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Kiyasu Y, Poudel S, Koike D, Watanabe J, Kowatari R, Fukumoto M, Yamaoka-Fujikawa Y, Kikuchi Y, Arai K, Booka E, Ishida S, Yokoyama S, Saito M. Current status of the surgical training system in Japan: results of a nationwide questionnaire survey of graduating surgical trainees. Surg Today 2024:10.1007/s00595-024-02884-0. [PMID: 38926216 DOI: 10.1007/s00595-024-02884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To identify the problems trainees face during surgical training in Japan. METHODS A nationwide online questionnaire survey was conducted targeting newly certified surgical trainees. RESULTS The response rate was 53.8% (758/1410). Among those respondents, 25.6% were women, 71.4% were either married or had a partner, 41.3% had children, 72.7% had performed over 200 surgeries under general anesthesia, and 54.1% had chosen, before graduating from medical school, to become a surgeon. While 88.8% were interested in learning surgical techniques, 63.8% were hesitant to become a surgeon for fear of a compromised quality of private life (QOL). Conversely, only 1.4% chose their surgical training programs based on QOL. Overall, 84.6% of the trainees were satisfied with their training and this correlated with the number of surgeries performed. Only 29.9% received non-technical skill training. The average number of night shifts per month was 5.6, and 10.6% worked over 80 h per week. Harassment was reported by 41.5% of the respondents. Moreover, 33.0% had considered dropping out at some time, primarily because of their QOL (51.1%) or the harassment they had encountered (50.4%). CONCLUSION This survey revealed that while trainees were satisfied with the overall training system, issues such as long working hours and harassment are prevalent. Working to improve these issues could make surgery more attractive for young trainees.
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Affiliation(s)
- Yoshiyuki Kiyasu
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Saseem Poudel
- Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, Japan.
| | - Daisuke Koike
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine, BANTANE Hospital, Aichi, Japan
| | - Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Masayuki Fukumoto
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Yuta Kikuchi
- Department of Surgery, Otakanomori Hospital, Chiba, Japan
| | - Keisuke Arai
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Sonoko Ishida
- Department of Surgery, Kita-Harima Medical Center, Hyogo, Japan
| | - Shinichiro Yokoyama
- Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Hida K, Hirano S, Poudel S, Kurashima Y, Stefanidis D, Hashimoto D, Akiyama H, Eguchi S, Fukui T, Hagiwara M, Izaki T, Kawamoto S, Otomo Y, Nagai E, Takami H, Takeda Y, Toi M, Yamaue H, Yoshida M, Yoshida S, Kodera Y, Saito M. The degree of satisfaction and level of learning in male and female surgical residents: a nationwide questionnaire survey of graduating residents in Japan. Surg Today 2023; 53:1275-1285. [PMID: 37162584 DOI: 10.1007/s00595-023-02683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Since 2002, the Japan Surgical Society has established a board certification system for surgeons to be certified for a specialty. Surgery remains a male-dominated field in Japan. This study aimed to clarify if the Japanese surgical residency training system is equally suitable for female and male residents. METHODS The Japan Surgical Society conducted the first questionnaire survey regarding the system of surgical training for the residents in 2016. The questionnaire included the degree of satisfaction with 7 aspects of the training system, including the number and variety of cases experienced and duration and quality of instruction, and the learning level for 31 procedures. The degree of satisfaction and level of learning were compared between female and male residents. RESULTS The degree of satisfaction was similar for all items between female and male residents. Female residents chose breast surgery as their subspecialty more frequently than male residents and were more confident in breast surgery procedures than male residents. Conversely, fewer female residents chose gastrointestinal surgery and were less confident in gastrointestinal surgery procedures than male residents. CONCLUSION Female residents were as satisfied with the current surgical training system as male residents. However, there may be room for improvement in the surgical system, considering that fewer applications for gastrointestinal surgery come from female residents than from males.
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Affiliation(s)
- Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Saseem Poudel
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Dimitrios Stefanidis
- Department of Surgery, School of Medicine, Indiana University, Indianapolis, USA
| | | | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Kumamoto University, Kumamoto, Japan
| | - Masaru Hagiwara
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Tomoko Izaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuko Takeda
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Motofumi Yoshida
- Department of Medical Education, Graduate School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Shigetoshi Yoshida
- Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan
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Kato N, Kojima T, Ouchi M, Nakamura T, Tokuda Y, Yakushiji T, Ichikawa K. Gender-based differences in the job titles and lifestyles in the cataract and refractive surgery society in Japan. Medicine (Baltimore) 2023; 102:e35216. [PMID: 37800820 PMCID: PMC10553083 DOI: 10.1097/md.0000000000035216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate sex differences in the titles and lifestyles of Japanese ophthalmologists, we evaluated work places and private lives. Retrospective cross-sectional study. The study included 1721 members (1344 males and 377 females) of the Japanese Society of Cataract and Refractive Surgery. An online, anonymized questionnaire was distributed to the society members. The questionnaire included 40 questions to collect data on profiles, lifestyles, job title, families, spouses, children, household chores, child-rearing, and work satisfaction. In total, 219 members (144 males and 75 females; 53.4 ± 1.0 and 51.3 ± 9.9 years old, respectively) completed the questionnaire. The job title, working time, annual income, marriage rate, and the number of children significantly differed between male and female respondents. Female respondents had greater responsibilities toward house chores, child care, and nursing, whereas several male doctors had spouses who did not work or worked for shorter times, earned a lower income, and contributed greater toward family responsibilities. Female respondents changed their job titles after having children more frequently than male respondents. Both males and females had limited time available for community activities and volunteer work. There were no significant differences in daily sleep duration. Both sexes were equally satisfied with their career choice of ophthalmology; however, fewer females recommended ophthalmology as a career for students and children compared to males. There are significant sex differences among ophthalmologists in Japan in terms of family responsibilities; this topic has received insufficient attention.
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Affiliation(s)
| | | | | | | | | | - Tadayuki Yakushiji
- Department of Cardiology, Showa University Northern Yokohama Hospital, Kanagawa, Japan
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Shimada A, Itano O, Ishida T, Tamura T, Minagawa T, Hirano Y, Tsuruta M, Oyama T, Hoshimoto S, Shinoda M. The impact of preclinical clerkship in general surgery on medical students' attitude to a surgical career. Surg Today 2023; 53:800-815. [PMID: 36462056 PMCID: PMC9734737 DOI: 10.1007/s00595-022-02626-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/09/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE With the advent of a new program for postgraduate medical students in 2004, the number of applicants choosing surgical careers in Japan has been declining. We conducted this study to evaluate the impact of preclinical clerkship and how it affects students' attitudes toward a surgical career. METHODS The subjects of our study were fifth-year medical students who participated in a clinical clerkship in general surgery in our department between April 2021 and March 2022. We conducted pre- and post-preclinical clerkship surveys to assess the perceived image of surgeons and the impact of clerkship on surgical career interest. RESULTS Among 132 medical students (77 men and 55 women) who rotated through preclinical clerkship in our department, 125 participated in the survey and 66% expressed interest in a surgical career. In the post-clerkship survey, an increased interest in a surgical career was expressed by 79% of the students; notably, including those who initially expressed interest. Approximately 77% of students were satisfied with the practical skill training they received. CONCLUSION Engaging medical students early in surgical experience through a preclinical clerkship for general surgery appears to promote their interest in a surgical career.
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Affiliation(s)
- Ayako Shimada
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan.
| | - Takashi Ishida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takuya Tamura
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takuya Minagawa
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Yuki Hirano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Masashi Tsuruta
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Takashi Oyama
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Sojun Hoshimoto
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Masahiro Shinoda
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
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Forsythe RO, Van Herzeele I, Zayed H, Argyriou A, Stavroulakis K, Saratzis A. International Cross-Sectional Survey of Bullying, Undermining, and Harassment in the Vascular Workplace. Eur J Vasc Endovasc Surg 2023; 65:748-755. [PMID: 36871928 DOI: 10.1016/j.ejvs.2023.02.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Bullying, undermining behaviour, and harassment (BUH) may exist in healthcare settings, impacting on patient care. The aim of this international study was to evaluate the characteristics of BUH experienced by physicians treating vascular diseases at various career stages. METHODS This was an anonymous international structured non-validated cross-sectional survey distributed via relevant professional societies in collaboration with the Research Collaborative in Peripheral Artery Disease. The survey was disseminated through societies' newsletters, emails, and social media. Data were collected online, allowing free text entries alongside structured multiple choice questions based on previous surveys. Demographics, geographical information, and data relating to stage and training environment were collected. RESULTS Of 587 respondents from 28 countries, 86% were working in vascular surgery, mostly at a university hospital (56%); 81% were aged between 31 and 60 years, 57% were working as a consultant, and 23% as a resident. Respondents were mostly white (83%), male (63%), heterosexual (94%), and without disability (96%). Overall, 253 (43%) reported experiencing BUH personally, 75% had witnessed BUH toward colleagues, and 51% witnessed these in the last 12 months. Female sex and non-white ethnicity were associated with BUH (53% vs. 38% and 57% vs. 40% respectively; p < .001 in both cases). While working as a consultant, 171 (50%) reported experiencing BUH, more often among females, non-heterosexuals, those who were not working in their country of birth, and non-white people. Specialty and hospital type were not associated with BUH. CONCLUSION BUH remains a major problem in the vascular workplace. Female sex, non-heterosexuality, and non-white ethnicity are associated with BUH at various career stages.
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Affiliation(s)
- Rachael O Forsythe
- Centre for Cardiovascular Science, University of Edinburgh and Department of Vascular Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hany Zayed
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Angeliki Argyriou
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | | | - Athanasios Saratzis
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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Yu TH, Hou YH, Hsu HY, Chang RE. Exploring Factors Associated With the Work Hours of Attending Physicians Working in Hospitals. Int J Health Policy Manag 2022; 11:2907-2916. [PMID: 35490261 PMCID: PMC10105180 DOI: 10.34172/ijhpm.2022.6242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Long work hours for physicians not only harm the health of physicians, but also endanger patient safety. Compared with resident physicians, attending physicians-especially hospital-employed attending physicians-assume more responsibilities but has not gotten enough attention. The purpose of this study was to explore whether a hospital's geographic location and emergency care responsibility might influence the number of hours worked. METHODS The respondents of 2365 attending physicians from 152 hospitals in the 2018 survey of Taiwan physician work hours were used as the data source. The total work hour per week and its components, the regular scheduled shift and three types of on-call shifts, were used as outcome variables. Hospital geographic location and emergency care responsibility were the independent variables. The multilevel random effect model was employed to examine the study objective after adjusting for clinical specialty, hospital teaching status, and ownership. RESULTS The average number of total working hours was 69.09 hours per week; the regular scheduled shift was account for 75% of total work hours. The results showed the total work hours were only varied by the level of hospital's emergency care responsibility. However, the results also demonstrated the hours of duty shifts were varied by hospital's geographic location and emergency care responsibility. The results of the multilevel random effect model revealed that the hospital's emergency care responsibility was the factor consistently associated with attending physician's work hour, no matter the total work hours or its composition. CONCLUSION In this study, we explored how a hospital's location and its level of emergency care responsibility were associated with physicians' work hours for each type of shift. Our findings offer an opportunity to review the rationality of physician workforce allocation, and financial incentives and administrative measures could be the next steps for balancing the work hours of attending physicians.
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Affiliation(s)
- Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan
| | - Ying-Hui Hou
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan
| | - Hui-Yi Hsu
- Department of Operations Management, Ten-Chan General Hospital, Taoyuan, Taiwan
| | - Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Rockman CB. Mirror, mirror, on the wall. J Vasc Surg 2022; 76:1111-1122. [DOI: 10.1016/j.jvs.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 10/31/2022]
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Abstract
INTRODUCTION Working conditions are changing rapidly in medicine. We analyzed the actual work situation and future plans in the next 5 years and in the long term. MATERIALS AND METHODS A survey among the members of the German Society of Pediatric Surgery was performed asking how and where physicians work now and how and where they want to work in the future. RESULTS Five hundred twelve questionnaires were sent out, and 195 colleagues answered the questionnaire (99 women, 94 men, and 2 of unknown gender). Among them, 27% were trainees, 16% were fully trained pediatric surgeons, 6% were senior physicians, and 50% were consultants, while 66% worked full time, 25% worked part time, and 8% did not work in pediatric surgery. In the future, 49% of consultants and 24% of the trainees wanted to work part time. Among the 73 participants who wanted to become a department head, 33% of them also wanted to work part time. CONCLUSION Pediatric surgery is changing toward a discipline with many female doctors and people working part time. Leaders in pediatric surgery should be aware of this development to adapt their working conditions to reality.
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Affiliation(s)
- Andrea Schmedding
- Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe-University, Frankfurt/Main, Germany
| | - Mechthild Sinnig
- Department of Pediatric Surgery and Center for Pediatric Burns, Children's Hospital AUF DER BULT, Hannover, Germany
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Challenges of the COVID-19 Pandemic for the Work–Family Balance of Pediatric Surgeons. SURGERIES 2022. [DOI: 10.3390/surgeries3030027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has been a great challenge, especially for families. We aimed to analyze the impact of the pandemic on childcare for and the work–family balance of pediatric surgeons in Germany. An anonymized questionnaire on the working and familial situation before and during the COVID-19 pandemic was sent to the members of the German Society of Pediatric Surgery and trainees in pediatric surgery (April–July 2021). One-hundred-fifty-three participants (59% female) completed the questionnaire. A total of 16% of the males and 62% of the females worked part-time. Most (68%) had underage children. During the COVID-19 pandemic, 36% reported a decrease in patients and interventions, and 55% reported an increase in the organizational work-related burden. Childcare for underage children during lockdown was organized mainly with the help of institutional emergency childcare (45%), staying home (34%), one parent working from a home office (33%), or staying home by themselves (34%). Before the lockdown, 54% reported a good work–family balance. During the lockdown, this worsened by 42%. Most of the families had to organize themselves. Different means such as a home office, flexible working hours, and different models for childcare can help to improve the situation.
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Schizas D, Papapanou M, Routsi E, Mastoraki A, Lidoriki I, Zavras N, Avgerinos DV, Lazaris AM, Tsaroucha A. Career barriers for women in surgery. Surgeon 2022; 20:275-283. [PMID: 34996719 DOI: 10.1016/j.surge.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Despite the increasing numbers of female medical students, surgery remains male-dominated. PURPOSE To highlight the principal career obstacles experienced by aspiring female surgeons. METHODS A narrative review of literature on the position and career barriers of female surgeons has been conducted, using the MEDLINE and EMBASE databases. MAIN FINDINGS Implicit and even explicit biases against female surgeons remain prevalent, negatively impacting their training performance and overall professional trajectory. Female surgeons are globally underrepresented in leadership positions and senior academic rankings, especially that of a full professor. They feel hampered by lack of effective mentorship, whose value for a successful career has been acknowledged by all medical students, surgeons and surgical leaders. Their work-life imbalance is sometimes expressed as lower likelihood than their male contemporaries of getting married or having children and may be attributed to their conventional association with the role of caretaker, their personal desire to accommodate occupational and family duties and the inadequate implementation of parental leave and childcare policies. Female surgeons' "infertility" may be further explained by direct and indirect pregnancy-related difficulties. Female surgeons are also financially undercompensated compared to their male contemporaries. Finally, specialty-specific challenges should not be overlooked. CONCLUSIONS While encouraging steps have been made, women in surgery feel still hindered by various obstacles. The qualitative, interview-based nature of current literature requires more meticulous studies on these barriers with a more quantitative and objective approach. Attenuation of gender imbalance in surgical specialties requires further changes in mentality and more targeted modifications in relevant policies.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Michail Papapanou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
| | - Eleni Routsi
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Irene Lidoriki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Nikolaos Zavras
- Department of Pediatric Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, NewYork Presbyterian, New York, NY, United States
| | - Andreas M Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alexandra Tsaroucha
- Second Department of Surgery and Laboratory of Experimental Surgery, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
BACKGROUND Women are becoming doctors in greater numbers. Despite this, there is evidence of female doctors' continued differential treatment compared to their male counterparts. PURPOSE The aim of this study was to review systematically the extant literature on the gender-based pay gap in medicine across time, different medical specialties, and different countries of clinical practice. METHODS Systematic search of three databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies needed to be empirical and contain either an unadjusted or adjusted gender-based finding related to pay. RESULTS A total of 46 articles published since 2000 contained a gender-based finding related to physician pay. Thirty-two of these 46 articles presented either adjusted or unadjusted means comparisons (or both) comparing pay between male and female physicians. Eighteen of the 46 articles controlled for one or more variables in examining pay between the two groups. Across almost all studies, female doctors earn significantly less than men, often tens of thousands of dollars less annually, despite similar demographic and work-related profiles. This earnings gap is persistent across time, medical specialty, and country of practice. PRACTICE IMPLICATIONS The gender-based pay gap is an ongoing crisis within medicine that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias and the implementation of more supportive policies aimed at better equalizing compensation through greater support and transparency related to salary negotiations, promotional opportunities, and pay scales across various job titles.
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Chang RE, Yu TH, Shih CL. The number and composition of work hours for attending physicians in Taiwan. Sci Rep 2020; 10:14934. [PMID: 32913272 PMCID: PMC7483534 DOI: 10.1038/s41598-020-71873-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/10/2020] [Indexed: 11/09/2022] Open
Abstract
Long work hours among physicians is a worldwide issue in the healthcare arena. Previous studies have largely focused on the work hours of resident physicians rather than those of attending physicians. The purpose of this study was to investigate total work hours and the composition of those work hours for attending physicians across different hospital settings and across different medical specialties through a nationwide survey. This included examining differences in physician workload and its composition with respect to different hospital characteristics, and grouping medical specialties according to the work similarities. A cross-sectional self-reported nationwide survey was conducted from June to September of 2018, and the two questionnaires were distributed to all accredited hospitals in Taiwan. The number of physician work hours in different types of duty shifts were answered by medical specialty in each surveyed hospital. Each medical specialty in a hospital filled only one response for its attending physicians. The findings reveal that the average total work hours per week of an attending physician is around 69.1 h, but the total work hours and their composition of different duty shifts varied among hospital accreditation levels, geographic locations, emergency care responsibilities, and medical specialties. Because of the variance in the number and composition of attending physicians' work hours, adjusting physician work hours to a reasonable level will be a major challenge for health authority and hospital managers.
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Affiliation(s)
- Ray-E Chang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Institute of Health Policy and Management, National Taiwan University, Room 639, No 17, Hsu-Chow Road, Taipei, 100, Taiwan.
| | - Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Science, Taipei, Taiwan
| | - Chung-Liang Shih
- Department of Medical Affairs, Ministry of Health and Welfare, Taipei, Taiwan
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13
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How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society. Surg Today 2020; 51:309-321. [PMID: 32901376 DOI: 10.1007/s00595-020-02129-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify the conflicts between a career as a surgeon and pregnancy and childbirth for women in Japan. METHODS The Japan Surgical Society conducted a nationwide survey on pregnancy and childbirth among its members who are women. The questionnaire included items regarding demography, working styles, and pregnancy and childbirth, including adverse events and harassment. RESULTS The response rate was 29.9% (1068 responses, median age, 37 years). Among the responders, 61% were married and 47% had children (average number of children, 1.7). Half of the respondents reported having experienced sexual harassment and 62% reported having received unwelcome comments about pregnancy. About 20% had undergone fertility treatment. In total, 51% had pregnancies, with miscarriages in 33% of these. The top answer for the best timing for pregnancy and childbirth was after becoming board-certified. Nearly one-third of first-time mothers experienced adverse events during pregnancy and delivery, and 28% quit or changed their job because of their pregnancy and the birth of their first child. CONCLUSIONS Japanese women who choose a career as a surgeon face obstacles during pregnancy and childbirth. It is vital to share the findings of this study and understand the issues associated with pregnancy and childbirth regardless of gender. Interventions are essential to ensure that every pregnant surgeon has a safe working environment to allow unobstructed development of her career.
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Women in otolaryngology in Turkey: Insight of gender equality, career development and work-life balance. Am J Otolaryngol 2020; 41:102305. [PMID: 31727333 DOI: 10.1016/j.amjoto.2019.102305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to collect information about the demographics, academic ambitions, job satisfactions, career development and work-life balance of female otorhinolaryngologists (FORL) in Turkey and to determine their experiences with, and attitudes towards gender discrimination throughout their academic careers. STUDY DESIGN AND SETTING A prospective survey study. SUBJECTS AND METHODS The study was aimed to include all FORL who completed their residency program. An online survey was used to collect their responses. RESULTS Out of 208 invitations, 156 FORL participated to the survey. The mean age of the participants was 39.7 ± 6.1 (29-75) years. 16.6% of the FORL used to occupy or still occupying administrative positions in their respective medical centers; 15.4% of them used to be assigned or still being assigned to a duty in otorhinolaryngology associations. Gender discrimination was 2.5 fold higher (p = 0.006 OR: 2.55 (95% CI 1.31, 4.99) in departments where there were no female faculty members. 53.2% of the female surgeons were both physically and psychologically harassed for their gender during their residency programs to deter from completing their program in otolaryngology. This finding is 4.1 fold higher than those who stated that they had not been exposed to any such gender discrimination (p = 0.001 OR: 4.094 (95% CI 2.22, 7.57). CONCLUSION Healthcare policy-makers and institutions should consider taking all the necessary actions to prevent gender discrimination in order to increase job satisfaction and achievements of female specialists in the field of otorhinolaryngology.
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Current conditions and issues of physicians and working conditions at institutions accredited by the Japanese Breast Cancer Society. Breast Cancer 2019; 27:159-165. [PMID: 31440900 DOI: 10.1007/s12282-019-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In Japan, with the rapid increase of breast cancer patients, there has been increasing demand for breast cancer treatment. As the main workforce for breast cancer treatment, women physicians are thought to be in key positions, since the number of women physicians has recently been increasing. METHODS To clarify the current statuses and issues of physicians and work conditions at the accredited breast cancer care facilities, a survey was conducted by the Japanese Breast Cancer Society (JBCS). RESULTS The main workforces engaged in breast cancer care are surgeons, and the number of breast surgeons of all institutions in this survey was 1338 (full time 1124, part time 214). The percentages of women among surgeons, breast specialists accredited by the JBCS, and residents are 22%, 25%, and 38%, respectively. Among breast specialists, more women tended to work at university hospitals and cancer hospitals. Twenty-eight percent of women were married and among those, 76% had at least one child. Many hospitals allow short working hours or exemption from in-house call for women surgeons during pregnancy and child-rearing. In contrast, half of the facilities apply a "single doctor-in-charge system", where the patient's primary physician has to be on-call every day. Many institutions convene conferences for breast cancer treatment planning before or after the scheduled working hours. CONCLUSIONS Current systems for treatment of breast cancer should be improved so that all surgeons specializing in the breast can develop their career while maintaining their personal life.
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Mainardi GM, Cassenote AJF, Guilloux AGA, Miotto BA, Scheffer MC. What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study. BMJ Open 2019; 9:e023811. [PMID: 31048423 PMCID: PMC6502025 DOI: 10.1136/bmjopen-2018-023811] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In many countries an increase in the number of women in medicine is accompanied by gender inequality in various aspects of professional practice. Women in medical workforce usually earn less than their male counterparts. The aim of this study was to describe the gender wage difference and analyse the associated factors in relation to Brazil's physicians. PARTICIPANTS 2400 physicians. SETTING Nationwide, cross-sectional study conducted in 2014. METHODS Data were collected via a telephone enquiry. Sociodemographic and work characteristics were considered factors, and monthly wages (only the monthly earnings based on a medical profession) were considered as the primary outcome. A hierarchical multiple regression model was used to study the factors related to wage differences between male and female physicians. The adjustment of different models was verified by indicators of residual deviance and the Akaike information criterion. Analysis of variance was used to verify the equality hypothesis subsequently among the different models. RESULTS The probability of men receiving the highest monthly wage range is higher than women for all factors. Almost 80% of women are concentrated in the three lowest wage categories, while 51% of men are in the three highest categories. Among physicians working between 20 and 40 hours a week, only 2.7% of women reported receiving >US$10 762 per month, compared with 13% of men. After adjustment for work characteristics in the hierarchical multiple regression model, the gender variable estimations (ß) remained, with no significant modifications. The final effect of this full model suggests that the probability of men receiving the highest salary level (≥US$10 762) is 17.1%, and for women it is 4.1%. Results indicate that a significant gender wage difference exists in Brazil. CONCLUSION The inequality between sexes persisted even after adjusting for working factors such as weekly workload, number of weekly on-call shifts, physician office work, length of practice and specialisation.
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Affiliation(s)
| | | | | | - Bruno A Miotto
- Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
| | - Mario Cesar Scheffer
- Medicina Preventiva, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Brazil
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Peral SL, Geldenhuys M. A Rasch Analysis of the Tims, Bakker, and Derks (2012) Job Crafting Scale. JOURNAL OF CAREER ASSESSMENT 2018. [DOI: 10.1177/1069072718788787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A Rasch validation was performed on the Tims, Bakker, and Derks’s Job Crafting Scale (JCS) in the South African working context. The JCS, which has been linked to employee well-being and career-related outcomes, continues to be the most widely used measure of job crafting behavior. Data obtained from the JCS generally showed good fit to the Rasch model. Four items were flagged during the analysis for displaying misfit (1 item) or differential item functioning (3 items), warranting further research attention. The study disclosed the dimensionality of the JCS, the hierarchical ordering and fit of the items, the functionality of the response format, and the ability of the JCS to measure invariantly across men and women, yielding new and interesting insights into the psychometric properties of the scale. The study contributes to research concerning the validity of the JCS in a non-European context, particularly through the use of Rasch analysis as a validation technique.
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Affiliation(s)
- Sergio L. Peral
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, South Africa
| | - Madelyn Geldenhuys
- Department of Industrial Psychology and People Management, University of Johannesburg, Johannesburg, South Africa
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Do Women Work Less Than Men in Urology: Data From the American Urological Association Census. Urology 2018; 118:71-75. [PMID: 29723591 DOI: 10.1016/j.urology.2018.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To further explore the issue of work parity between male and female urologists in the context of demographics, practice characteristics, subspecialty affiliation, and planned retirement. MATERIALS AND METHODS We analyzed data from the 2014 American Urological Association census, which is a specialty wide survey distributed to the entire urology community in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared clinical and nonclinical hours worked by gender after adjusting for age, practice setting, fellowship type, and whether or not the urologist performed inpatient operations. RESULTS Of the 11,703 practicing urologists in the United States, female urologists make up approximately 7.7% of the workforce (n ~ 897). Female practicing urologists were younger (66.4%, <45 years old), had shorter training intervals, and a younger planned retirement age than their male counterparts (63 years vs 68.5 years, P <.001). More women were fellowship-trained in a urologic subspecialty (54.9% vs 34.9%, P <.001) and more were in academic practices (33.2% vs 21.9%, P = .03). After adjusting for age, practice type, subspecialty, and inpatient operations performed, there was no difference in hours worked between women and men (beta-coefficient -2.8, 95% confidence interval -6.4 to 0.7, P = .12). CONCLUSION Gender does not appear to drive the number of hours urologists work per week. There is work hour parity between women and men practicing urologists in both clinical and nonclinical hours. Women are proportionately more likely to pursue fellowship training and hold academic positions.
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Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part. 2: personal life. Surg Today 2017; 48:308-319. [PMID: 28921482 DOI: 10.1007/s00595-017-1586-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the true conditions and perceptions of the personal lives of men and women working as surgeons in Japan. METHODS In 2014, all e-mail subscribed members of the Japan Surgical Society (JSS, n = 29,861) were invited to complete a web-based survey. The questions covered demographic information, work environment, and personal life (including marital status, childcare, and nursing care for adult family members). RESULTS In total, 6211 surgeons (5586 men and 625 women) returned the questionnaires, representing a response rate of 20.8%. Based on the questionnaire responses, surgeons generally prioritize work and spend most of their time at work, although women with children prioritize their family over work; men spend significantly fewer hours on domestic work/childcare than do their female counterparts (men 0.76 h/day vs. women 2.93 h/day, p < 0.01); and both men and women surgeons, regardless of their age or whether they have children, place more importance on the role of women in the family. CONCLUSIONS The personal lives of Japanese surgeons differed significantly according to gender and whether they have children. The conservative idea that women should bear primary responsibility for the family still pertains for both men and women working as surgeons in Japan.
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