Personal and practice-related characteristics of a subsample of US women dermatologists: data from the Women Physicians' Health Study

Report

Personal and practice-related characteristics of a subsampleof US women dermatologists: data from the WomenPhysicians' Health Study

Erica Frank, MD, MPH, and Sareeta R. Singh, MD

Abstract

Background The number of women dermatologists has increased dramatically over the past

few decades. Despite this, there have been few studies examining the personal or

professional characteristics of women dermatologists practicing in the USA.

Methods A representative random sample of active, part-time, professionally inactive, and

retired US women physicians, aged 30±70 years, was studied; this article compares data

from the 95 responding dermatologists with data from 4350 other respondents.

Results Women dermatologists were more likely to be US born, white, and married to a

physician than were other women physicians; they were similar to other women physicians in

age, marital status, children, amount of stress at home, political self-characterization, and

personal health behavior. Women dermatologists were more likely to be board certi®ed and

to practice in solo or two-person practices than were other women physicians. They had

fewer nights on call, were less likely to state that they worked too much, reported less stress

at work, were more satis®ed with their careers, and reported higher household incomes. With

the decided exception of skin cancer prevention and screening, they were unlikely to have

considerable training, con®dence, or interest in routine prevention-related screening or

counseling for patients.

Conclusions Women dermatologists are unlikely to be part of a minority group, likely to be

married to another physician, and likely to have a high household income. They report

reasonable work stress and high career satisfaction. Given these ®ndings, it is not surprising

that only 10% would consider changing their specialty were they to relive their lives.

Introduction

The prevalence of women dermatologists continues to

increase; women represented 26.8% of dermatology

residents nationally in 1980, 39.9% in 1985, and 47.8%

in 1990.1 Although physician characteristics are important

predictors of patient outcomes,2 and may also be of

inherent interest, there have been few studies of personal or

professional characteristics of US dermatologists of either

gender.3,4 While studies concerning the demographic

characteristics of women physicians have been per-

formed,5,6 studies of women physicians as a collective

group have limited applicability to physicians in individual

specialties, dermatology included. This can be attributed

not only to the differences in the individual specialties

themselves, but also to the varying appeal of some

specialties to women with particular personality traits.

To explore the personal characteristics and practice-related

issues of US women dermatologists and to compare them

with other US women physicians, we analyzed data from

the Women Physicians' Health Study (WPHS), a national

questionnaire-based study of 716 characteristics of 4501

women physicians.

Methods

The design and methods of WPHS have been more fully

described elsewhere, as have the basic characteristics of the

population.5±7 WPHS surveyed a strati®ed random sample of US

women MDs; the sampling frame is based on the American

Medical Association's (AMA's) Physician Master®le, a database

From the Departments of Family and

Preventive Medicine and

Dermatology, Emory University

School of Medicine, Atlanta, Georgia

Correspondence

Erica Frank, MD, MPH

Department of Family and Preventive

Medicine

69 Butler St. S.E.

Atlanta, GA 30303

E-mail: [email protected]

ã 2001 Blackwell Science Ltd International Journal of Dermatology 2001, 40, 393±400

393

intended to record all MDs residing in the USA and possessions.

Using a sampling scheme strati®ed by decade of graduation from

medical school, we randomly selected 2500 women from each of

the last four decades' graduating classes (1950±1989). We

oversampled older women physicians, a population that would

otherwise have been sparsely represented by proportional

allocation because of the recent increase in the number of

women physicians. We included active, part-time, professionally

inactive, and retired physicians, aged 30±70 years, who were not

in residency training programs in September 1993, when the

sampling frame was constructed. In that month, the ®rst of four

mailings was sent out; each mailing contained a cover letter and a

self-administered four-page questionnaire. Enrollment was

closed in October 1994 (®nal n = 4501).

Of the potential respondents, an estimated 23% were ineligible

to participate because of incorrect addresses, because they were

men, deceased, or living out of the country, or because they were

interns or residents. Our response rate was 59% of physicians

eligible to participate. We compared respondents and

nonrespondents in three ways. First, we used our phone survey

(comparing our phone-surveyed random sample of 200

nonrespondents with all the written survey respondents). Second,

Table 1 Demographic and personal characteristics of US women physicians²

Dermatologists All other physicians P value

n n

Total, % (se) 95 1.9 (0.2) 4350 98.1 (0.2)

Age, % (se)

30±39 years 24 42.0 (6.1) 1100 45.3 (0.7)

40±49 years 32 38.4 (5.7) 1324 34.9 (0.7)

50±59 years 23 15.5 (3.4) 994 14.4 (0.4)

60±70 years 16 4.2 (1.2) 932 5.4 (0.2)

Age, mean years 95 41.9 (0.8) 4350 42.2 (0.1)

Age, median years 95 40.0 (0.9) 4350 39.9 (0.2) 39.9

Ethnicity, % (se) *

Hispanic, Black, other 5 3.0 (1.4) 416 12.3 (0.7)

Asian 6 8.5 (3.5) 691 12.6 (0.6)

White 83 88.5 (3.7) 3173 75.1 (0.8)

Birthplace, % (se) *

USA 75 91.2 (3.2) 2796 76.3 (0.8)

Other country 11 8.8 (3.2) 1182 23.7 (0.8)

Marital status, % (se)

Married, yes 73 81.9 (4.6) 3044 73.0 (0.9)

Married, no 18 18.1 (4.6) 1204 27.0 (0.9)

Partner's education³, % (se) *

Medical school graduate 56 77.5 (5.7) 1335 45.1 (1.1)

Graduate school graduate 13 18.3 (5.1) 953 32.9 (1.1)

Less than or equal to college graduate 2 4.2 (3.1) 596 22.1 (1.0)

Percent with children, % (se) 79 79.4 (5.1) 3189 69.6 (0.9)

MD was main preschool caretaker, % (se) 12 11.7 (3.7) 608 17.9 (0.9)

Home stress, % (se)

Severe 5 6.1 (2.9) 197 5.6 (0.5)

Moderate 39 42.7 (5.9) 1571 42.6 (1.0)

Light 50 51.2 (6.0) 2397 51.8 (1.0)

Political characterization, % (se)

Conservative 33 36.0 (5.8) 1159 26.0 (0.8)

Moderate 30 31.5 (5.4) 1563 36.6 (0.9)

Liberal 31 32.5 (5.8) 1512 37.4 (0.9)

*P < 0.0001.²Chi-squared test for prevalences, t-test for means, and median split tests for medians.³Includes married and unmarried couples.

Report Characteristics of US women dermatologists Frank and Singh

International Journal of Dermatology 2001, 40, 393±400 ã 2001 Blackwell Science Ltd

394

we contrasted all respondents with nonrespondents based on

information from the AMA's Physician Master®le. Finally, we

examined surveys from each mailing wave (all respondents, from

waves 1±4) to compare respondents and nonrespondents with

regard to a large number of key variables. From these three

investigations, we found that nonrespondents were less likely

than respondents to be board-certi®ed. Respondents and

nonrespondents did not consistently or substantively differ on

other tested measures, however, including age, ethnicity, marital

status, number of children, alcohol consumption, fat intake,

exercise, smoking status, hours worked per week, percentage in

primary care practice, personal income, and percentage actively

practicing medicine.

On the basis of these ®ndings, we weighted the data by decade

of graduation (to adjust for our strati®ed sampling scheme), and

by decade-speci®c response rate and board-certi®cation status

(to adjust for our identi®ed response bias). Using these weights,

we were able to make inferences with regard to the entire

population of women physicians who graduated from medical

school between 1950 and 1989. We then analyzed the

characteristics of the responding women dermatologists (n = 95)

and compared their responses to those of nondermatologist

women physicians.

Results

Personal characteristics

Our subsample of women dermatologists was more likely

to be US born, white, and married to a physician than were

other women physicians (Table 1). Due to multiple testing,

only characteristics signi®cant at P < 0.01 are discussed for

this and other tables. They were similar to other women

physicians in age, marital status, whether or not they have

had children, amount of stress at home, and political self-

characterization.

Personal health habits

The personal health behavior of our subsample of women

dermatologists was not signi®cantly different from the

good habits of other women physicians (Table 2). Their

dietary habits, exercise frequency, smoking habits, and

alcohol consumption were comparable to those of non-

dermatologist women physicians. Compliance with the

examined US Preventive Services Task Force recommend-

ations was also not signi®cantly different between the two

groups.

Table 2 Personal health practices of US women physicians*²

Dermatologists All other physicians

n n

General health status, % (se)

Excellent/very good 71 74.0 (5.5) 3180 78.7 (0.8)

Good 17 18.9 (5.1) 833 17.0 (0.7)

Fair/poor 6 7.1 (3.2) 218 4.3 (0.4)

Compliant with USPSTF guidelines³, % (se) 65 74.8 (5.4) 2570 67.0 (0.9)

Cigarette smoking, % (se)

Current 2 2.8 (2.0) 181 3.7 (0.4)

Ex-smoker 25 23.9 (5.1) 894 18.6 (0.7)

Never 67 73.3 (5.3) 3097 77.7 (0.8)

Alcohol drinking Ð ever, % (se) 75 81.1 (4.7) 2887 72.2 (0.9)

Drinks per week for drinkers, median, % (se) 67 1.9 (0.3) 2487 1.3 (0.1)

Exercise (minutes/week), median, % (se) 88 200 (28.5) 3818 174 (4.3)

Block fat score, median, % (se) 88 20.0 (1.5) 3977 21.1 (0.3)

Fruit & vegetable servings/day, median, % (se) 87 3.1 (0.2) 3888 3.0(0.0)

Vitamin supplementation, % (se) 58 60.9 (6.0) 2459 58.3 (1.0)

*No P values were < 0.05.²Chi-squared test for prevalences, t-test for means, and median split tests for medians.³Percent complying with all screening recommendations from the US Preventive Services Task Force (USPSTF) regardingcholesterol (check every < 5 years), blood pressure (every < 2 years), Pap smears (every < 3 years if uterus is present), clinicalbreast examination (every < 3 years if age 30±39 years, every < 1 year if > 40 years), and mammography (every < 2 years if50±70 years).

Frank and Singh Characteristics of US women dermatologists Report


395

Table 3 Training and practice characteristics of US women physicians²


n n

Board-certi®ed in principal specialty, % (se)

Graduated medical school 1950±79 63 81.5 (6.7) 2179 63.9 (1.1) **

Graduated medical school 1980±89 21 80.0 (9.4) 956 61.0 (1.6) *

Board-eligible in principal specialty, % (se)

Graduated medical school 1950±79 7 18.5 (6.7) 572 23.5 (1.0)

Graduated medical school 1980±89 2 12.4 (8.6) 244 33.6 (1.6) *

Board-certi®ed in other specialty, % (se)

Graduated medical school 1950±79 0 0.0(0.0) 32 0.7 (0.1)

Graduated medical school 1980±89 2 7.6 (5.2) 17 1.1 (0.3)

Primary worksite, % (se) ****

Solo practice 39 35.4 (5.8) 847 17.3 (0.7)

Two-physician practice 20 24.2 (5.3) 217 6.3 (0.5)

Group practice 18 24.4 (5.3) 975 28.2 (0.9)

Hospital 4 5.9 (3.0) 893 25.0 (0.9)

Medical school 7 6.2 (2.7) 439 10.7 (0.6)

Government facility 3 2.6 (1.9) 418 9.5 (0.6)

Not now active 2 1.3 (1.1) 218 3.0 (0.3)

Practice place, % (se)

Urban 46 51.3 (6.1) 2321 56.0 (1.0)

Suburban 39 41.8 (6.0) 1351 33.7 (0.9)

Rural 7 7.0 (2.8) 396 10.3 (0.6)

Income per hour *

$0±$36 19 20.9 (6.5) 1154 40.2 (1.1)

$37±$59 20 25.8 (5.7) 1064 31.3 (1.0)

> $59 36 45.1 (6.6) 1099 28.5 (0.9)

Personal income in $1000s, median (se) 77 79 (9.8) 3504 73 (1.0)

Household income in $1000s, median (se) 77 171 (17.1) 3542 130 (2.6) **

Clinical hours per week, median (se) 93 31.6 (1.5) 4175 37.8 (0.8) **

Nonclinical hours per week, median (se) 90 4.2 (0.5) 4028 5.0 (0.2)

On call nights per month, median (se) 88 1.2 (1.1) 4130 4.8 (0.2) ***

Hours of sleep when on call, mean (se) 48 7.1 (0.1) 2767 5.6 (0.0) ****

Continuing medical education

Hours per month, mean (se)

Total 94 12.8 (0.9) 4203 12.5 (0.2)

Journal 94 4.8 (0.4) 4173 5.1 (0.1)

Text 90 2.5 (0.5) 3988 3.1 (0.1)

Lecture 89 4.7 (0.8) 3903 3.6 (0.1)

Audio 85 0.9 (0.1) 3751 0.7 (0.0)

TV-video 83 0.3 (0.1) 3743 0.4 (0.0)

Work amount, % (se) **

Too little 3 8.0 (4.6) 84 1.7 (0.3)

A comfortable amount 64 65.2 (6.0) 2239 53.8 (1.0)

Too much/far too much 26 26.9 (5.2) 1822 44.5 (1.0)

Control of work environment, % (se) *

Always/almost always 39 36.6 (5.9) 1267 27.2 (0.9)

Usually 40 44.7 (6.0) 1700 40.6 (1.0)

Sometimes 12 13.6 (3.9) 882 24.7 (0.9)

Rarely/never 3 5.2 (2.9) 300 7.4 (0.5)



396

Training- and practice-related characteristics

Women dermatologists were more likely to be board-

certi®ed than were other women physicians (Table 3).

Women dermatologists were more likely to practice in

solo or two-person practices than were other women

physicians. Also, when compared to nondermatologist

women physicians, they worked fewer in-of®ce hours per

week, had fewer nights on call, and reportedly slept more

hours during their nights on call. The reported mean

number of hours per month spent by women dermatolo-

gists for continuing medical education (CME) was similar

to that of the women nondermatologists surveyed.

Although the reported median personal income was not

signi®cantly different from that of other women physicians,

the median household income was higher among women

dermatologists. In addition, they reported modestly

(P < 0.05) higher hourly wages than did other women

physicians.

Career satisfaction

When queried about the amount of work and the level of

work-related stress, our subsample of women dermatolo-

gists was less likely to report that they worked too much,

less likely to report severe work-related stress, and more

likely to report satisfaction with their careers. In addition,

reported control of the work environment was modestly

(P < 0.05) better than that of other women physicians.

Women dermatologists were signi®cantly less likely than

other women physicians to express the desire to change

their specialty (Table 3).

Patient counseling practices

With the exception of skin cancer prevention and screen-

ing, the extent to which women dermatologists performed

preventive counseling practices was considerably less than

their nondermatologist colleagues. In addition, women

dermatologists felt that nonskin-related preventive health

counseling had less relevance to their practice. They also

reported less self-con®dence and less training in performing

these practices compared with primary care practitioners

and other specialists (Table 4). Virtually all women

dermatologists discussed or performed skin cancer screen-

ing for their patients either at every visit or at least once a

year. They felt that these activities were highly relevant to

their practices, and reported having received extensive

training in and having high self-con®dence in skin cancer

screening and prevention counseling.

Discussion

The number of women physicians has increased dramatic-

ally in recent years and, by the year 2010, women are

expected to comprise 29% of practicing physicians.8

Similarly, in the past few decades, the number of women

dermatologists practicing in the USA has risen consider-

ably. In 1980, 26.8% of US dermatology residents were

women;8 by 1990, this number had increased to 47.8%.9

From these data, it is clear that, in the future, women

dermatologists will play an increasingly important role in

their profession. Although previous studies have been

performed on the demographic characteristics of women


n n

Career satisfaction, % (se) **

Always/almost always 61 61.7 (5.8) 2230 48.7 (1.0)

Usually 29 32.6 (5.6) 1417 35.6 (0.9)

Sometimes/rarely/never 4 5.7 (2.8) 561 15.6 (0.7)

Change specialty, % (se) ****

De®nitely/probably 6 5.3 (2.4) 932 20.9 (0.8)

Maybe 5 4.8 (2.4) 745 18.1 (0.8)

Probably not/de®nitely not 83 89.9 (3.3) 2546 61.0 (0.9)

Work stress, % (se) ****

Severe 3 2.9 (1.9) 534 13.4 (0.7)

Moderate 68 72.6 (5.7) 2716 68.8 (0.9)

Light 23 24.6 (5.6) 859 17.8 (0.7)

*P < 0.05; **P < 0.01; ***P < 0.001; ****P < 0.0001.²Chi-squared test for prevalences, t-tests for means, and median split tests for medians.

Table 3 Continued.



397

physicians,3,4 this is the ®rst national study comparing the

personal characteristics and practice-related issues of

women dermatologists with those of other women

physicians.

In this analysis, we found that women dermatologists are

more likely to be US born and white than are other women

physicians. Why foreign born and minorities are under-

represented among women dermatologists is unclear.

Table 4 Prevention-related screening: practices, perceived relevance, self-con®dence, and amount of training²³

Screening Specialty Do or discuss Highly Highly Highly

at least relevant¶, con®dent²², trained³³,

yearly§, % (se) % (se) % (se) % (se)

Cholesterol Dermatologists 0.2 (0.3) 0.0 (0.0) 14.0 (4.6) 5.2 (2.9)

Primary care§§ 38.5 (1.8)**** 62.5 (1.8) 65.7 (1.8)**** 23.1 (1.5)***

Other specialties¶¶ 18.3 (1.2)**** 11.5 (1.0) 28.3 (1.6)** 12.0 (1.1)*

Blood pressure Dermatologists 6.7 (2.6) 0.7 (0.7) 18.7 (5.3) 6.1 (3.4)

Primary care 94.7 (0.9)**** 81.0 (1.6) 74.4 (1.7)**** 38.3 (1.8)***

Other specialties 48.9 (1.7)**** 32.0 (1.6) 40.7 (1.8)*** 19.5 (1.5)***

Colorectal cancer²²² Dermatologists 0.3 (0.3) 0.0 (0.0) 6.8 (3.1) 9.9 (4.0)

Primary care 55.9 (1.8)**** 50.9 (1.9) 53.3 (1.9)**** 20.1 (1.5)*

Other specialties 12.4 (1.1)**** 10.4(1.1) 24.8 (1.6)**** 12.6 (1.3)

Skin cancer/ Dermatologists 95.1 (2.3) 99.3 (0.7) 97.3 (1.4) 90.2 (3.6)

sunscreen use Primary care 33.7 (1.7)**** 32.8 (1.7) 46.3 (1.9)**** 15.4 (1.3)

Other specialties 14.2 (1.2)**** 9.1 (1.0) 27.9 (1.7)**** 12.3 (1.3)

HIV risks/testing Dermatologists 2.3 (2.0) 18.9 (5.1) 31.4 (6.2) 19.0 (5.4)

Primary care 22.2 (1.5)**** 43.3 (1.9)*** 58.5 (1.9)*** 29.1 (1.7)

Other specialties 8.7 (0.9) 20.8 (1.4) 36.5 (1.8) 19.7 (1.5)

Flu vaccine³³³ Dermatologists 4.7 (2.5) 0.0 (0.0) 8.9 (3.4) 4.1 (2.7)

Primary care 62.5 (1.8)**** 54.1 (1.9) 60.6 (1.9)**** 22.2 (1.5)***

Other specialties 23.1 (1.4)**** 16.8(1.2) 28.9 (1.6)**** 11.1 (1.1)*

Nutrition Dermatologists 8.4 (3.7) 4.7 (2.9) 17.1 (4.8) 5.9 (3.0)

Primary care 48.1 (1.8)**** 58.4 (1.9)**** 44.8 (1.9)**** 17.9 (1.5)**

Other specialties 27.5 (1.5)**** 26.1 (1.5)**** 35.8 (1.7)** 18.0 (1.4)**

Weight Dermatologists 5.2 (3.1) 0.7 (0.7) 7.8 (3.2) 2.1 (1.6)

Primary care 64.2 (1.7)**** 61.8 (1.9)**** 49.7 (1.9)**** 20.2 (1.5)****

Other specialties 31.1 (1.6)**** 29.1 (1.5)**** 38.4 (1.8)**** 17.2 (1.4)****

Exercise Dermatologists 3.7 (1.9) 0.7 (0.7) 13.8 (4.2) 2.1 (1.6)

Primary care 57.7 (1.8)**** 57.8 (1.9)**** 49.7 (1.9)**** 19.0 (1.5)****

Other specialties 31.1 (1.6)**** 25.5 (1.5)**** 41.8 (1.8)**** 18.7 (1.4)****

Smoking§§§ Dermatologists 5.5 (2.3) 3.6 (2.0) 14.3 (4.1) 6.7 (3.1)

Primary care 83.8 (1.3)**** 71.4 (1.8)**** 63.3 (1.9)**** 25.5 (1.6)****

Other specialties 46.6 (1.7)**** 39.3 (1.7)**** 47.4 (1.8)**** 21.7 (1.5)***

Alcohol use Dermatologists 1.9 (1.4) 0.0 (0.0) 10.3 (3.6) 5.7 (3.0)

Primary care 49.4 (1.8)**** 52.0 (1.9) 46.1 (1.9)**** 20.2 (1.5)****

Other specialties 32.3 (1.5)**** 38.4 (1.7) 45.3 (1.8)**** 26.8 (1.6)****

Clinical breast exam¶¶¶ Dermatologists 1.6 (1.4) 0.0 (0.0) 15.6 (5.9) 8.0 (3.8)

Primary care 86.6 (1.2)**** 84.8 (1.5) 84.9 (1.5)**** 52.5 (2.1)****

Other specialties 25.1 (1.5)**** 14.6 (1.3) 32.5 (1.9)** 20.0 (1.7)**

Mammography²²²² Dermatologists 3.0 (1.7) 0.0 (0.0) 14.2 (5.7) 8.6 (3.9)

Primary care 75.3 (1.6)**** 79.8 (1.7) 82.1 (1.6)**** 50.2 (2.1)****

Other specialties 21.2 (1.4)**** 13.8 (1.3) 27.5 (1.8)* 15.8 (1.5)

Hormone replacement therapy³³³³ Dermatologists 0.7 (0.7) 0.0 (0.0) 6.6 (3.0) 6.6 (3.6)

Primary care 63.3 (1.8)**** 72.1 (1.8) 72.1 (1.8)**** 46.3 (2.1)****

Other specialties 13.9 (1.1)**** 10.7 (1.1) 16.5 (1.4)** 10.2 (1.2)

Footnote on facing page.



398

Minority or foreign born medical students may be less

likely to be admitted to dermatology residencies. Alternat-

ively, they may have fewer opportunities for a dermatology

elective during their training (some medical schools do not

have their own dermatology departments) and thus they

may be less likely to apply. Further studies to explore these

and other possibilities are warranted.

In this study, we also found that the personal health

habits of women dermatologists, such as cigarette smoking,

alcohol consumption, dietary habits, vitamin supplementa-

tion, and exercise frequency, were similar to the good

habits of other women physicians. In general, women

physicians report superior health-related behavior com-

pared to other women, even when the comparison is

adjusted for socioeconomic status.5

With regard to career satisfaction, women dermatolo-

gists reported being satis®ed with their careers signi®cantly

more so than other women physicians. In past studies,

correlates of job satisfaction have included decision-

making authority and work schedule.10±12 In this analysis,

women dermatologists reported a greater control of work

environment and a considerably greater comfort level with

their workload than did nondermatologist women physi-

cians. These factors, along with the perception of less

work-related stress among dermatologists, may account for

the high degree of professional satisfaction by women in

this specialty. Thus, it is not surprising that compared with

other women physicians, women dermatologists are

signi®cantly less inclined to consider a change in their

specialty.

In the current study, women physicians were queried on

their likelihood of addressing 14 prevention-related health

issues with their patients. Along with each health-related

issue, the perceived relevance of that issue to the

physician's practice was reported. Physicians also indicated

the extent of past training they had received in counseling

and their level of con®dence in counseling ability for each

item. Our study clearly reveals that women dermatologists

were diligent in the screening and prevention of skin

cancer. Virtually all women dermatologists discussed skin

cancer prevention or performed skin cancer screenings for

their patients at intervals ranging from every visit to once

yearly. Women dermatologists felt that this activity was

highly relevant to their practices. They also considered

themselves well trained (90.2%) and were highly con®dent

(97.2%) with regard to skin cancer screening and preven-

tion counseling. In contrast to the above, our study shows

a relative lack of preventive counseling by women

dermatologists in other health-related issues in comparison

to primary care providers and specialists.13 Interestingly,

however, our study reveals that neither specialty physicians

nor primary care physicians consistently counseled their

patients in most preventive health-related issues. In fact, of

the 14 health-related topics, 75% of primary care

physicians consistently counseled patients on only four

issues. In addition, none of the women nondermatologists

reported having high con®dence or being highly trained in

counseling patients on any of the 14 topics at a level

comparable to women dermatologists in skin cancer

screening and prevention.

Comprehensive (primary) care and prevention counsel-

ing to promote and maintain a healthy state are considered

by some to be the responsibility of primary care physicians.

While there are many issues that may be best addressed by

*P < 0.05; **P < 0.01; ***P < 0.001; ****P < 0.0001.²n varies slightly by question.³Chi-squared test.§Percentage of physicians responding `èvery visit'' or `èvery < 1 year'' to ``Considering your typical patients, how often do youusually discuss or perform screening: every visit, every < 1 year, every > 1±2 years, every > 2±3 years, every > 3±5 years, only atinitial visit, only if clinically indicated, never.''¶Percentage of physicians responding ``highly'' to query regarding physician's perception of the column risk factors' ``relevance toyour practice: highly, somewhat, not very, not at all.''²²Percentage of physicians responding ``highly'' to query regarding physician's ``self-con®dence in counseling: highly, somewhat,not very, not at all.''³³Percentage of physicians responding `èxtensive'' to query regarding physician's `àmount of training in counseling: extensive,some, little, none.''§§Primary care physicians are de®ned here as general practitioners, general internists, obstetricians/gynecologists, and specialistsin public health/preventionists.¶¶All other physicians are de®ned here as anesthesiologists, dermatologists, emergency department physicians, medicinespecialists, neurologists, ophthalmologists, psychiatrists, and surgeons.²²²Includes only those patients > 50 years (per USPSTF guidelines).³³³Includes only those patients > 65 years (per USPSTF guidelines).§§§Includes only smokers.¶¶¶Includes all women patients.²²²²For all women patients > 50 to < 75 years.³³³³For women patients who are postmenopausal.



399

primary care providers, many opportunities exist for

dermatologists to in¯uence their patients' health-related

behavior. Although discussing estrogen replacement

therapy and cholesterol screening is beyond the scope of

dermatology, dermatologists could make a greater effort to

discuss issues such as smoking, exercise, and obesity. In

addition, all physicians should continue their efforts, and

even put forth a greater effort, to counsel patients on

routine health maintenance and preventive practices.

One of the limitations of this study is that women

dermatologists are compared to other specialty physicians

combined, rather than to one particular specialty, such as

ophthalmology. A second important limitation is that the

women dermatologists included in this article are a

subsample of a larger study, and include only 2% of all

women dermatologists.14

The current study highlights the demographics, personal

health habits, and practice-related characteristics of

women dermatologists in the US. Our results indicate that

women dermatologists are content with their careers and

appear to maintain a balance between their professional

and personal lives. As shown in this study, there is a

relative lack of minority and foreign born women in the

®eld of dermatology. Potential reasons for this under-

representation warrant further attention. Finally, our study

con®rms that women dermatologists are consistent and

diligent in the screening and prevention of skin cancer.15

They, along with primary care and other specialty

physicians, could assume a more active role in patient care

by broadening their preventive focus to include screening

and counseling on more health-related issues.16 Given their

con®dence and training, perhaps women dermatologists, in

their diligence in counseling and screening patients for skin

cancer, can serve as a model for other physicians in

preventive screening and counseling.

References

1 American Medical Association. Women in Medicine in

America: In the Mainstream. Chicago, IL: American

Medical Association, 1991.

2 Frank E, Kunovich-Frieze T. Physicians' prevention

counseling behaviors: current status and future directions.

Prev Med 1995; 24: 543±545.

3 Palmer AE. Women dermatologists on the North American

continent: an overview. Int J Dermatol 1978; 17:

808±822.

4 Fahs IJ, Lynch FW, Ward RD, Larson JM. Dermatologists

in the United States, 1968 through 1973. Arch Dermatol

1976; 112: 235±242.

5 Frank E, Rothenberg R, Brown WV, Maibach H. Basic

demographic and professional characteristics of US

Women Physicians. West J Med 1997; 166: 179±184.

6 Frank E, Brogan DJ, Mokdad AH, et al. Health-related

behaviors of women physicians vs other women in the

United States. Arch Intern Med 1998; 158: 342±348.

7 Frank E. The Women Physicians' Health Study:

background, objectives, and methods. J Am Med Assoc

1995; 50: 64±66.

8 American Medical Association. Women in Medicine: 1995

Data Source. Chicago, IL: American Medical Association,

1995.

9 American Medical Association. Women in Medicine: 1998

Data Source. Chicago, IL: American Medical Association,

1998.

10 Linn LS, Yager J, Cope D, Leake B. Health status, job

satisfaction, job stress and life satisfaction among

academic and clinical faculty. J Am Med Assoc 1985; 254:

2775±2782.

11 Lichtenstein RL. The job satisfaction and retention of

physicians in organized settings: a literature review. Med

Care Rev 1984; 41: 139±179.

12 Weinberg DJ, Engasser PG. Dermatologists in Kaiser

PermanenteÐNorthern California. Arch Dermatol 1996;

132: 1057±1063.

13 Clark R, Reitschel R. The cost of initiating appropriate

therapy for skin diseases: a comparison of dermatologists

and family physicians. J Am Acad Dermatol 1983; 9:

878±896.

14 Turczyn P. Project Co-ordinator, Department of Member

Services, American Academy of Dermatology [personal

communication]. 2001 March 28.

15 Feldman SR, Peterson SR, Fleischer AB. Dermatologists

meet the primary care standard for ®rst contact

management of skin disease. J Am Acad Dermatol 1998;

39: 182±186.

16 Star®eld B. Is primary care essential? Lancet 1994; 344:

1129±1133.



400

Documents

Personal and practice-related characteristics of a subsample of US women dermatologists: data from the Women Physicians' Health Study