The Benefits of “Bottom Up” Approaches in Affirmative Action

Affirmative action policies often encounter resistance even among those groups who they are designed to help. One of the reasons for this is that they are typically implemented in a “top down” fashion: Those in leadership positions within or outside of an organisation identify the need for affirmative action, decide on the policies and “force” them on the organisation.

A study by Louise McCall and colleagues addresses this issue by investigating whether a “bottom up” approach is more effective. They used focus groups to raise awareness of the under-representation of women in senior positions in academic medicine and to develop equal opportunity strategies. This approach did indeed result in a number of benefits. Not only did members of the focus groups come up with their own ideas of addressing gender inequality, but members of the faculty were also more accepting and supportive of the developed affirmative action strategies.

Lack of acceptance of affirmative action has been shown to be one of the main barriers to its effectiveness. Using focus groups or other “bottom up” approaches might be a great way of circumventing this problem and tackling inequality issues more effectively.

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Class-Based Affirmative Action in Medicine

Although women remain under-represented in surgery, there has been a huge change in the number of women in medicine in general and they now make up about half of new medical students. Unfortunately, things look quite different with regards to socioeconomic status (SES).

Speaking from an American perspective Stephen Magnus and Stephen Mick discuss the literature on whether medical school should adopt an affirmative action approach with regards to social class and come to the conclusion that this may indeed be beneficial for a number of reasons. First and foremost, it would contribute to presenting equal opportunities to all members of societies. Lower SES students have to face a variety of additional obstacles compared to their higher SES counterparts and affirmative action would counteract some of these obstacles.

In addition to that, the authors also make compelling arguments that affirmative action policies would benefit lower SES patients as well. First, evidence suggests that doctors from lower SES backgrounds are better at communicating with lower SES patients and second, doctors from lower SES backgrounds are more likely to offer medical services to lower SES patients in the first place.

On the other hand, critics of affirmative action often argue that these policies stigmatise minority groups, who are already battling with negative stereotypes. What do you think?

The Impact of Work Hour Restrictions in Surgery

Surgery is a time demanding job and that is indeed one of the reasons cited by female and male medical students alike of why they are not interested in going into surgery. While many people argue that long work hours are necessary to avoid frequent handoffs of care and loss of information, others point out that long work hours are detrimental for both physical and mental health and can lead to additional errors.

A study speaking to this issue comes from the US, where Matthew Hutter and colleagues investigated the effects of mandated restrictions in the work hours of surgical residents. Notably, we are not talking about restrictions that would make their work hours “normal” by any regular-work-person standards. Their work was restricted to 80 hours a week. But even so, they found effects after the changes were implemented including decreased burnout and increased quality of life. However, participants also voiced concerns about reduced quality of care.

These issues are of course also important for part-time work, which seems to be an option that many women in surgery would like to opt for. So how can the same benefits be achieved while maintaining a high quality of care for patients?

Working Part-Time?

Last week we reported some interesting findings on the effects of different arrangement aimed at helping women in the workplace on female physician’s career motivation. Today, we would like to focus on other effects of those measures, working part-time. This measure aims to give women, especially those with kids, the opportunity to spend more time at home without abandoning their careers. However, a study by Rosemary Crompton and Clare Lyonette shows how problematic part-time work can be. In their qualitative study with accountants and physicians they find that working part-time is perceived as quite detrimental to women’s careers and the type of work they can do, especially for physicians working in hospitals. One participant notes:

“a lot of the time the part-time posts are just waiting list initiatives, you know, they need somebody to see this number of back pains or this number of people with such and such, whereas a full-time post, you’re part of a team, you’re setting up a service or doing something a bit more meaningful. So it would be difficult to get the equivalent post as a part-time person, I think.”

The authors also note that women in medicine try to avoid specialties in which part-time work might be detrimental (such as surgery) and prefer going into General Practice, which is perceived as more family friendly. On the bright side – at least for all you women in medicine – , the authors find that women in medicine fare considerably better than those in accountancy. However, whether that holds true for women in surgery, is another question.