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CAREER inequality and the gender pay gap loom large across all fields of work, but given the high levels of education and growing numbers of women in the medical workforce, stymied career paths and dissatisfaction are still a surprisingly large part of the experience of practising medicine for many women.
The impact of family responsibilities on female medical professionals was much larger than for their male counterparts, according to research from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, and difficulties in maintaining work–life balance really started to bite for those who hadn’t yet completed their specialty training, compared with those who were fully trained when they started a family.
While such results may not be particularly surprising, given that it’s a phenomenon widely seen in other occupations, they suggest that even highly educated professional women, who we may expect to have greater bargaining power in their relationships and who indeed may be a family’s primary earner, still shoulder the main responsibility for being the primary carers in their families.
The research asked men and women doctors whether their employment was restricted by their ability to access childcare. The differences were stark: women scored very high on this question, indicating that employment was highly restricted, particularly for trainee specialists, compared with men.
“The interesting thing is that women see childcare as their responsibility. Within what should be more equal partnerships – because of the high education and earning power of the woman – there still does not seem to be higher bargaining power,” Professor Guyonne Kalb, MABEL researcher, and director of the Labour Economics and Social Policy Program at University of Melbourne, said.
Professor Kalb’s research has implications for the gender composition and balance of the medical workforce, and the predominance of one gender over another in certain fields of medicine. It may also explain why women may feel compelled to trade earning power for predictable hours, or be limited to less lucrative employment; for example, they may avoid the business pressures of starting a private practice. Parenting duties, whether self-imposed or otherwise, restrict women’s choices in the medical profession.
Professor Kalb also looked at the impact of children on working hours of medical specialists and GPs, grouping the impact by the age of the respondents’ youngest child. She found that women GPs were much more able to respond to the demands of maintaining a career and looking after young children than those in other specialties by working part-time.
“Women have a much higher representation among GPs than among specialists,” Professor Kalb said. “Women specialists still respond to having children but to a much lesser extent than GPs; this may indicate something about the flexibility of the work. GPs can work part-time more easily than specialists, and it’s an option that seems to be chosen once women start to have children. It’s one way to respond to family responsibilities.”
Emergency paediatrician Dr Nadine Sharples said that, especially at university, women’s attitudes to specialties tallied with this assessment.
“When I was at university I thought that I would be a GP, as that would provide the best work-life balance and other specialties would be too difficult to combine with having a family.”
A supportive partner makes all the difference; Dr Sharples considers herself lucky to have been supported to pursue her chosen specialty. She met her husband, a fellow medical student, at university and entered a paediatric specialty while he did adult physician training.
“We were lucky that we could support each other through the long hours of work and then the hours of study afterwards,” she said.
Though the MABEL research doesn’t examine the differences across other specialties, widely discussed anecdotal evidence points to the dominance of men in surgery. While there have been many reasons offered about the cause of this gender imbalance, the contribution of difficult or inflexible hours cannot be underestimated when it comes to the choices women make about whether to enter the specialty.
“I suspect there’s a strong correlation [between specialty choice and flexibility of hours],” said Professor Kalb. “I think there is definitely some indication that hours and the expectation of hours is more important for women than for men.”
For younger women doctors, the timing of having children was critical – they could not afford to have any hiccups in their careers because they were still on the way up. Professor Kalb’s research revealed stark differences between doctors who had finished their qualification before having children, and doctors who had children while still in training or working as hospital non-specialists.
“One of the things we observe is that these younger doctors, who are not fully qualified, react quite differently to having children than the GPs and fully qualified specialists,” she said. “GPs and specialists seem to be much more able to reduce their hours – whereas the way the doctors in training actually respond is by not participating, rather than reducing hours; and if they participate, they work close to the full hours. There is less choice.”
As a result, trainee doctors turned in a much lower life–work balance satisfaction rating than their older, established counterparts. The results were particularly stark for women trainee specialists, who reported the greatest dissatisfaction.
Job share partnerships may be a solution for trainees looking to secure positions that require full-time hours, but they are hard to find.
“A paediatric surgical registrar told me recently that she is delaying having a baby since the possibility of a job share position is exceedingly limited in her field,” said Dr Sharples.
“She would need to find a trainee with similar experience who wanted to work part-time – then they would have to apply to the hospital as a joint package and would have to be assessed not only on individual skills but on whether the partnership would work.”
Dr Sharples said that the self-doubt caused by career breaks to raise a family also limited women doctors, regardless of how supportive the working environment may be.
“I had 4 months off after the birth of my second child. I had just become a consultant when I became pregnant, and I was scared that I would lose the skills that I had spent many years attaining and that I wouldn’t have a role in my department.
“These were all perceived attitudes on my part – my director assured me there would always be a place for me in the department. Despite all of this, I rushed back to work after 16 weeks at home. I felt like I needed to prove to myself that I ‘hadn’t lost it’ – all those technical skills I use every day. I feel that it was important for my confidence to return. I didn’t want to be perceived as the slack one.”
Professor Kalb said that many men were much more free to go on to any specialty they chose, and any configuration of practice, without the same pull that accompanied women.
“For many men, a non-working (or part-time working) partner frees them up to work any configuration of hours they need to further their career – and a lot of specialties do require odd hours.
“Flexibility is perceived as a choice, but many women doctors with young children don’t have any choice about flexibility – they have to be flexible.”
This article was commissioned by MABEL.
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If the profession was more accepting of pre-specialist training career breaks, this problem would be vastly improved. As it stands, residents or basic trainees can’t take time off to raise little kids without the chances of then entering a training program vastly reduced. It is a culture problem. There is very little someone will forget of eventual relevance if they take a few years to raise children before specialty training.
As a female consultant who has a teaching role and as an “older” mother of young children (I waited until after I qualified to have my kids), I quite openly discuss issues about parenting and work place flexibility with my students and junior doctors. The reality is that you can aim to have everything but you can’t have it all at the same time – something has to give. Having children will affect your career trajectory.
It varies somewhat between the specialties, but taking time off to have children affects your completion of training, and parenting young children affects your ability to take on certain roles/postings/rotations (even as part of couple without children travelling to work in another location for 6 months is not hard to do, but moving away form your family and other supports when you have young children compounds the difficulty of everything).
Even after completing specialist training, the ability to do the extra things that help you network and get into senior roles – such as doing committee work, attending after hours meetings,,, – is more difficult when you have to factor in the care of young children.
It is not impossible to balance have a very good career and having children as a female doctor, but it takes planning and being organised, and sometimes making some tough decisions. A supportive partner really helps too.
Evolution has the casting vote. Women will “marry up” to seek the best genes in return for the risks of internal gestation and childbirth. A junior male consultant has a wide choice of partners from nurses, physios more junior doctors etc but a junior female consultant would not be seen dead dating a resident or male nurse. So the female will tend to value the male role more than hers and has done so since Adam
What a shocking waste of money the whole MABEL study has been. So the net result has been to show that women do a lot of the chid rearing? What an incredible surprise! May be the next task of MABEL will be to publish a paper showing that there tends to be more sunlight around midday compared to around midnight.
Thank you for publishing this and creating discussion! It’s not about getting angry or pointing fingers – it’s about implementing changes to an outdated system to allow the medical profession to enjoy their whole lives, not sacrifice family in order to feel their are meeting minimum requirements. As a young Physician trainee, I find myself at 30 years of age wishing I could start having children but I don’t see any easy way to do this in the next 2 years and working part time without putting my defensive armour on and speaking up to make a “special request”, and having my commitment to the college doubted. I don’t want to choose between a career that excites me and motherhood.
I remember as a young consultant being horrified when a senior female colleague spoke at a women in medicine meeting about giving up her career to follow her husband with their children interstate so he could pursue his goals-how was this encouraging or inspiring?
Now with two children of my own and sacrificing my own brilliant career to one less auspicious, to be able to spend time with them and be their parent, both mother and father. Do I regret it-not one bit-I I made a choice to be a single parent and with that came a choice to put my children first, not my career. I have a great job, wonderful patients-I love them too. I am not in the career I planned, or the place I planned when embarking on my consultant career, but I am in a good place, great family, great friends, great job with an excellent income, a lovely home, all possible because I have the privilege to have a medical degree and the good health, capacity and strength to make my own choices. I have the privilege to care for my patients who trust their health and their lives to me. I go home every day from my work with many uplifting experiences, inspiring stories and the satisfaction to know I am able to make a difference to the world-not through fame, fortune or prominence but by the day to day care of my patients. I don’t have the satisfaction of the job titles, the academic titles, the publications or the massive salaries of some of my colleagues, but I made a choice, many choices, and took paths I would never have pictured as my young aspiring self. I have not compromised myself or my patients to play political games, or take the easy road if there are hard choices to make. I have learnt to say “No”- a word not in my working vocabulary before I had my children. So I have compromised my career for my children, but never my patients. Life is about choices and you can’t have it all-you just have to work out what is right for you, and be content that any responsibility you take on-be it family or work related to make sure you can do it well and fulfil the duties of that role [or don’t take it!!!]. Be careful what you judge as success in life.
The tone of this article suggests that a mother looking after her own children is a hideous imposition on the mother.
In actual fact, a mother looking after her own children is the most natural thing in the world, one of the most rewarding activities in life (far more rewarding than typical paid employment), and the standard way of life for the human species for about 2 million years.
I am a specialist and a male and I have done the majority of looking after the children as a single parent. It can be exhausting (far more than work) but it is a wonderful thing to do. But there is no way at all that i could work the hours and give the same time commitment as my colleagues. So of course I realise that I can’t hope to earn as much. I can’t give the same on call commitment and I can’t come out at all hours of the day.
So I don’t expect that i would be paid as much as many of my colleagues. But I feel incredibly privileged to have been able to spend more time with my young children.
There is ZERO real pay inequality. And why do people assume that the parents who spend less time on their career and more time with the children are not the lucky ones. What about the joy-of-spending-precious-time-with-your-children inequality?
“The interesting thing is that women see childcare as their responsibility.”
Was there overlap between the results of men and women (pretty likely)? Even if there wasn’t overlap, did all women say childcare was their responsibility (even more unlikely)?
Is this an example of confirmational bias? Does the professor have a belief that women are systematically disadvantaged?
Could an alternative explanation be that it is family oriented individuals (regardless of their gender) who “see childcare as their responsibility”?
It might seem a pedantic point, but recognising the aspirations of males who wish to have work-life balance would seem as legitmate as recognising the aspirations of females.
“Within what should be more equal partnerships”
Who says?
There is a Dilbert cartoon in which Dogbert is saying “we have stopped talking about work/life balance because it implies that your life matters”.
If you actually believe that your doctor’s life matters, answer the simple question: Would you have your surgery done by a robot which did a better job than a human?
If you have travelled in an aeroplane or a modern car, you have have already answered that question. We do not care about the life which made the perfect airtight welds in the metal, because it was not even living.
We may give lip service to having work/life balance, but when the golden hour for our myocardial infarction or CVA comes on a Saturday night, we want to drag our cardiologist/neurologist out of her daughter’s school concert, and we certainly do not want her to finish breastfeeding then changing and settling the baby before attending to our stenting/thrombolysis.
In those specialties where the fun starts when the pubs close and the drunks get behind the steering wheel (e.g. orthopaedics or neurosurgery) we do not want our surgeon to have any balance, simply to be available without notice in the wee hours of the morning, to patch us up when the drunk guy runs us over. For those doctors with small children, these demands require a partner who has a full-time availability as the primary carer for the children, or a live-in nanny who has a draconian employment contract for the same horrible hours of availability, presumably at a much lower rate of pay.
It is no surprise that a trainee on a lower pay scale has trouble paying for multiple nannies to cover the weekends on call.
My own experience resonates with these MABEL findings. I have chosen to have a family during training and have subsequently befallen a ‘stymied career path’. I don’t expect concessions for ‘choosing’ to have a family, I wouldn’t have it any other way. Life goes on and I am blessed with 3 beautiful children. I would like to advise my female colleagues in medicine to plan on finishing their specialist training prior to embarking on family life. Particularly with the deficit of training places. There are no real options for part time and job share in any specialty. The training hours required in every circumstance are incompatible with a healthy family life, particularly when your children are small and most people are some distance from extended family help. Quality childcare options are limited, and in retrospect not really a great choice for small developing minds. If attitudes like the above comment prevail, archaic medical constructs will continue to drive intelligent, creative, compassionate people from the medical workforce into other careers that don’t have such an obvious false economy.
“Professor Kalb also looked at the impact of children on working hours of medical specialists and GPs… ”
“Women have a much higher representation among GPs than among specialists…”
General practice is a specialty.
Women in medicine should have all the options, career choices and pay rates that are available to men: unless and until they have children. At that point, biological determinism means that they must, for a time, step off the conveyor belt. They can Lean In all they like, but unless the baby is to be just another accoutrement of the successful professional life, they may actually wish to raise the child. It is not then realistic to think that they can return to all the above options on a par with male medicos and their childless female counterparts. If the partner is to do the child-rearing, that is a negotiation for the couple to undertake, not for medicine to provide: training schemes and employers can only make so many accommodations.
Women at least have a choice: they are not compelled to have children, but equally it may not be possible to have it all.
There is no such thing as gender equality in medicine for socioeconomic and partnership reasons.In general men tend to marry/partner across/down the socioeconomic scale and with respect to age.Women tend to partner across/up.The more qualified a woman ,the fewer potential partners in this scenario.My advice to young female doctors is to look for a partner with lower career aspirations/work hours and greater fathering skills than average if you wish to have a career in medicine and children and avoid ill health as a result of inequitable work loads in relation to your home life.Otherwise be prepared to outsource child-minding/rearing,household duties etc.
It would be interesting to know how many males read and vote on this article.