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Gender Disparities in Work and Parental Status Among Early Career Physicians

Gender Disparities in Work and Parental Status Among Early Career Physicians Research Letter | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Elena Frank, PhD; Zhuo Zhao, MS; Srijan Sen, MD, PhD; Constance Guille, MD Introduction Women now make up half of incoming US medical students. While much progress has been made Author affiliations and article information are listed at the end of this article. toward equalizing levels of entry into the field of medicine for men and women, large gaps in salary 2,3 and leadership positions remain. To gain insight into the timing and drivers of gender gaps for the newest generation of physicians, we followed a cohort of physicians emerging from training for attrition from the workforce and the role of family considerations in decisions about how much to work. Methods Physicians from multiple specialties (Table 1) who enrolled in the prospective longitudinal Intern Health Study from March 2007 to June 2013 completed an online survey about their current employment status (ie, full-time, part-time, or not employed) and gender in August 2016. All participants provided informed consent and were compensated $25. Participants working full-time were asked whether they ever considered working part-time (ie, yes or no). Except for those who reported working full-time and not having ever considered part-time work, all participants responded to an open-text question, “what specific factors influenced your decision to work full- Table 1. Medical Specialties time, part-time, or not at all?” Data were analyzed from June 2018 to June 2019. We conducted χ of 344 Participants analyses to compare gender differences in employment status using SAS version 9.4 statistical Participants, software (SAS Institute). P values less than .05 were considered significant, and all tests were Specialty No. (%) Anesthesiology 15 (4.4) 2-tailed. NVivo11 software (QSR International) was used for word frequency analysis of free-text Dermatology 11 (3.2) responses. Related words were thematically grouped by all of us independently, and group Emergency medicine 14 (4.1) consensus was achieved. We followed the Strengthening the Reporting of Observational Studies in Family medicine 13 (3.8) Epidemiology (STROBE) reporting guideline, and the University of Michigan institutional review board Internal medicine 91 (26.5) approved the study. Internal medicine, 12 (3.5) pediatrics Medical genetics 1 (0.3) Missing 2 (0.6) Results Neurology 6 (1.7) Overall, 344 of 486 participants (70.8%) agreed to take part in the survey (177 [51.5%] women; Nuclear medicine 2 (0.6) median [interquartile range] age, 35.0 [34.0-36.5] years). Participants had completed their medical Obstetrics and gynecology 14 (4.1) training a mean (SD) of 3.2 (1.7) years before completing the survey. A total 298 participants (86.6%) Ophthalmology 12 (3.5) reported currently working full-time, 39 (11.3%) part-time, and 7 (2.0%) not at all. Women physicians Other 37 (10.8) were significantly more likely to report not working full-time than men physicians (40 of 177 [22.6%] Otolaryngology 5 (1.5) vs 6 of 167 [3.6%]; odds ratio [OR], 7.83; 95% CI, 3.22-19.04) (Table 2), and differences were even Pathology, anatomic and 4 (1.2) clinical greater among women with children compared with men with children (33 of 108 [30.6%] vs 5 of Pediatrics 40 (11.6) 109 [4.59%]; OR, 9.15; 95% CI, 3.41-24.54). A 9.6% gender gap in full-time employment (24 of 27 Preventive medicine 1 (0.3) men [88.9%] vs 23 of 29 women [79.3%]) was present in the first year after training and grew to Psychiatry 25 (7.3) 38.7% by 6 years after training (21 of 21 men [100%] vs 19 of 31 women [61.3%]). Of physicians Radiation oncology 2 (0.6) currently working full-time, women were significantly more likely to report considering part-time Radiology, diagnostic 10 (2.9) work compared with men (87 of 135 [64.4%] vs 33 of 156 [21.2%]; OR, 6.76; 95% CI, 4.01-11.38) Surgery 22 (6.4) Urology 5 (1.5) (Table 2) and differences were even greater among women with children compared with men with Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 1/3 JAMA Network Open | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Table 2. Current Work Hours by Gender and Years Since Training Years Since No./Total No. (%) Completing Residency Training Male (n = 167) Female (n = 177) Odds Ratio (95% CI) Currently Working Full-time 1 24/27 (88.9) 23/29 (79.3) 2.09 (0.47-9.35) 2 45/47 (95.7) 35/40 (87.5) 3.21 (0.59-17.57) 3 36/36 (100) 23/26 (88.5) 10.87 (4.20-28.15) 4 23/23 (100) 21/29 (72.4) 18.85 (7.40-46.66) 5 12/12 (100) 16/22 (72.7) 9.85 (3.85-25.18) 6 21/21 (100) 19/31 (61.3) 27.56 (11.04-68.60) Currently Working Full-time but Considering Part-time 1 5/24 (21.7) 14/22 (63.6) 6.65 (1.79-24.73) 2 10/44 (22.7) 22/35 (62.9) 5.75 (2.15-15.38) 3 7/34 (20.6) 14/23 (60.9) 6.00 (1.84-19.53) 4 4/22 (18.2) 15/20 (75.0) 13.50 (3.07-59.46) 5 3/12 (25.0) 9/16 (56.3) 3.86 (0.75-19.84) 6 4/20 (20.0) 13/19 (68.4) 8.67 (2.01-37.38) children (52 of 74 [70.3%] vs 19 of 100 [19.0%]; OR, 10.08; 95% CI, 4.98-20.41). Women were more likely than men to mention family as a factor influencing their work status considerations (33 of 87 [37.9%] vs 5 of 33 [15.2%]; OR, 3.42; 95% CI, 1.20-9.74). Overall, 31 of 40 women physicians (77.5%) currently working part-time or not at all cited family as the factor that influenced their employment status decision. Discussion The current generation of young women physicians is the first to come of age in an era when they are not a clear minority in medicine, when women have workplace rights, and when attitudes toward gender roles are increasingly egalitarian. Yet, when it comes to balancing a medical career and a family, our findings suggest that not much has changed. Today’s young women physicians still struggle to have it all and therefore reduce their work hours at substantially higher rates than men in 3-6 an effort to reduce work-family conflict. While our qualitative data support the quantitative responses regarding work-family conflict, future studies using a validated assessment tool, as opposed to a text-based response, may yield additional information. More notable is a substantial gender disparity in work status that emerges immediately following medical training. Within 6 years, almost three-quarters of women physicians reported reducing work hours to part-time or considering part-time work. The emergence of this gap so early in physicians’ careers may contribute to later gender inequities in compensation and promotion and suggests the importance of expanding social and institutional support for work-family balance moving forward. Until policies and a culture allowing women and men to be both parents and physicians are created, women are less likely to be retained and to advance. ARTICLE INFORMATION Accepted for Publication: June 13, 2019. Published: August 2, 2019. doi:10.1001/jamanetworkopen.2019.8340 Open Access: This is an open access article distributed under the terms of the CC-BY License.©2019FrankEetal. JAMA Network Open. Corresponding Author: Constance Guille, MD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Floor 5, South Tower, MSC861, Charleston, SC 29425 (guille@ musc.edu). JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 2/3 JAMA Network Open | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Author Affiliations: Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor (Frank, Zhao, Sen); Department of Psychiatry, Medical School, University of Michigan, Ann Arbor (Sen); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Guille). Author Contributions: Drs Sen and Guille had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Frank, Sen, Guille. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Frank, Guille. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Zhao. Obtained funding: Sen. Administrative, technical, or material support: Zhao, Sen. Supervision: Sen, Guille. Conflict of Interest Disclosures: None reported. Funding/Support: This work was funded by career development award 1K23DA039318-01 from the National Institute on Drug Abuse, grant R01MH101459 from the National Institute of Mental Health, grant UL1-TR001450 from the National Center for Advancing Translational Sciences, and grant 8D477-01 from the American Foundation for Suicide Prevention. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions: We acknowledge and thank the physicians taking part in this research. Without their efforts this study would not be possible. REFERENCES 1. Barzansky B, Etzel SI. Medical schools in the United States, 2017-2018. JAMA. 2018;320(10):1042-1050. doi:10. 1001/jama.2018.11679 2. Rao AD, Nicholas SE, Kachniarz B, et al. Association of a simulated institutional gender equity initiative with gender-based disparities in medical school faculty salaries and promotions. JAMA Netw Open. 2018;1(8):e186054. doi:10.1001/jamanetworkopen.2018.6054 3. Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. Inadequate progress for women in academic medicine: findings from the National Faculty Study. J Womens Health (Larchmt). 2015;24(3):190-199. doi:10.1089/jwh.2014.4848 4. Guille C, Frank E, Zhao Z, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138 5. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353. doi:10.7326/M13-0974 6. Ly DP, Jena AB. Sex differences in time spent on household activities and care of children among US physicians, 2003-2016. Mayo Clin Proc. 2018;93(10):1484-1487. doi:10.1016/j.mayocp.2018.02.018 JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 3/3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Network Open American Medical Association

Gender Disparities in Work and Parental Status Among Early Career Physicians

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10.1001/jamanetworkopen.2019.8340
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Abstract

Research Letter | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Elena Frank, PhD; Zhuo Zhao, MS; Srijan Sen, MD, PhD; Constance Guille, MD Introduction Women now make up half of incoming US medical students. While much progress has been made Author affiliations and article information are listed at the end of this article. toward equalizing levels of entry into the field of medicine for men and women, large gaps in salary 2,3 and leadership positions remain. To gain insight into the timing and drivers of gender gaps for the newest generation of physicians, we followed a cohort of physicians emerging from training for attrition from the workforce and the role of family considerations in decisions about how much to work. Methods Physicians from multiple specialties (Table 1) who enrolled in the prospective longitudinal Intern Health Study from March 2007 to June 2013 completed an online survey about their current employment status (ie, full-time, part-time, or not employed) and gender in August 2016. All participants provided informed consent and were compensated $25. Participants working full-time were asked whether they ever considered working part-time (ie, yes or no). Except for those who reported working full-time and not having ever considered part-time work, all participants responded to an open-text question, “what specific factors influenced your decision to work full- Table 1. Medical Specialties time, part-time, or not at all?” Data were analyzed from June 2018 to June 2019. We conducted χ of 344 Participants analyses to compare gender differences in employment status using SAS version 9.4 statistical Participants, software (SAS Institute). P values less than .05 were considered significant, and all tests were Specialty No. (%) Anesthesiology 15 (4.4) 2-tailed. NVivo11 software (QSR International) was used for word frequency analysis of free-text Dermatology 11 (3.2) responses. Related words were thematically grouped by all of us independently, and group Emergency medicine 14 (4.1) consensus was achieved. We followed the Strengthening the Reporting of Observational Studies in Family medicine 13 (3.8) Epidemiology (STROBE) reporting guideline, and the University of Michigan institutional review board Internal medicine 91 (26.5) approved the study. Internal medicine, 12 (3.5) pediatrics Medical genetics 1 (0.3) Missing 2 (0.6) Results Neurology 6 (1.7) Overall, 344 of 486 participants (70.8%) agreed to take part in the survey (177 [51.5%] women; Nuclear medicine 2 (0.6) median [interquartile range] age, 35.0 [34.0-36.5] years). Participants had completed their medical Obstetrics and gynecology 14 (4.1) training a mean (SD) of 3.2 (1.7) years before completing the survey. A total 298 participants (86.6%) Ophthalmology 12 (3.5) reported currently working full-time, 39 (11.3%) part-time, and 7 (2.0%) not at all. Women physicians Other 37 (10.8) were significantly more likely to report not working full-time than men physicians (40 of 177 [22.6%] Otolaryngology 5 (1.5) vs 6 of 167 [3.6%]; odds ratio [OR], 7.83; 95% CI, 3.22-19.04) (Table 2), and differences were even Pathology, anatomic and 4 (1.2) clinical greater among women with children compared with men with children (33 of 108 [30.6%] vs 5 of Pediatrics 40 (11.6) 109 [4.59%]; OR, 9.15; 95% CI, 3.41-24.54). A 9.6% gender gap in full-time employment (24 of 27 Preventive medicine 1 (0.3) men [88.9%] vs 23 of 29 women [79.3%]) was present in the first year after training and grew to Psychiatry 25 (7.3) 38.7% by 6 years after training (21 of 21 men [100%] vs 19 of 31 women [61.3%]). Of physicians Radiation oncology 2 (0.6) currently working full-time, women were significantly more likely to report considering part-time Radiology, diagnostic 10 (2.9) work compared with men (87 of 135 [64.4%] vs 33 of 156 [21.2%]; OR, 6.76; 95% CI, 4.01-11.38) Surgery 22 (6.4) Urology 5 (1.5) (Table 2) and differences were even greater among women with children compared with men with Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 1/3 JAMA Network Open | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Table 2. Current Work Hours by Gender and Years Since Training Years Since No./Total No. (%) Completing Residency Training Male (n = 167) Female (n = 177) Odds Ratio (95% CI) Currently Working Full-time 1 24/27 (88.9) 23/29 (79.3) 2.09 (0.47-9.35) 2 45/47 (95.7) 35/40 (87.5) 3.21 (0.59-17.57) 3 36/36 (100) 23/26 (88.5) 10.87 (4.20-28.15) 4 23/23 (100) 21/29 (72.4) 18.85 (7.40-46.66) 5 12/12 (100) 16/22 (72.7) 9.85 (3.85-25.18) 6 21/21 (100) 19/31 (61.3) 27.56 (11.04-68.60) Currently Working Full-time but Considering Part-time 1 5/24 (21.7) 14/22 (63.6) 6.65 (1.79-24.73) 2 10/44 (22.7) 22/35 (62.9) 5.75 (2.15-15.38) 3 7/34 (20.6) 14/23 (60.9) 6.00 (1.84-19.53) 4 4/22 (18.2) 15/20 (75.0) 13.50 (3.07-59.46) 5 3/12 (25.0) 9/16 (56.3) 3.86 (0.75-19.84) 6 4/20 (20.0) 13/19 (68.4) 8.67 (2.01-37.38) children (52 of 74 [70.3%] vs 19 of 100 [19.0%]; OR, 10.08; 95% CI, 4.98-20.41). Women were more likely than men to mention family as a factor influencing their work status considerations (33 of 87 [37.9%] vs 5 of 33 [15.2%]; OR, 3.42; 95% CI, 1.20-9.74). Overall, 31 of 40 women physicians (77.5%) currently working part-time or not at all cited family as the factor that influenced their employment status decision. Discussion The current generation of young women physicians is the first to come of age in an era when they are not a clear minority in medicine, when women have workplace rights, and when attitudes toward gender roles are increasingly egalitarian. Yet, when it comes to balancing a medical career and a family, our findings suggest that not much has changed. Today’s young women physicians still struggle to have it all and therefore reduce their work hours at substantially higher rates than men in 3-6 an effort to reduce work-family conflict. While our qualitative data support the quantitative responses regarding work-family conflict, future studies using a validated assessment tool, as opposed to a text-based response, may yield additional information. More notable is a substantial gender disparity in work status that emerges immediately following medical training. Within 6 years, almost three-quarters of women physicians reported reducing work hours to part-time or considering part-time work. The emergence of this gap so early in physicians’ careers may contribute to later gender inequities in compensation and promotion and suggests the importance of expanding social and institutional support for work-family balance moving forward. Until policies and a culture allowing women and men to be both parents and physicians are created, women are less likely to be retained and to advance. ARTICLE INFORMATION Accepted for Publication: June 13, 2019. Published: August 2, 2019. doi:10.1001/jamanetworkopen.2019.8340 Open Access: This is an open access article distributed under the terms of the CC-BY License.©2019FrankEetal. JAMA Network Open. Corresponding Author: Constance Guille, MD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Floor 5, South Tower, MSC861, Charleston, SC 29425 (guille@ musc.edu). JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 2/3 JAMA Network Open | Medical Education Gender Disparities in Work and Parental Status Among Early Career Physicians Author Affiliations: Molecular and Behavioral Neuroscience Institute, University of Michigan, Ann Arbor (Frank, Zhao, Sen); Department of Psychiatry, Medical School, University of Michigan, Ann Arbor (Sen); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston (Guille). Author Contributions: Drs Sen and Guille had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Frank, Sen, Guille. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Frank, Guille. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Zhao. Obtained funding: Sen. Administrative, technical, or material support: Zhao, Sen. Supervision: Sen, Guille. Conflict of Interest Disclosures: None reported. Funding/Support: This work was funded by career development award 1K23DA039318-01 from the National Institute on Drug Abuse, grant R01MH101459 from the National Institute of Mental Health, grant UL1-TR001450 from the National Center for Advancing Translational Sciences, and grant 8D477-01 from the American Foundation for Suicide Prevention. Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Additional Contributions: We acknowledge and thank the physicians taking part in this research. Without their efforts this study would not be possible. REFERENCES 1. Barzansky B, Etzel SI. Medical schools in the United States, 2017-2018. JAMA. 2018;320(10):1042-1050. doi:10. 1001/jama.2018.11679 2. Rao AD, Nicholas SE, Kachniarz B, et al. Association of a simulated institutional gender equity initiative with gender-based disparities in medical school faculty salaries and promotions. JAMA Netw Open. 2018;1(8):e186054. doi:10.1001/jamanetworkopen.2018.6054 3. Carr PL, Gunn CM, Kaplan SA, Raj A, Freund KM. Inadequate progress for women in academic medicine: findings from the National Faculty Study. J Womens Health (Larchmt). 2015;24(3):190-199. doi:10.1089/jwh.2014.4848 4. Guille C, Frank E, Zhao Z, et al. Work-family conflict and the sex difference in depression among training physicians. JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138 5. Jolly S, Griffith KA, DeCastro R, Stewart A, Ubel P, Jagsi R. Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Ann Intern Med. 2014;160(5):344-353. doi:10.7326/M13-0974 6. Ly DP, Jena AB. Sex differences in time spent on household activities and care of children among US physicians, 2003-2016. Mayo Clin Proc. 2018;93(10):1484-1487. doi:10.1016/j.mayocp.2018.02.018 JAMA Network Open. 2019;2(8):e198340. doi:10.1001/jamanetworkopen.2019.8340 (Reprinted) August 2, 2019 3/3

Journal

JAMA Network OpenAmerican Medical Association

Published: Aug 2, 2019

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