For Harold Reiter the tipping point was the entering class of 2002.
As the new chair of admissions at McMaster University's medical school, he took one look at the proportion of women admitted - a whopping 76.9 per cent - and wondered what had happened to the men.
The gender gap at the university's Michael G. DeGroote School of Medicine was one of the widest in the country and one of the factors that prompted Dr. Reiter to rethink the admissions criteria.
"It was those very numbers that made me start to look at the breakdown of the applicant pool, in terms of the ratio of male to female, and the discovery of what was, I think, an over-emphasis on grade point average," he said.
Basing admissions mostly on marks, it seemed, had contributed to the decline of men's numbers in medical schools. Dr. Reiter, who was new to the position, decided the school should put less emphasis on marks and broaden its requirements, which eventually it did. The proportion of men has since slightly increased.
Dr. Reiter's candour is rare. Admissions officials are uncomfortable acknowledging that they are even troubled by the lack of men in medical school. During the past decade, men's interest in medicine has hardly budged, while women have been drawn to doctoring in ever higher numbers - a trend many regard as yet another sign of males slipping in the sphere of academics. The imbalance is greatest in Quebec, where women make up more than 70 per cent of students at francophone medical schools.
Medicine has been flagged as a field where the gender imbalance could lead to a shortfall of labour - just as an aging population increases demand. Research shows that female doctors are more inclined to work part-time than their male colleagues, and avoid certain specialties, such as surgery, as they balance demands of raising a family.
Nick Busing, president and CEO of the Association of the Faculties of Medicine of Canada, says "this is a major debate, about getting the right balance of men and women in medicine."
Asked to explain the sudden 20-percentage-point jump in male students admitted to the University of Calgary's medical school between 2004 and 2005, for instance, Dr. Ian Walker, director of undergraduate admissions, was dismissive.
Dr. Walker said the fluctuations were random. "We had no concerted gender factor in our admissions process whatsoever," he said. "That is just a statistical blip."
However, according to Paul Cappon, more than one faculty has done something about the gender factor.
Dr. Cappon, president and CEO of the Canadian Council on Learning, says that for the past five to eight years, some universities across the country have been tinkering with admissions to boost the number of men in medical school - looking beyond marks to give male applicants, in particular, credit for things like community service.
He predicted no one would say it was going on.
Dr. Cappon, who was a vice-president at Laurentian University, a former director-general of the Council of Ministers of Education of Canada and a former professor of medicine at McGill University, says "schools are doing that surreptitiously in Canada, deans of law and medicine. I used to be an academic VP running a university and I know they are doing it."
Schools are "doing it surreptitiously, because it's politically incorrect to do it," he says.
Medical education statistics collected by the AFMC seem to support his allegation. While women apply to medical school in record numbers - and make up nearly 60 per cent of students admitted - men still stand a better chance of being accepted in every province but three, according to data from the entering class of 2007. They were Alberta, Quebec and Prince Edward Island.
Women's applications to medical school outnumbered men's by nearly 38 per cent in 2007-2008, according to data from 15 of the country's 17 medical schools, collected by the AFMC Association of the Faculties of Medicine.
Nationally, the statistics suggest that men and women have even chances of receiving an offer from a Canadian medical school. But a closer look reveals that men have better odds than women - in some cases, significantly better - at being accepted at several schools.
In 2009, at Dalhousie University's medical school, 15 of every 100 male applicants were admitted, compared to only 11 of every 100 females. Men seemed to have the same advantage at the University of Saskatchewan's medical school, where 14 of every 100 male applicants made the cut, compared with 10 women.
For decades, medical schools have chased women - highlighting female physicians as role models, offering scholarships, and celebrating parity when it arrived in the 1990s. Even now, when men are in the minority of medical students in Canada - there are at least nine scholarships exclusively for women to become medical doctors, and none for men. Turning the tide is a tricky business and seems to betray years of women's progress.
When the British Medical Journal ran a 2008 article entitled "Are there too many female medical graduates? Yes." The backlash was swift. Female physicians note they still make up just a fraction of certain specialties, and that it is backward to assume men should never have to share more home duties.
In Canada, women are now poised to become the dominant face of doctoring - more than half the physicians in Canada under age 35 are female, and most retiring doctors are male.
"There was such a strong stereotype of physicians being male," said Dr. Busing. "I think that we have to be sensitive that we are not perpetuating another kind of stereotype."
He said all of the medical schools are broadening their admissions criteria, realizing that marks alone don't predict a good doctor, but whether gender also is driving the change he says he is not certain.
Dr. Busing said more work needs to be done to understand why men are not as interested as women in medicine, that it may be they are choosing other higher-paying professions, in the fields of finance, for instance.
A 2004 article in the Canadian Medical Association Journal warned that "planners and policy makers should be proactive" in accommodating the female majority in medicine in order to stave off a crisis in health care.
The notion of a stealth policy of affirmative action for men is not new. It first surfaced south of the border in 2006. That year, the dean of Kenyon College wrote an op-ed in The New York Times lamenting that she had to pass over "glorious stacks of girls" in favour of less qualified boys in order to keep some semblance of a gender balance at the school. She said the trend is widespread in postsecondary schools in order to keep themselves marketable.
Dr. Cappon says it's an image issue here too: "If it looks like a woman's program, you'll have trouble attracting both men and women."Report Typo/Error