Exploring gender differences in the working lives of UK hospital consultants

Exploring gender differences in uptake of GP partnership roles: a qualitative mixed-methods study

BACKGROUND

The unadjusted gender pay gap in general practice is reported to be 33.5%. This reflects partly the differential rate at which women become partners, but evidence exploring gender differences in GPs' career progression is sparse.

AIM

To explore factors affecting uptake of partnership roles, focusing particularly on gender differences.

DESIGN AND SETTING

Convergent mixed-methods research design using data from UK GPs.

METHOD

Secondary analysis of qualitative interviews and social media analysis of UK GPs' Twitter commentaries, which informed the conduct of asynchronous online focus groups. Findings were combined using methodological triangulation.

RESULTS

The sample comprised 40 GP interviews, 232 GPs tweeting about GP partnership roles, and seven focus groups with 50 GPs. Factors at individual, organisational, and national levels influence partnership uptake and career decisions of both men and women GPs. Desire for work-family balance (particularly childcare responsibilities) presented the greatest barrier, for both men and women, as well as workload, responsibility, financial investment, and risk. Greater challenges were, however, reported by women, particularly regarding balancing work-family lives, as well as prohibitive working conditions (including maternity and sickness pay) and discriminatory practices perceived to favour men and full-time GPs.

CONCLUSION

There are some long-standing gendered barriers that continue to affect the career decisions of women GPs. The relative attractiveness of salaried, locum, or private roles in general practice appears to discourage both men and women from partnerships presently. Promoting positive workplace cultures through strong role models, improved flexibility in roles, and skills training could potentially encourage greater uptake.

Neurology faculty comfort and experience with communication skills

BACKGROUND

Neurology faculty care for complex patients, teach, and work within multidisciplinary teams. It is imperative for faculty to have strong communication skills.

METHODS

We surveyed NYU neurology teaching faculty to determine levels of comfort and experience over the past year with providing negative feedback to a trainee; debriefing after an adverse clinical outcome; and assisting a struggling colleague. We examined the relationship between levels of comfort and experience with 1) faculty self-identified sex and 2) number of years since completion of medical training.

RESULTS

The survey was completed by 36/83 teaching neurology faculty (43 %); 17 (47 %) respondents were female and 21 (58 %) were ≤10 years post-training. The proportions of faculty who reported feeling uncomfortable were 44 % (16/36) for assisting a struggling colleague, 28 % (10/36) for providing negative feedback, and 19 % (7/36) for debriefing an adverse outcome. Proportions of faculty who reported they had no experience were 75 % (27/36) for assisting a struggling colleague, 39 % (14/36) for debriefing an adverse clinical event, and 17 % (6/36) for providing negative feedback. Female respondents and faculty who were ≤10 years post-training were more likely to report feeling uncomfortable with assisting a struggling colleague and to have had no experience doing so in the past year. On multivariate analyses accounting for sex and experience, sex remained independently associated with feeling uncomfortable with assisting a struggling colleague (OR = 12.2, 95 % CI: 2.1-69.6, p = 0.005).

CONCLUSION

Faculty development may be needed to improve comfort and experience with challenging communication-based interactions. Female faculty and faculty early in their careers may benefit most.

Distribution of male and female procedural and surgical specialists in Australia

Objective This study examined the distribution of the sexes across Australian medical procedural specialties in 2017 and investigated the proportion of currently registered female specialists based on their graduation date from 1969 to 2008. Methods A cross-sectional analysis of current Australian procedural and surgical specialists registered with the Australian Health Practitioner Registration Agency as of January 2017 was undertaken. Participants included 4851 surgical specialists (594 female, 4257 male) and 14948 specialists in specialties with high levels of procedural clinical work (4418 female, 10530 male). The number of male and female specialists across each procedural specialty and the medical school graduation date of current female specialists were analysed. Results In 2017, female fellows represented only one in 10 surgeons and three in 10 procedural specialists. All surgical specialties are underrepresented by female specialists. Cardiology is least represented by female practitioners (one in 10), followed by intensive care and ophthalmology (two in 10). General surgery, otolaryngology and urology saw more female specialists with graduation dates between 1983 and 2003 compared with the other surgical specialties. Conclusion The number of female practitioners registered as specialists is increasing, but they continue to be underrepresented at specialist level across many procedural and surgical specialties. What is known about the topic? Although the number of female students entering medical school now outnumbers that of males, female practitioners remain underrepresented at the specialist level. What does this paper add? Surgery continues to be underrepresented by female specialists, but general surgery, otolaryngology and urology have shown increases in females reaching specialist level. All procedural specialties have shown increasing numbers of female practitioners reaching the specialist level. What are the implications for practitioners? All surgical specialties and nearly all procedural specialties need to adopt evidence-based practices to make their training programs both appealing and sustainable to female trainees in order to work towards achieving gender parity.

Sexism experienced by consultant cardiologists in the United Kingdom

OBJECTIVES

The aims were to compare the frequency with which male and female cardiologists experience sexism and to explore the types of sexism experienced in cardiology.

METHODS

A validated questionnaire measuring experiences of sexism and sexual harassment was distributed online to 890 UK consultant cardiologists between March and May 2018. χ² tests and pairwise comparisons with a Bonferroni correction for multiple analyses compared the experiences of male and female cardiologists.

RESULTS

174 cardiologists completed the survey (24% female; 76% male). The survey showed that 61.9% of female cardiologists have experienced discrimination of any kind, mostly related to gender and parenting, compared with 19.7% of male cardiologists. 35.7% of female cardiologists experienced unwanted sexual comments, attention or advances from a superior or colleague, compared with 6.1% of male cardiologists. Sexual harassment affected the professional confidence of female cardiologists more than it affected the confidence of male cardiologists (42.9% vs 3.0%), including confidence with colleagues (38% vs 10.6%) and patients (23.9% vs 4.6%). 33.3% of female cardiologists felt that sexism hampered opportunities for professional advancement, compared with 2.3% of male cardiologists.

CONCLUSION

Female cardiologists in the UK experience more sexism and sexual harassment than male cardiologists. Sexism impacts the career progression and professional confidence of female cardiologists more, including their confidence when working with patients and colleagues. Future research is urgently needed to test interventions against sexism in cardiology and to protect the welfare of female cardiologists at work.

Gender Matters: A Gender Analysis of Healthcare Workers’ Experiences during the First COVID-19 Pandemic Peak in England

The coronavirus (COVID-19) arrived in the United Kingdom (UK) in February 2020, placing an unprecedented burden on the National Health Service (NHS). Literature from past epidemics and the COVID-19 pandemic underscores the importance of using a gender lens when considering policy, experiences, and impacts of the disease. Researchers are increasingly examining the experiences of healthcare workers (HCWs), yet there is a dearth of research considering how gender shapes HCWs’ personal experiences. As the majority of HCWs in the UK and worldwide are women, research that investigates gender and focuses on women’s experiences is urgently needed. We conducted an analysis of 41 qualitative interviews with HCWs in the British NHS during the first peak of the COVID-19 pandemic in the Spring of 2020. Our findings demonstrate that gender is significant when understanding the experiences of HCWs during COVID-19 as it illuminates ingrained inequalities and asymmetrical power relations, gendered organizational structures and norms, and individual gendered bodies that interact to shape experiences of healthcare workers. These findings point to important steps to improve gender equality, the wellbeing of healthcare workers, and the overall strength of the NHS.

Gender gap in research: a bibliometric study of published articles in primary health care and general internal medicine

BACKGROUND

Many studies examined gender inequalities in research, but only a few data are available for general biomedical journals. We assessed the prevalence of female first authorship in general biomedical journals and examined its variations across a number of author, article and journal characteristics.

METHODS

This study was nested within a larger project designed to analyze the bibliometric characteristics of scientific articles. We retrieved 767 randomly selected articles published in 2016 in high impact factor journals of primary healthcare (n = 9) and general internal medicine (n = 9). We extracted the following data: author (gender, number of publications and affiliation of the first author), paper (number of authors, number of participants and study design) and journal characteristics (journal discipline and 2015 impact factor). We compared the proportion of articles authored by women and men using univariate and multivariate logistic regressions adjusted for intra-cluster correlations.

RESULTS

The female authorship proportion was 48% (63% for primary healthcare and 33% for general internal medicine, P-value < 0.001). In multivariate analysis, women published fewer articles (<5 versus >15 publications: OR 1.6 [95% CI 1.1-2.4]), were more often affiliated with institutions in the Western world (OR 2.2 [95% CI 1.2-3.9]), were more likely to publish qualitative studies (versus systematic reviews or experiments: OR 2.7 [95% CI 1.5-4.8]) and to publish in primary healthcare journals (OR 1.7 [95% CI 1.1-2.7]).

CONCLUSIONS

The underrepresentation of women in articles published by general internal medicine journals, in articles from the non-Western world and in systematic reviews and trials should be addressed.

General internal medicine and family medicine journals: Comparative study of published articles using bibliometric data

Like research in general internal medicine, family medicine research can play an important role in improving medical knowledge. We aimed to compare articles published in family medicine journals with articles published in general internal medicine journals. In this bibliometric study, we retrieved 658 randomly selected quantitative articles published in 2016 in 18 high impact factor journals of family medicine and general internal medicine. We extracted the following data: author (gender, number of publications, and place of residence of the first author), paper (number of participants, study design) and journal characteristics (journal discipline, 2015 impact factor). We compared the two groups of articles, using multivariate logistic regressions adjusted for impact factor and intra-cluster correlations. The first author of the articles published in family medicine journals, compared to general internal medicine journals, was more often a woman (OR 2.8 [95%CI 1.8-4.4], P-value < .001), living in the Western world (OR 14.4 [95%CI 6.0-34.4], P-value < .001), and a less experienced researcher (<5 vs >15 publications: OR 2.4 [95%CI 1.5-4.0], P-value .01). In addition, these studies generally included more participants (>1000 vs <100: OR 3.5 [95%CI 1.4-8.6], P-value .02). There was no statistically significant difference in the study design between the two groups of articles (P-value .25). Despite some differences between the two groups of articles, studies published in family medicine journals do not appear to be any less ambitious in terms of study design and sample size than those published in general internal medicine journals.

The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study

BACKGROUND

A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex.

METHODS

A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis.

RESULTS

One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all.

CONCLUSIONS

In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching.

TRIAL REGISTRATION

Non interventional thus not required.

Impact of gender on the career development of female traditional Korean medicine doctors: a qualitative study

OBJECTIVE

This study aims to examine the impact of gender and expected gender roles on the career development of young female traditional Korean medicine (KM) doctors.

DESIGN

We conducted semistructured interviews to examine the experiences of study subjects regarding early career choices, employment, job performance and career moves, as well as future career aspirations, from the perspective of gender. The transcription was analysed using the Strauss and Corbin constant comparative analysis method.

SETTING

The interview was conducted at a quiet and comfortable place selected by the participants in South Korea.

PARTICIPANTS

Ten female KM doctors in their 30s participated in the study.

RESULTS

This study reveals that, initially, the participating female KM doctors were unaware of their gender affecting career decisions. However, after graduation and during employment, female doctors experienced direct discrimination or gender segregation while selecting areas of treatment and specialty; they found that they were preferred to work in paediatrics and dermatology departments than in departments treating musculoskeletal health problems. Furthermore, after entering the workforce, female KM doctors found that their gender significantly affects patient-doctor relationships and life events, such as pregnancy and childbirth require temporary career breaks. In addition, female KM doctors assumed stereotypical gender roles both in the workplace and at home, as well as becoming the main nurturer of their children.

CONCLUSION

Gender and stereotyped gender roles affect the overall career planning, career moves and even patient-doctor relationships of female KM doctors. Female doctors were also more likely to experience specific gender roles in the workplace and at home, including both childbirth and childrearing.

Sex and Care: The Evolutionary Psychological Explanations for Sex Differences in Formal Care Occupations

Men and women exhibit clear differences in occupational choices. The present article elucidates sex differences in terms of formal care occupational choices and care styles based on evolutionary psychological perspectives. Broadly (1) the motivation to attain social status drives male preference for occupations that signals prestige and the desire to form interpersonal affiliation underlies female preference for occupations that involve psychosocial care for people in need; (2) ancestral sex roles leading to sexually differentiated cognitive and behavioral phenotypic profiles underlie present day sex differences in care styles where men are things-oriented, focusing on disease management while women are people-oriented, focusing on psychosocial management. The implications for healthcare and social care are discussed and recommendations for future studies are presented.

Maternal air pollution exposure and preterm birth in Wuxi, China: Effect modification by maternal age

BACKGROUND

Numerous studies have investigated prenatal air pollution and shown that air pollutants have adverse effect on birth outcomes. However, which trimester was the most sensitive and whether the effect was related to maternal age is still ambiguous.

OBJECTIVES

This study aims to explore the association between maternal air pollution exposure during pregnancy and preterm birth, and if this relationship is modified by maternal age.

METHODS

In this retrospective cohort study, we examine the causal relationship of prenatal exposure to air pollutants including particulate matters, which are less than 10 µm (PM₁₀), and ozone (O₃), which is one of the gaseous pollutants, on preterm birth by gestational age. A total of 6693 pregnant women were recruited from Wuxi Maternal and Child Health Care Hospital. The participants were dichotomized into child-bearing age group (< 35 years old) and advanced age group (> = 35 years old) in order to analyze the effect modification by maternal age. Logistic and linear regression models were performed to assess the risk for preterm birth (gestational age < 37 weeks) caused by prenatal air pollution exposure.

RESULTS

With adjustment for covariates, the highest level of PM₁₀ exposure significantly increased the risk of preterm birth by 1.42-fold (95% CI: 1.10, 1.85) compared those with the lowest level in the second trimester. Trimester-specific PM₁₀ exposure was positively associated with gestational age, whereas O₃ exposure was associated with gestational age in the early pregnancy. When stratified by maternal age, PM₁₀ exposure was significantly associated with an increased risk of preterm birth only in the advanced age group during pregnancy (OR:2.15, 95% CI: 1.13, 4.07). The results suggested that PM₁₀ exposure associated with preterm birth was modified by advanced maternal age (OR _interaction = 2.00, 95% CI: 1.02, 3.91, P_interaction = 0.032).

CONCLUSION

Prenatal air pollution exposure would increase risk of preterm birth and reduced gestational age. Thus, more attention should be paid to the effects of ambient air pollution exposure on preterm birth especially in pregnant women with advanced maternal age.

Validity of the Parental Burnout Inventory Among Dutch Employees

The purpose of this study was to validate the Parental Burnout Inventory (PBI) in a Dutch sample of working parents. The Dutch version of the PBI and questionnaires about work were administered to 627 working parents, with at least one child living at home. We investigated whether the tri-dimensional structure of the PBI held in a sample of male and female employed parents. Furthermore, we examined the relationships between PBI and the constructs work-related burnout, depressive mood, parenting stress and work-family conflict, which we assessed with widely used and validated instruments, i.e., emotional exhaustion [a subscale of the Dutch version of Maslach's Burnout Inventory], a Dutch Parental Stress Questionnaire and Work-Family Conflict. The results support the validity of a tri-dimensional parental burnout syndrome, including exhaustion, distancing and inefficacy. Low to moderate correlations between parents' burnout symptoms and professional exhaustion, parenting stress, depressive complaints and work-family conflict experiences were found, suggesting that the concept of PBI differs significantly from the concepts of job burnout, depression and stress, respectively. The current study confirms that some parents are extremely exhausted by their parental role. However, the number of Dutch employees reporting extreme parental burnout is rather low.

Social capital in a regional inter-hospital network among trauma centers (trauma network): results of a qualitative study in Germany

Background

As inter-hospital alliances have become increasingly popular in the healthcare sector, it is important to understand the challenges and benefits that the interaction between representatives of different hospitals entail. A prominent example of inter-hospital alliances are certified ‘trauma networks’, which consist of 5-30 trauma departments in a given region. Trauma networks are designed to improve trauma care by providing a coordinated response to injury, and have developed across the USA and multiple European countries since the 1960s. Their members need to interact regularly, e.g. develop joint protocols for patient transfer, or discuss patient safety. Social capital is a concept focusing on the development and benefits of relations and interactions within a network. The aim of our study was to explore how social capital is generated and used in a regional German trauma network.

Methods

In this qualitative study, we performed semi-standardized face-to-face interviews with 23 senior trauma surgeons (2013-14). They were the official representatives of 23 out of 26 member hospitals of the Trauma Network Eastern Bavaria. The interviews covered the structure and functioning of the network, climate and reciprocity within the network, the development of social identity, and different resources and benefits derived from the network (e.g. facilitation of interactions, advocacy, work satisfaction). Transcripts were coded using thematic content analysis.

Results

According to the interviews, the studied trauma network became a group of surgeons with substantial bonding social capital. The surgeons perceived that the network’s culture of interaction was flat, and they identified with the network due to a climate of mutual respect. They felt that the inclusive leadership helped establish a norm of reciprocity. Among the interviewed surgeons, the gain of technical information was seen as less important than the exchange of information on political aspects. The perceived resources derived from this social capital were smoother interactions, a higher medical credibility, and joint advocacy securing certain privileges.

Conclusion

Apart from addressing quality of care, a trauma network may, by way of strengthening social capital among its members, serve as a valuable resource for the participating surgeons. Some member hospitals could exploit the social capital for strategic benefits.

Gender and physician specialization and practice settings in Ecuador: a qualitative study

Background

The increasing proportion of women in the medical profession is a worldwide phenomenon often called the “feminization of medicine.” However, it is understudied in low and middle-income countries, particularly in Latin America.

Methods

Using a qualitative, descriptive design, we explored the influence of gender and other factors on physician career decision-making and experiences, including medical specialty and public vs. private practice, in Quito, Ecuador, through in-depth, semi-structured interviews (n = 31) in 2014. Theoretical sampling was used to obtain approximately equal numbers of women and men and a range of medical specialties and practice settings; data saturation was used to determine sample size. Transcripts were analyzed using content coding procedures to mark quotations related to major topics and sub-themes included in the interview guide and inductive (grounded theory) approaches to identify new themes and sub-themes.

Results

Gendered norms regarding women’s primary role in childrearing, along with social class or economic resources, strongly influenced physicians’ choice of medical specialty and practice settings. Women physicians, especially surgeons, have had to “pay the price” socially, often remaining single and/or childless, or ending up divorced; in addition, both women and men face limited opportunities for medical residency training in Ecuador, thus specialty is determined by economic resources and “opportunity.” Women physicians often experience discrimination from patients, nurses, and, sometimes, other physicians, which has limited their mobility and ability to operate independently and in the private sector. The public sector, where patients cannot “choose” their doctors, offers women more opportunities for professional success and advancement, and the regular hours enable organizing work and family responsibilities. However, the public sector has generally much less flexibility than the private sector, making it more difficult to balance work and family responsibilities.

Conclusion

Women may outnumber men in medicine in Ecuador and across many parts of the world, but a number of structural issues-economic, social, and cultural-must be addressed for women to establish themselves in a wide variety of medical specialties and practice settings and for countries to realize the benefit of the investments being made to train and employ them.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1917-1) contains supplementary material, which is available to authorized users.

Factors associated with less-than-full-time working in medical practice: results of surveys of five cohorts of UK doctors, 10 years after graduation

BACKGROUND

The greater participation of women in medicine in recent years, and recent trends showing that doctors of both sexes work fewer hours than in the past, present challenges for medical workforce planning. In this study, we provide a detailed analysis of the characteristics of doctors who choose to work less-than-full-time (LTFT). We aimed to determine the influence of these characteristics on the probability of working LTFT.

METHODS

We used data on working patterns obtained from long-term surveys of 10,866 UK-trained doctors. We analysed working patterns at 10 years post-graduation for doctors of five graduating cohorts, 1993, 1996, 1999, 2000 and 2002 (i.e. in the years 2003, 2006, 2009, 2010 and 2012, respectively). We used multivariable binary logistic regression models to examine the influence of a number of personal and professional characteristics on the likelihood of working LTFT in male and female doctors.

RESULTS

Across all cohorts, 42 % of women and 7 % of men worked LTFT. For female doctors, having children significantly increased the likelihood of working LTFT, with greater effects observed for greater numbers of children and for female doctors in non-primary care specialties (non-GPs). While >40 % of female GPs with children worked LTFT, only 10 % of female surgeons with children did so. Conversely, the presence of children had no effect on male working patterns. Living with a partner increased the odds of LTFT working in women doctors, but decreased the odds of LTFT working in men (independently of children). Women without children were no more likely to work LTFT than were men (with or without children). For both women and men, the highest rates of LTFT working were observed among GPs (~10 and 6 times greater than non-GPs, respectively), and among those not in training or senior positions.

CONCLUSIONS

Family circumstances (children and partner status) affect the working patterns of women and men differently, but both sexes respond similarly to the constraints of their clinical specialty and seniority. Thus, although women doctors comprise the bulk of LTFT workers, gender is just one of several determinants of doctors' working patterns, and wanting to work LTFT is evidently not solely an issue for working mothers.

Women in medicine: historical perspectives and recent trends

INTRODUCTION

Women now outnumber men in British medical schools. This paper charts the history of women in medicine and provides current demographic trends.

SOURCES OF DATA

A historical literature review and routinely collected data from Department of Health and the Health and Social Care Information Centre.

AREAS OF AGREEMENT

Clear gender differences are apparent in working practices, including greater likelihood of working part time and specializing in certain areas of medicine.

AREAS OF CONTROVERSY

The increasing need to increase activity among the existing medical workforce is timely amidst a changing workforce demographic.

GROWING POINTS

Workforce planners, policymakers and Royal Colleges should continue to develop interventions that may reduce disparities in career choices, as well as considering ways to increase participation and activity.

AREAS TIMELY FOR DEVELOPING RESEARCH

Further research is needed to explore the cost-effectiveness of existing and future interventions in this field.