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.

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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.

“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.

Are Female Doctors With Young Children Less Motivated?

No. No they aren’t. Although it is often claimed that career motivation suffers from having children – at least for women – a study by Berber Pas and colleagues from the Netherlands finds that this is not necessarily the case. Neither being a mother nor the age of the youngest child significantly predicted career motivation.

What did matter, however, was one’s view on motherhood. Those who had more traditional views on what a mother ought to be (e.g. spending most of their time with their children) were less motivated than those who had more modern views on this issue. Moreover, a supportive work environment – especially supervisor’s support for one’s career goals – was beneficial for career motivation of female doctors.

This clearly shows that the negative attitude of some employers towards working mothers – or those who might one day become mothers – is quite unwarranted. Instead, it is important to focus on supporting female doctor’s career goals and changing unrealistic expectations of what a “good mother” is.

Climbing the Surgical Career Ladder as a Woman

While women are under-represented in surgery in general, this under-representation is even more pronounced among surgical leaders. Nevertheless, there are women who have made it to the top of the surgical career ladder. How did they do it and what can we learn from them?

Rena Kass and colleagues can give us some answers. They interviewed ten female surgical leaders and asked them about barriers for women in surgery and how to overcome them. Almost all participants mentioned overt discrimination as a major barrier. For example, one participant explained:

“I would go on interviews and people would ask ‘What makes you think that you can tell a group of … mostly male surgeons, what to do and that they are going to listen to you?’ They would phrase it in various ways but … they were all really asking ‘Look, you’re a woman, you’re soft spoken, you don’t look like what we expect, what makes you think … you can come here and run the place?”

Other obstacles mentioned included the lack of effective mentors, a hostile work environment and personal illness.

So what do you need to overcome these barriers and make it to the top? The majority of participants mentioned perseverance and resilience as one of the most important attributes necessary to overcome barriers. As one of them put it:

“perseverance and not taking ‘no’ for an answer. When I was in high school the guidance counselor told me that women did not become doctors … then, when I did not get into medical school, the pre-med advisor … said ‘why don’t you just settle down and be an engineer?’ I said no, I want to be a doctor … I reapplied and got in. When I got out of my training and didn’t have any publications, my chairman said, ‘it’s going to be an uphill battle, being an academic surgeon’. I said, well that’s what I want to be. So I would say … the thing that distinguishes the ones who make it through to the end is perseverance, desire, and drive.”

Other important attributes included being hard-working and passionate, having a good support structure and communication skills.

Gender Equality of Surgeons at Home

There are a number of studies about gender differences of surgeons out there – but are there gender differences in surgeons’ spouses? Although we have never asked ourselves this question before, we stumbled across a survey which investigated just this and thought it quite interesting. After all, spousal support is without a doubt an important factor in career satisfaction or life satisfaction more generally.

Interestingly, there was no gender difference in percentage of respondents who had children or in number of children. The myth of the childless career woman thus seems to be just that – a myth. There was, however, a gender difference in whether or not spouses had a job outside of the home. While 88% of male spouses worked outside of the home, only 55% of female spouses did so. Both male and female spouses indicated that they would be happier if their spouse worked less. Maybe unsurprisingly female spouses indicated that they carried most of the responsibilities for home and childcare whereas this was not the case for male spouses – and this held true regardless of the working hours of the spouse. This is problematic, as it indicates that female surgeons have an overall higher workload than their male counterparts – and while a number of initiatives aim at improving work conditions for women at work, the differential work load outside of the workplace remains largely unaddressed.

Patients’ Perceptions of Female Doctors

Female doctors, especially those in their early careers, might be worried about being judged as less competent than their male counterparts by colleagues and patients alike. However, research by Shah and Ogden suggests that young female doctors should be more confident in how they are perceived, at least by patients.

In their study they presented patients with one of eight pictures of a doctor who was either young or old, male or female and Asian or White and asked them about their perceptions of and reactions to those doctors, for example how comfortable they would feel with the doctor physically examining them or how good they thought the doctor would be at explaining the cause of their symptoms to them. While Asian and White doctors were perceived quite similarly, young and female doctors were overall evaluated more positively. For example, patients believed that younger doctors were more likely to have a positive personal manner and better technical skills. They also stated that they would have more faith into the younger doctors’ diagnosis. Similarly, female doctors were – maybe not surprisingly – rated as more likely to explore the emotional aspects of health and having a better personal manner. However, contrary to stereotypes, they were also rated as having better technical skills and patients had more faith in their diagnoses.

So can we hope that we are slowly moving away from the stereotype of the old, white, male doctor? Patients certainly seem to do so!

Work-Life-Balance and Burnout in Female and Male Hospital Doctors

As women continue to carry a larger part of the responsibilities regarding housekeeping and childcare, it is not surprising that they generally find it harder to achieve satisfactory levels of work-life-balance in occupations that are generally associated with long working hours such as medicine. A recent survey study looked at how the perception of hospital doctors’ work-life-balance was related to burnout and intentions to quit their job and how whether this depended on gender.

The author found that work-life-balance was the most important predictor of burnout and that support from superiors and co-workers as well as working in a family friendly environment significantly lowered burnout. Interestingly, support from co-workers was the most important factor for female doctors, whereas support from one’s superiors and working in a family friendly work environment was more important for male doctors. Similarly, work-life-balance and support for co-workers were related to female but not male doctors’ intentions to quit, while working on a rota working pattern was predictive of male but not female doctors’ intentions to quit. Overall, women also reported higher levels of burnout.

This is interesting, as it shows that reducing burnout and retaining skilled doctors, might be achieved quite differently for men and women. It also shows that the fact that women are still responsible for the majority of domestic tasks is reflected in their higher need for a work-life-balance and that this issue needs to be addressed, both at and outside of the workplace.

Gender and Mentoring in Medicine

Mentoring is an often quoted path for career success in medicine and other careers alike and there are some studies that corraborate this idea. A study by Stamm and Buddenberg-Fischer investigates this notion in the field of medicine using a Swiss sample.

In their longitudinal study they examined the influence of mentoring during specialist training and found that, indeed, having a mentor and receiving psychosocial support from a mentor during this time was related to higher career success both in objective measures such as such as academic advancements and subjective measures, as well as career satisfaction. Receiving career support from a mentor on the other hand was related to subjective and objective career success, but not to career satisfaction. With regards to gender, about  60% of men but only about 41% of women reported having a mentor during their specialist training. The authors argue that these issues could and should be resolved by formal mentoring programs. Interestingly, however, their study indicates that gender of the mentor might not be as relevant. Women and men in their study did not differ with regards to the preferred gender of their mentor.

Why Medical Students Choose Surgery – And Why They Don’t

In order to understand why women do or do not go into surgery, it is important to understand what motivates medical students to go into surgery in general. A questionnaire study by Glynn and Kerin from 2010 looked at just that.

Overall, about 20% of respondents said that they would like a career in surgery. Interestingly, this was true regardless of gender. However, when asked about whether it was likely for them to actually end up in surgery, the number dropped to 13% and was significantly higher for men than women. The most important factors that influenced planning to go into surgery were employment, career opportunities and intellectual challenge. Moreover, prestige was an important factor for those who could see themselves becoming surgeons. Medical students who highly valued their lifestyle during training, on the other hand, were less likely to indicate an interest in a future career in surgery.

But what about women in particular? Well, the authors found that on-call schedules, patient relationships and lifestyle after training were more important for female compared to male medical students. Also, for medical students with medical family backgrounds gender mattered more than for those who did not come from medical families. This is interesting, as it points to the fact that family members might not only work as positive role models who show what is possible, but can rather also strengthen existing gender stereotypes in medicine.