Within the framework of our prospective SwissMedCareer Survey , the present paper reports on data acquired in the fifth questionnaire survey in 2009, seven years after cohort doctors' graduation from medical school. It focuses on gender-specific careers, especially on the impact of parenthood, and not on the various career stages between the beginning and the end of residency (T1 - T5).
As reported in other studies [6, 11, 20–22], and as has also been found in the present study, female physicians with children work reduced hours, mainly to enable them to fit in domestic responsibilities. Although male physicians with children may also opt for part-time work , the male participants in our study mostly work full-time, regardless of whether they are parents or not. However, it is still difficult for males to find a part-time job . Medicine in Switzerland seems to be a professional field in which traditional gender roles are not questioned to the same degree as in some other Western countries . It has to be assumed that many mothers and fathers still think that childrearing is mainly the mother's responsibility.
As found in a previous study , female physicians, irrespective of whether they are parents or not, demonstrate lower objective career success scores in terms of publications, grants, scholarships, and research activities. This result can be traced back to the fact that women physicians aspire less often to an academic career than their male counterparts, findings that are also reported by other authors [3, 24, 25]. There are several reasons for the absence of women in academia: for instance, a lack of role models as well as rigid career paths, the latter being responsible for the incompatibility of work and family life [3, 26]. Women often anticipate career obstacles in connection with parenthood and abstain from a prestigious career [5, 20]. This also applies to their specialty choice: female physicians are significantly under-represented in prestigious surgical specialties [1, 27–30]. From a constructive point of view, it has to be considered that the career success scale used only measures one aspect of career success in aiming for an academic career path. However, even for a leading position in a hospital, an academic degree (professorship) is often required in Switzerland.
When it comes to subjectively assessed career success, a more differentiated pattern emerges: Compared to the other groups, it is female physicians with children who assess their career success at the lowest level. This is a realistic assessment taking into account fewer hours of work and interruptions to training due to childbearing. Female physicians without parenting obligations assess their subjectively rated career success as high as their male colleagues; even so, they score lower in relation to the criterion of objective career success. As described, objective career success mainly means scientific success.
The satisfaction with one's own career does not vary between male and female physicians, irrespective whether they have children or not. However, physicians with children, regardless of their gender, tend to be less satisfied with their own career than those without children. This means that parenthood does not only have an impact on subjective career success, but also on an individual's satisfaction with his or her own career. It has to be assumed that the work-family conflict may be compounded to the extent that it has a negative impact on satisfaction with one's own career. Other authors also mentioned these influences [31, 32].
Female doctors, especially those with children, more frequently aspire to work in a private general or specialist practice which allows for working flexible hours. This trend is also noticed in Great Britain [1, 28, 33]. It is furthermore striking that twice as many female as male study participants have not yet decided on their career path, although they are in their 8th year after graduation. It has to be assumed that female doctors anticipate difficulties in combining work and family obligations . For this reason, their career planning strategy is often less well mapped out than is the case with male doctors , although career planning at an early stage represents a crucial factor, especially for female physicians wishing to start a family. This aspect should be addressed in mentoring programs.
As shown in several studies [35–37], mentoring is a key factor in career support and success. In the present study female physicians, irrespective of whether they are parents or not, reported to have a mentor less often and to receive less career support in the sense of networking than male physicians. In order to set up mentorship, a mentee has to take the initiative and address an experienced senior physician higher up the hierarchy ; it is well-known that females are often reluctant to put themselves forward as proactive individuals [14, 39]. Another reason is the absence of female role models who are able to act as mentors for female physicians. The "old boys' network" is known to play an important role in career support and females rarely profit from it .
A further point worth mentioning is that female and male respondents with children have less mentoring experience than those without children. It may be assumed that the demands of parenthood in terms of time will mean sacrifices in relation to the time needed for professional networking; this is often relegated to off-duty hours or to conferences.
Similar findings are evident in relation to factors 'satisfaction with own career' and 'satisfaction with career support'. Physicians with children are less satisfied than those without a family. Presumably physician parents suffer from work-family conflicts . To summarize, having a family is, to some extent, at the expense of one's professional career.
The cohort doctors were asked what kind of work-life pattern they aspire to in the future. As already seen in relation to careers, female physicians - and even more so if they have children - are less career-oriented and opt for part-time or a three-phase career path (work - family break - returning to the workplace). Not only females, but also parenting physicians of both genders are seeking a satisfying balance between their professional career and their personal life. These findings reflect the change in lifestyle aspired to by the younger generation of physicians: they want medical careers and working practices organized in such a way as to enable them to lead a "normal" life [1, 10, 33].
Overall, females are more satisfied than males, especially in the domains 'friends', 'leisure activities' and 'income'. As expected, physicians with children are more satisfied with family life, but this is the only difference of any significance in multivariate analysis. There is no interaction between gender and parenthood, i.e. no combined effect has been found to be engendered by these two factors. To point out an interesting detail, females appear to have lower expectations as regards enhanced satisfaction with 'income'. In fact, at this stage of their postgraduate training, there is generally-speaking no evidence of earnings being gender-biased.
In summary, significant differences in relation to gender are to be found in career-related factors and, to a smaller degree, in life satisfaction. However, the greatest gender-related difference in the work-life balance aspired to lies in the fact that females more often consider part-time work or a break in their professional career to discharge family obligations. This result reflects the fact that female physicians have a distinctly different scheme of life to their male colleagues.
Gender segregation and gender equity
Although the profile of the medical profession has changed, the findings of the present study indicate that career paths in medicine are still gender-biased to the disadvantage of female physicians. Horizontal and vertical gender segregation can be discernible. Horizontal segregation is evident from the differences in choice of specialty. Males choose specialties such as surgery or cardiology which are more prestigious and provide higher income. Females are over-represented in specialties such as pediatrics, psychiatry or gynecology & obstetrics, specialties which carry lower prestige and income. The vertical gender segregation is reflected in the medical hierarchy. The higher positions in academia and hospital medicine are mainly held by male physicians.
There are a number of factors indicating that gender equity is far from being realized in medicine. Many young women choose to be trained in medicine because they want to treat patients. They often do not attach the same importance as men do to climbing the career ladder, achieving a high income or a powerful and influencing position. This attitude implies that females are often reluctant to put themselves forward and to appear proactive. The way they network is also different. Empathizing with a person is more important for females than whether a senior professional has major influence in the medical field. For this reason female physicians do not enjoy the same level of career support as males.
Anticipating the difficulties they are likely to encounter in combining a professional career with family obligations, females often do not plan their career in the same goal-oriented way as men. Such attitudes and behavior emerge as serious obstacles. To date, the idea of holding a senior position on a part-time basis has unfortunately not been readily accepted. Instead of fighting for career and employment conditions that fit into the female physicians' biography, they seem instead to be adapting to the existing male-dominated structures.
The present study has strengths and limitations. The issues of the impact of gender and parenthood on a professional career have not been studied in such detail and with such extensive sampling as has been the case in our study. Because the influence of these two factors is so extensive, we have limited the data analyses as regards gender and parenthood. A further strength is the high participation rate over a seven year period. Our report relates to a somewhat homogeneous sample in terms of age and professional status. Therefore, the findings cannot be extended to other academic professions and generalizations are not possible.