The impact of gender and parenthood on physicians' careers - professional and personal situation seven years after graduation

Study design and study sample

The study is an ongoing prospective survey of a cohort of graduates of the three medical schools in German-speaking Switzerland (Basel, Berne, and Zurich)(SwissMedCareer Study), beginning in 2001 (T1) [13]. Subjects were re-evaluated every two years. The present paper refers to the results of the fifth assessment (T5), conducted in 2009, seven years after graduation.

To ensure participants' anonymity, the returned questionnaires were only identified by a code. The respondents sent their addresses to an independent address-administration office, allowing for follow-up. The study was approved by the ethical committee of Zurich University.

The study sample consists of 579 physicians (292 females, 50.4%; 287 males, 49.6%) participating at T5 with a full data set (81.4% of the initial sample at T1), excluded were 6 physicians not working in a medical field. Twenty-two female and five male physicians are actually taking a break from work, mainly because of children. The mean age of the participants is 35.1 years (SD 2.2 years, range 31 - 50 years). Of the respondents 508 (88.0%) have a stable partnership, of whom 285 are married. Of 180 (35.3%) participants the partner is also a physician. One hundred and one (34.6%) of the females, and 110 (38.5%) of the males have children. There is a tendency of male doctors having more often two and more children compared to female doctors (p = 0.051).

Instruments

All instruments are self-assessment scales. In the following, it is described what constructs are measured by the instruments:

- Questions concerning socio-demographic data,

- Employment in percent of fulltime (100%)

- Choice of medical specialty (Primary Care, Internal Medicine, Surgical fields, Gynecology & Obstetrics, Anesthesiology, Pediatrics, Psychiatry, other specialties such as Ophthalmology, Oto-Rhino-Laryngology, Pathology, Radiology)

- Workplace (Regional hospital, Cantonal hospital, University Hospital, Research Institute, family medicine practice, specialist practice, others such as Health Administration, Medical Informatics, Public Health Institutions)

- Career aspired to (family medicine practice, specialist practice, hospital career without a senior position (Spitalarzt), hospital career with senior positions or academic career)

- Career Success Scale [14] is a measure of objective career steps consisting of 7 items addressing scientific activities (research projects, lectures, publications, grants, criteria which correspond to the requirements for tenure track).

- Subjective Assessment of Career Success [15] is a measure of one's own career advancement compared to that of other cohort subjects (7-point Likert scale, 1 = less successful - 7 = more successful).

- Question on Satisfaction with Career Success [13] (7-point Likert scale, 1 = very unsatisfied - 7 = very satisfied) is a measure of a person's satisfaction with his/her career success.

- Mentor-Protégé Relationships Questionnaire [16] (Likert scale 0 - 4) consists of five scales measuring different types of career-support. We used the Networking Scale (4 items) and the Support in career planning scale (3 items). These two scales describe crucial aspects of mentoring. Our data analyses show that the two scales are highly correlated (r = 0.71). We therefore combined them into one scale named 'Mentoring-Experience Scale', having a high Cronbach's alpha = 0.93. We further used the Emotional Support Scale (4 items).

- Question on Satisfaction with Career Support [13] (7-point Likert scale, 1 = very unsatisfied - 7 = very satisfied).

- Work-life Balance (5-point Likert scale) [17] investigates which of the four different models of work-life balance (career orientation, balance of work and personal life, part-time orientation, three-phase orientation: work-family break-work) the participants want to experience within 5 years.

- Life-Satisfaction Questionnaire (Fragebogen zur Lebenszufriedenheit FLZ ^M ) (5-point Likert scale) [18, 19] is a measure that assesses the satisfaction with 8 life areas (friends/acquaintances, leisure/hobbies, health, income/financial security, occupation/work, housing/living condition, family life/children and partner relationship/sexuality).

Statistical analyses

All analyses were carried out with SPSS for windows release 15. Descriptive statistics are given in terms of means and standard deviations, counts and percentages respectively. The impact of gender and parenthood on the continuous variables employment, career success and career support, work-life balance and life satisfaction, was investigated by separate two-factorial multivariate and univariate analyses of variance; F- and p-values are reported as well as partial eta-squared for estimation of effect size. Categorical variables such as career steps, specialty choice, workplace, and career aspired to were analyzed with Chi-square tests.

Employment (Table 1)

Career success and support (Table 2)

Work-life balance (Table 3)

Life-satisfaction (Table 4)

Career steps/Mentoring (Table 5)

Specialty choice (Table 5)

Female physicians choose surgical fields less often and more often gynecology & obstetrics and pediatrics. Physicians with children more often choose primary care, have not yet decided on a specialty and are less inclined to choose anesthesiology.

Workplace (Table 5)

Compared to male physicians, females work less often at university hospitals and research institutions, and more often in family medicine practice and in other medical fields. Compared to physicians with children, physicians without children tend to work more often at cantonal and university hospitals, and less often in other medical fields.

Career aspirations (Table 5)

Female physicians more often aspire to a career as a hospital doctor without a senior position and less often to a hospital or academic career, or have yet to reach a decision on their career. Physicians with children aspire more often to a career as a family physician and less often to a hospital career. Compared to females without children, females with children more often opt for a medical career in a private practice and less often for a hospital career.

In summary, the results show that female physicians tend to be less advanced in their professional career and choose less prestigious medical specialties and career paths. Parenthood exacerbates these disadvantages, especially in females. That means that parenthood has to an extent a gender-differentiated effect.

Employment

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 [11], 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 [23]. 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 [6]. It has to be assumed that many mothers and fathers still think that childrearing is mainly the mother's responsibility.

Career-related factors

As found in a previous study [14], 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 [20]. For this reason, their career planning strategy is often less well mapped out than is the case with male doctors [34], 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.

Mentoring

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 [38]; 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 [35].

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 [32]. To summarize, having a family is, to some extent, at the expense of one's professional career.

Work-Life balance

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].

Life-satisfaction

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.