Career orientations of medical and pediatric residents

Attaining full professor: Women's and men's experiences in medical education

INTRODUCTION

The underrepresentation of women among senior faculty members in medical education is a longstanding problem. The purpose of this international qualitative investigation was to explore women and men's experiences of attaining full professorship and to investigate why women remain underrepresented among the senior faculty ranks.

METHODS

Conducted within a social constructionist orientation, our qualitative study employed narrative analysis. Two female and two male participants working in medical education were recruited from five nations: Australia, Canada, the Netherlands, United Kingdom and United States. All participants held an MD or PhD. During telephone interviews, participants narrated the story of their careers. The five faculty members on the research team were also interviewed. Their narratives were included in analysis, rendering their experiences equal to those of the participants.

RESULTS

A total of 24 full professors working in medical education were interviewed (n = 15 females and n = 9 males). While some aspects were present across all narratives (ie personal events, career milestones and facilitating and/or impeding factors), participants' experience of those aspects differed by gender. Men did not narrate fatherhood as a role navigated professionally, but women narrated motherhood as intimately connected to their professional roles. Both men and women narrated career success in terms of hard work and overcoming obstacles; however, male participants described promotion as inevitable, whereas women narrated promotion as a tenuous navigation of social structures towards uncertain outcomes. Female and male participants encountered facilitators and inhibitors throughout their careers but described acting on those experiences differently within the cultural contexts they faced.

DISCUSSION

Our data suggest that female and male participants had different experiences of the work involved in achieving full professor status. Understanding these gendered experiences and their impact on career progression is an important advancement for better understanding what leads to the underrepresentation of women among senior faculty members in medical education.

Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence

Women are under-represented in academic medicine. We reviewed the empirical evidence focusing on the reasons for women's choice or rejection of careers in academic medicine. Using a systematic search, we identified 52 studies published between 1985, and 2015. More than half had methodological limitations and most were from North America. Eight main themes were explored in these studies. There was consistent evidence for four of these themes: women are interested in teaching more than in research; participation in research can encourage women into academic medicine; women lack adequate mentors and role models; and women experience gender discrimination and bias. The evidence was conflicting on four themes: women are less interested in research than men; women lose commitment to research as their education and training progress; women are deterred from academic careers by financial considerations; and women are deterred by concerns about work-life balance. Inconsistency of findings across studies suggests significant opportunities to overcome barriers by providing a more enabling environment. We identified substantial gaps in the scientific literature that could form the focus of future research, including shifting the focus from individuals' career choices to the societal and organisational contexts and cultures within which those choices are made; extending the evidence base to include a wider range of countries and settings; and testing the efficacy of interventions.

Gender differences in the ability to identify a mentor at morning report: a multi-institutional survey

BACKGROUND

Prior studies have shown that mentors are very important for career development of physicians, and that many female physicians have not had a mentor during their training. However, little is known about the availability of mentors for residents.

PURPOSE

To identify resident and program characteristics that were associated with the ability to identify a potential mentor at resident morning report.

METHOD

We performed a cross-sectional survey of 356 internal medicine residents at a convenience sample of 13 residency programs. The instrument included questions about demographic characteristics, subspecialty fellowship plans, and ability to identify a potential mentor at morning report during the previous 6 months.

RESULTS

Seventy-three percent were able to identify a potential mentor at morning report within the previous 6 months (63% of women vs. 79% of men). Among residents planning on entering general internal medicine, women were less likely than men to be able to identify a potential mentor (55% vs. 77%). The likelihood of identifying a mentor varied between the different programs, with a range from 27% to 89%.

CONCLUSION

Many residents could identify a potential mentor at morning report, although there was a wide variability between programs. Female residents who were going into general internal medicine were less likely than their male colleagues to find a potential mentor. Medical educators should ensure that all residents have exposure to potential generalist mentors.

Pediatric generalists and subspecialists: determinants of career satisfaction

OBJECTIVES

To evaluate the work life and job satisfaction of pediatric generalists and subspecialists in comparison to each other and to a group of general internists and internal medicine subspecialists.

METHODS

Data were collected by survey of a national sample of 5704 general pediatricians, subspecialty pediatricians, general internists, internal medicine subspecialists, and family physicians who were selected randomly from the American Medical Association Masterfile using stratified sampling with disproportionate weighting to ensure ethnic diversity and representation of high managed care areas. Surveys were mailed up to 4 times and contained 150 items that reflected 10 facets of physician job satisfaction as well as an assessment of individual and practice demographic information. This study reports data from all groups except for family medicine.

RESULTS

The adjusted response rate was 58% for general pediatricians (n = 590), 67% for specialty pediatricians (n = 345), and 52% (n = 1823) for the entire pool. In comparison with general internists, general pediatricians were more likely to be female (44% vs 24%); to work part time (20% vs 12%); to have lower annual income ($125 679 vs $143 875); and to report significantly higher levels of job, career, and specialty satisfaction on a 5-point scale (3.81 vs 3.52, 3.80 vs 3.55, and 3.76 vs 3.17 respectively). In comparison with internal medicine subspecialists, pediatric subspecialists were more likely to be female (42% vs 22%); to work in academically affiliated settings (35% vs 17%); to have lower incomes ($156 284 vs $192 006); to receive significantly less time for a complete history and physical examination (39 minutes vs 51 minutes); and to report similar levels of job, career, and specialty satisfaction (3.69 vs 3.71, 3.74 vs 3.78, and 3.60 vs 3.47 respectively). Of all 4 physician groups, general pediatricians worked the fewest hours (50/week), spent the greatest percentage of time in the office and the lowest percentage in the hospital (58% and 16%, respectively), saw the lowest percentage of patients with complex medical and complex psychosocial problems (15% and 17%, respectively), and were the least likely to endorse symptoms of burnout or job stress (13% and 18%, respectively). In comparison, pediatric subspecialists worked longer hours (59/week), spent the lowest percentage of time in the office and the greatest percentage of time in the hospital (22% and 44%, respectively), saw a much higher percentage of patients with complex medical and complex psychosocial problems (46% and 25%, respectively), and reported significantly higher levels of burnout and job stress (23% and 26%, respectively).

CONCLUSIONS

Despite lower incomes, general pediatricians reported the highest levels of satisfaction and the least job stress of all 4 physician groups, whereas pediatric subspecialists reported levels of stress and burnout that raise significant concerns for the workforce of pediatric subspecialists of the future. Initiatives that improve clinical workload, balance inpatient and outpatient hours, and increase personal time of pediatric subspecialists should be considered.

Practice activities and career satisfaction among fellows of the South Atlantic Association of Obstetricians and Gynecologists

OBJECTIVE

The practice activities and career satisfaction of obstetricians and gynecologists in private practice were compared with those in a teaching faculty setting.

STUDY DESIGN

The 475 fellows of the South Atlantic Association of Obstetricians and Gynecologists were surveyed; 314 responses (66.1%) were received. Private practice and teaching faculty respondents were compared regarding practice description, factors influencing choice of practice type, practice activities, and career satisfaction. Data were examined by chi 2 testing and analysis of variance.

RESULTS

Patient care involvement was the primary influence in practice choice by 86.0% of private practitioners; interest in teaching was the most important single factor for 58.2% of the teaching faculty. Significantly more teaching faculty than private practitioners had done research work during residency (81.2% vs 53.4%, p < 0.001). There were no differences regarding presentations at medical meetings during residency or publications from work performed during residency. The private practice group recorded more nights on call and more scheduled time off. The teaching faculty showed more publications, continuing medical education credits, hours worked per week, and medical meeting attendance. There were no differences in vacation days, malpractice charges, or expert witness appearances. The group showed no significant differences in their ratings of career satisfaction, but more of the teaching faculty group would elect again to enter obstetrics and gynecology if completing school today (82.4% vs 55.3%, p < 0.001).

CONCLUSION

Professional activities of private practice physicians differ from those of teaching faculty physicians. The great majority of both groups are satisfied with their careers.

Factors associated with future psychiatrists' selection of academic or clinical careers

Graduation Questionnaire data collected by the Association of American Medical Colleges (AAMC) were used to identify student and medical school characteristics associated with future psychiatrists' career plans. Subjects were senior medical students in the class of 1986 who definitely planned to specialize in psychiatry or child psychiatry. Medical school variables such as research experience, publication history, and exposure to a research-oriented environment were associated with plans for a career in academic medicine or research (versus clinical practice). Membership in a non-underrepresented minority group, having taken elective course work at a military or government agency, and having attended a private medical school all were associated with plans for a career in salaried clinical practice (versus private clinical practice).