Abstract
Over the past 3 decades, women have poured into the US labor force. Between 1970 and 2005, the percent of adult women working for pay increased from 43.3 to 59.3%. Women not only increased their participation in the labor force, they also increased their commitment to it. While 40% of employed women worked full-time year round in 1970, approximately 60% did so in 2004 (U.S. Bureau of Labor Statistics 2006).
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Notes
- 1.
This essay draws on research presented in our book, The Changing Face of Medicine. Cornell University Press, 2009.
- 2.
In fact, there are extremely few stay-at-home fathers. In 2006, the Census estimated that there were only 143,000 married fathers with children under 15 who remained out of the workforce primarily so they could care for 245,000 children (U.S. Bureau of Census 2006).
- 3.
The Federal Office on Women’s Health convened the National Task Force on Reentry into Clinical Practice for Health Professionals in 2000 (Mark and Gupta 2002). This effort led to recommendations for a national reentry policy and to an updated compendium of physician retraining initiatives. The national task force was followed by the convening of an American Academy of Pediatrics sponsored Physician Reentry into the Workforce Project. The project is a collaborative effort that includes many medical institutions including the AMA, the VHA, the American Board of Medical Specialties, the American Academy of Family Physicians, the American Board of Surgeons, and the Council on Graduate Medical Education.
- 4.
In fact, the increasing relative and absolute presence of women in pediatrics was listed as the second most critical concern for the American Academy of Pediatrics’ Committee on Workforce issues (American Association of Pediatrics 2005).
- 5.
It is also worth noting that the gender gap is specialty specific. While significant gaps exist between the average male and average female pediatrician work week, male and female surgeons and obstetrician-gynecologists log equivalent hours.
- 6.
Data from the Community Tracking Study physician surveys indicate that in 1996, 75% of men and 51% of women worked long weeks. By 2004, only 69.9% of men and 48.4% of women worked long weeks but the aging of the population between 1996 and 2004 might explain the decline in the tendency to work long weeks.
- 7.
Data from the 2004 CTS Physician Survey indicate that 16% of women and 6% of men physicians work less than 31 h in a normal week. Between the 1996 and the 2004 CTS Surveys, rates of part-time work increased slightly for men and women from 14.6 to 1% for women and from 4.1 to 5.9% for men. In contrast, between the 1990 and 2000 Census, the frequency of part-time work declined from 16 to 15%. The CTS survey involves only physicians who provide direct patient care at least 20 h per week and excludes radiologists, pathologists, and anesthesiologists. It also involves a survey of cities rather than a survey of the entire US population. Regardless of the data source, however, rates of part-time work for female physicians are remarkably stable.
- 8.
Data from the Physician Work Life Study indicates that 22% of US women respondents and 9% of US men respondents worked part-time (McMurray et al. 2005); however, this survey defines part-time as less than 40 h rather than less than 30 h.
- 9.
In 1968, Dr. Burch, then president of the American College of Cardiology, wrote in the American Journal of Cardiology: It is generally considered that there is too much to learn in medicine today. This is not true… Time is the premium, and how it is used is the important factor. The problem is not that there is too much to learn, but rather that there are too many distractions. The…physician devotes too much time to other interests…Such interests leave little time for medicine. The physician is often unable to resist these distractions and more often than not enjoys them more than he enjoys medicine…the devoted clinician obtains the greatest of pleasure from his work. He enjoys study, clinical practice and his patient more than anything else. He does not need to force himself to study and work with patients (Gerber 1983).
- 10.
We suggest that as managed health care has become more common, continuity of care has declined. We base this on research by Flocke et al. (1997) who found in their analysis of 138 community-based providers that patients with IPA/PPO health insurance were four times as likely as patients with fee-for-service insurance to report a forced change in their primary care physician, and that these changes were strongly correlated with patient satisfaction and other health outcomes.
- 11.
Under some circumstances, changes facing female physicians might be more severe since patients seeking specific drugs might expect female providers to be more accommodating of their requests.
- 12.
In 2006, nearly all offices, 96%, allowed part-time schedules, either as an affirmative policy or on a case-by-case basis, but as has been the case since NALP first compiled this information in 1994, very few lawyers are working on a part-time basis, just 5% overall. Associates are more likely to work part-time (4.7%) than partners (2.8%), but other lawyers, such as counsel and staff attorneys, show the highest rate of part-time work, over 16% (NALP 2006).
- 13.
Some have suggested that physicians dropping to part-time must be willing to take more than a proportional cut in take-home pay to make up for fixed expenses like overhead costs and health and malpractice insurance (Walpert 2002).
- 14.
Not only do malpractice premiums vary by state and specialty, they also vary within state. In 2002, a family practitioner in Cincinnati is $12,650, according to insurer ProAssurance, whereas the rate is $21,375 in Cleveland (Hawkins 2002).
- 15.
There is also limited evidence that continuity relates to positive health outcomes. In particular, research indicates that patients who see the same provider consistently are less likely to be hospitalized, are less likely to use emergency services, and are more likely to receive preventive services (Cabana and Jee, 2004).
- 16.
Research also suggests that part-time primary care physicians in an academic environment are more productive than their full-time counterparts. Most of these clinicians work full-time but limit their clinical responsibilities to attend to teaching and research (Warde 2001).
- 17.
Research on the relationship between continuity of care and health outcomes for diabetes patients is mixed. Some studies fail to find an association (Guilliford et al. 2007), while others suggest an association exists.
- 18.
For example, evidence is mounting that surgeons can extend the survival of cancer patients by ensuring negative margins on their resections (Lange and Lin 2004). The theory is that the positive relationship between higher volume and outcomes for cancer surgery patients stems from the fact that surgeons who perform the case more often are more likely to ensure negative margins.
- 19.
Healthy People goals suggest that 50% of mothers of 6-month olds should be breast-feeding. The rate for residents was only 15%. Residency work schedule was the most common reason cited for discontinuing breast-feeding (Miller et al. 1996).
- 20.
The IOM describes research that suggests that extreme work schedules increase residents’ risks of occupational injury through percutaneous needle sticks. It suggests that residents who endure long workdays are at significantly higher risks of traffic accidents, because they routinely drive in very fatigued states and it reviews research which indicates that extreme workweeks and limited sleep put resident physicians at risk for weight gain, depression, burnout, and other negative factors. The report even suggests that long workdays jeopardize resident physicians’ professional relationships with other health care providers.
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Boulis, A., Jacobs, J.A. (2011). Medicine as a Family-Friendly Profession?. In: Pescosolido, B., Martin, J., McLeod, J., Rogers, A. (eds) Handbook of the Sociology of Health, Illness, and Healing. Handbooks of Sociology and Social Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7261-3_12
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