop skills. In my class of 100 people, seven of the eight people who wanted OB/GYN got spots, including the one male. I believe these numbers are similar to the preceding class too.

I’m sorry, but my mental picture from this sentence is probably not what you intended. :wink:

I have seen a number of OB/GYNs since becoming an adult female. But just for the record, the most insensitive gynecologist I ever saw (who suggested that any woman who claimed to have PMS should see a psychiatrist) was a female and so was the one who conducted the most painful exam I ever had. Although I have seen a number of wonderful female doctors too, my current doc is a male and he is the most gentle, communicative and respectful Ob/Gyn I’ve ever had*. Being female does not guarantee understanding, sensitivity or gentleness in technique and being male does not exclude it.
(* - “had,” in this case, meaning “been the patient of”…)

I actually prefer a female doctor for that particular procedure. Smaller fingers. :wink: