I suspect this is how gynecologists felt a few decades ago. They woke up one day and realized that their fraternity was under siege. They saw that the grey-haired men who had always done the work, were being replaced by swarms of female gynecologists. Sure, part of it was the increased numbers of women in medicine in general, but there was obviously a disproportionate number in their field. I imagine they grumbled a bit but eventually stepped back and said, "Well, kind of makes sense". And so it may be in rheumatology. I previously posted about the appeal of rheumatology to women physicians in Mothers in Rheumatology, and this week I saw the breach become a flood. At our regional meeting of rheumatologists we were told that there are presently eight trainees in rheumatology for the province, (a very good year), and all eight are female. This adds to the last four or five graduates, all of whom are female. Looking over the hall, the ranks of grey haired men was noticeably thinning. Why the stampede into the lowest paying internal medicine specialty? I suppose lifestyle is an important factor, but you have to wonder if the fact that the majority of patients are female has something to do with it. Fibromyalgia patients are almost all female (yes, epidemiology studies may say otherwise but in the clinic, it's primarily a disease of women), in lupus it's 8-10:1, RA 3-4:1. A very brief survey of my patient lists shows that it is 75% female. No, it's not obstetric-like numbers where pregnancy has got to be close to 100% female, but still, you have to wonder if it has an influence. Will this predominantly female rheumatology patient population chose female doctors to treat them once there are enough female physicians to make that choice a possibility? I don't doubt it.