During her obstetrics and gynecology residency, Afua Mintah noticed that many patients were reluctant to allow male students to watch their exams.
After she completed her residency at Mount Sinai Beth Israel in New York and went into practice, the trend seemed to intensify. Now 39 and a physician at St. Mary Medical Center in Bucks County, Mintah is trying to recruit another ob-gyn to join her practice.
Not one man has applied, and she wonders whether the kind of patient concerns she saw in New York might be a reason far fewer men are entering the specialty.
"When [men] don't get that experience at the medical school level, it deters them from looking at [ob-gyn] as a potential career," said Mintah, whose own ob-gyn is a man.
"The entire face of the specialty is shifting," she notes, and it's happening fast.
The reasons for the trend? Partly, it's patient preference, with younger women showing more of a bias toward female providers than their elders, according to surveys. But there are plenty of women who either don't care about their doctor's sex or would prefer to see a man. Yet that's not a message many male students are getting.
"Students are hearing from deans of medical schools and other people that there isn't a need for men," said Peter Schnatz, president of the Obstetrical Society of Philadelphia, who practices at Reading Hospital.
According to a 2016 study, 41 percent of patients reported no preference in the sex of their ob-gyns, and 8 percent preferred males. The other half of the patients preferred female providers. A 2005 survey showed that 80 percent of patients believe that the sex of the physician does not affect the quality of care.
But, as Mintah observed, patients in teaching hospitals are much more likely to ask that male medical students leave during their exams, according to a 2012 study that Schnatz co-authored.
The patients were fine with having a male physician present, the researchers found. But getting shut out as a student might discourage a male from pursuing ob-gyn, Schnatz said.
"I think certainly it's a field that women are interested in," Schnatz said. "Mix that with the negative comments that [male] students are hearing, and they think, 'I guess this isn't a field for me.'"
At Thomas Jefferson University, over 90 percent of the ob-gyn residents, from those who started in 2010 to those who will complete their training in 2022, are female. At the University of Pennsylvania, 85 percent of ob-gyn residents from 2006 to 2022 are women.
Of current residents in the Drexel/Hahnemann ob-gyn residency, 80 percent are female. At Temple University, only one of the 21 students currently in the program is a male.
Overall, women are choosing medicine as a profession in greater numbers than ever before. But still, among residents from all specialties in 2017, men slightly outnumbered women, 53 percent to 47 percent.
Alissa Higgins, owner of the mom-centered fitness studio Fit4Mom Philadelphia, is pregnant with her second child and consistently asks for a female doctor when she has her appointments at the prenatal clinic at the Hospital of the University of Pennsylvania – since obstetric check-ups are so frequent, most practices tell patients not to expect to see the same provider every time.
"If they were to assign me a male, I would switch," said Higgins, 31. "I understand they study and know everything, but do they actually know what I'm going through? Not really."
On the other hand, Sandy Ludewig, 22, a personal trainer from New Jersey, sees a male gynecologist and likes him just fine.
"Both the male and female doctors have gone to the same schooling, and the procedure goes the same way each time," said Ludewig, whose first gynecology exam was with a female doctor. She thinks more women would make her choice if they could.
"Most of my friends see females, but that's just because they're more prevalent," she said.
Frank White, an ob-gyn in Media, says most new patients under age 35 ask for a female doctor.
"I think it's a very generational thing," said White, 56. But after a woman has her first child, the sex of her ob-gyn seems to matter less, he has noticed.
At Riddle Health Center, where he has practiced since 1996, White is the lone male doctor in an office of four physicians. Many other suburban ob-gyn practices he knows of are all women. But 22 years ago, "to have an all-female ob-gyn group would have been exceedingly rare," White said.
"I think it's a shame that one specialty in medicine is really almost eliminated from a male's choice," White said. His suggestion to men determined to get into ob-gyn: Train for a sub-specialty, rather than trying to become a generalist.
He isn't the only physician who suggests men take on additional training for a sub-specialty, such as maternal-fetal medicine or gynecologic oncology.
"As a generalist, it's an advantage to be a female. It's easier for a woman than a man to get busier, quicker if you're an ob-gyn," said Stephen Krell, CEO of clinical practice at Axia Women's Health, which has more than 100 patient-care centers across New Jersey and Pennsylvania.
Enrique Hernandez, a Temple University professor and chair of obstetrics, gynecology, and reproductive sciences, said he would like to see more diversity in Temple's program, but the infrequency of male applicants makes that very difficult.
"As you get more and more women in the programs, the men think, 'Maybe we're not competitive,'" Hernandez said.
There still are plenty of male ob-gyns practicing, though the American College of Obstetricians and Gynecologists predicts that, in 10 years, their numbers will decline to one-third.
Some think that's not particularly a problem. Others think a lack of diversity is always a problem, both for giving patients more choice, and for offering different perspectives.
"There's some concern in the field saying, 'What are we going to do if there's no men?'" Schnatz said. "People want a balance of women and men."
The implications might also be financial. In a specialty that is already paid under the average for medical specialties, the influx of women could drive down salaries even more, Hernandez said.