Marriage, Children and Happiness at Work

Work-life-balance or the anticipated and actual lack thereof is a widely cited cause for the under-representation of women in surgery. This is especially true for women who have a family or are planning to have one as women continue to carry most of the weight when it comes to childcare and household chores.

A study by Sullivan and colleagues investigates this issue in a large sample of surgical residents in the US. They found that generally married residents and those with children have the highest levels of work satisfaction. However, this difference was driven by male participants. As expected, female residents reported high levels of stress regarding home life as well as finances when they were married or had children.

These results once again stress that while creating equal opportunities at work is important, it is not enough to tackle gender inequality. As long as women continue to be responsible for more family related work, it is thus crucial to go beyond that and provide them with opportunities to combine both work and family and still achieve a good work-life-balance.

Social Support in the Medical Profession

Research generally suggests that women receive more social support than men in terms of emotional support. However, there is also evidence that when working in male-dominated fields, women often receive less support in terms of being provided with important information or instrumental help with work tasks. A questionnaire study by Jean Wallace from the University of Calgary investigates these issues in the medical profession.

In line with previous research she finds that women receive (or at least report receiving) more emotional support than their male colleagues. However, her results do not show a gender difference in instrumental support and women actually report receiving more rather than less informational support.

This is encouraging in that it shows that women are actually well integrated in supported in the medical field. On the other hand, the results might also simply be a reflection of the fact that women are more willing to admit receiving help.

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.

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.

The Conflicting Roles of Female Doctors

Working women with children in general and those in masculine domains in particular are confronted with a dilemma: Based on traditional gender roles, the ideal of a good mother requires them to focus most of their attention on their children and make sure they spend enough time at home, while the ideal of a good worker involves being committed to their job and able to focus most of their time and attention on work related issues. Men don’t face this issue as the ideal father is mostly characterised by being able to provide for their family, which is not in conflict with the ideal worker. So how do women deal with this conflict and how does it relate to their career motivation? Moreover, how can organisations alleviate this conflict?

A study by Berber Pas and colleagues from the Netherlands distinguishes between four different groups of women: Those who identified with the role of the ideal mother but not the role of the ideal worker (the authors call this the care goal frame), those who identify highly with the role of the ideal worker but not the role of the ideal mother (career goal frame), those who identify highly with both (switching goal frames) and those who don’t identify highly with either (non-traditional goal frames).

They further distinguish between three different types of policies which organisations implement in order to help working mothers. One set of arrangements aims at providing working mothers with the opportunity to fulfill their role as an ideal mother and spend more time with their children (ideal mother arrangements), for example part-time work arrangements. Another set of measures (ideal worker arrangements) aims at helping women to fulfill their roles as ideal workers, for example by providing coaching and mentoring. The last set of arrangements (revising work-culture arrangements) includes measures such as flexible work hours and is generally presented in a non-gendered way.

They investigated the relationship between these variables and career motivation in a large sample of female physicians and found that those women with switching goal frames were just as motivated as those with career goal frames and more motivated than the other two groups. Not surprisingly, the effectiveness of measures to increase women’s motivation depended on their goal frames. Women with career goal frames benefited from ideal worker arrangements whereas those with care goal frames benefited from ideal mother arrangements. Revising work-culture arrangements were overall the most motivating regardless of goal frames.

For more details, please check out the original paper, which is a very fascinating read.

Female and Male Surgeons’ Interactions with Patients

There are a number of benefits of involving patients in medical decision making, from legal concerns to quicker recovery in surgery patients. But do surgeons themselves see these benefits? And if so, to what degree do their actual interactions with patients reflect this? Are there gender differences? A study by Garcia-Retamero and colleagues can give us some answers.

They collected data from a diverse sample of surgeons from 60 different countries and found that the majority of surgeons agreed that involving patients in medical decision making was desirable. The preference for a collaborative role was more pronounced among female compared to male surgeons. However, when asked about their usual (rather than ideal) role in medical decision making, women were much less likely to be collaborative compared with men – 81% of female surgeons reported that their role was usually “active” (rather than collaborative), compared to 45% of men.

The authors suggest that this discrepancy between preferred and usual roles might be due to the fact that women may feel the need to act in a more “masculine” way in order to be seen as an authority but another possibility might be that female surgeons are simply more critical of their own behaviour.

Obstacles for Women in Pediatric Surgery

Just as any are within surgery, pediatric surgery struggles to recruit women. But what might be some of the barriers women in this field face and how do they influence job satisfaction? In order to investigate this issue, Donna Caniano and colleagues sent out a questionnaire to 95 female pediatric surgeons in the US.

They found that, in line with what female medical students might fear, women in pediatric surgery did express a desire to spend more time with their families and more room for personal interests in their lives. This is obviously an important issue which needs to be addressed. Offering part-time work may be an option and about half of participants showed interest in reduced hours. Moreover, about a third of female pediatric surgeons expressed interest in fixed-time schedules. However, women working in academic surgery were concerned that this would interfere with their career.

On a more positive note, regardless of these issues most women reported high career satisfaction, perceived their career to be rewarding and would make the same career choice again. Nevertheless, the issues raised above need to be addressed in pediatric surgery, but also in surgery in general.

“Being” a Doctor or “Working as” a Doctor?

About half of all new medical students in most Western countries are now female. However, are there differences in how they perceive their future jobs? Eva Johansson and Katarina Hamberg explored this question by analyzing the essays on the theme “to be a doctor” of Swedish medical students. While, overall, the essays written by men and women had a lot of themes in common, there were some interesting differences.

For example, female medical students seemed to approach the identity of being a doctor in a somewhat different way than male medical students. They more often expressed discomfort at “being” a doctor and constructed it as a job rather than an identity. As one participant put it: “If you say ‘to be’ it has a tendency to extend to much more than a job, to comprise your whole personality. At the same time it reduces your personality to what you achieve at work and nothing else. I think I am so much more than a med student.”

This is an interesting point as the degree to which something is part of one’s identity can have a plethora of consequences and the fact that female medical students struggle to integrate their job identity into their general identity may prove problematic. However, it is equally possible that over time these gender differences disappear.

Please feel free to share your own experiences on this matter in the comments.