Career preferences and the work–family balance in medicine: gender differences among medical specialists

Abstract

In this article career preferences of medical specialists in the Netherlands are analysed, based on a survey among the members of medical associations of five specialties. Four different career preferences were offered, each of which implied a possible variation in working hours. A questionnaire was sent to a random selected group of working specialists in general practice, internal medicine, anaesthesiology, ophthalmology and psychiatry. Logistic regressions were used to predict career preferences. Besides individual characteristics, work and home domain characteristics were taken into the analysis. Not surprisingly, the preference for career change in respect of working hours is higher among full-time MDs, especially women, than among part-time workers. In contradiction to what was expected, home domain characteristics did not predict a part-time preference for female, but for male MDs. One home domain characteristic, children's age, did predict the male part-time preference. Further gender differences were found in respect of the fit between actual and preferred working hours (A/P-fit). The majority of male MDs with a full-time preference had achieved an A/P-fit, whereas significantly less female MDs achieved their preferences. It was found that hospital-bound specialists are less positive towards part-time careers than other specialists. Furthermore, the change of working hours would imply a reduction in FTE for all specialties, if all preferences were met. Especially in hospital-bound specialisms it was not confirmed that the reduction in FTE would be low; this was found only in respect of interns. It may be concluded that individual preferences in career paths are very diverse. Personnel policy in medical specialties, especially in hospitals, will have to cope with changes in traditional vertical and age-related career paths. Flexible careers related to home domain determinants or other activities will reinforce a life cycle approach, in which the centrality of work is decreasing.

Introduction

The work of medical specialists is characterized by long working hours and high demands for quality and continuity of care. These demanding characteristics are expressed in the professional standards specialists set themselves and their colleagues (Leemeijer, 1991, Floor, 1993, Noordenbos and Winants, 1994). However, in the 1990s the centrality of work in the lives of doctors in the Netherlands is perceived to be decreasing (Noordenbos and Winants, 1994, Heymans and Du Moulin, 1996). Reasons for this development related to the need for reduced working hours can be mentioned. First, women form an increasing percentage of the medical workforce and various studies of women's career paths in medicine have shown that women tend to work fewer hours per week than men (Wakeford and Warren, 1989, Medical Manpower Standing Advisory Committee, 1992, Heiligers et al., 1997). Since 1992 50 to 60% of all medical students in the Netherlands have been female and the same development is found in other countries. In the UK women made up about 50% of the intake to medical school early in the 1990s (Uhlenberg and Cooney, 1990, Redman et al., 1994) in Australia 35% to 50% of medical graduates were women in the decade before 1990 (Uhlenberg and Cooney, 1990) and in the USA the proportion of female students has been over 30% (Wakeford and Warren, 1989). However, among working medical specialists women are still a minority in the Netherlands. Secondly, an increasing number of the younger male specialists-in-training also want to reduce the traditional investment of 50 to 60 h a week (Dijkstra, 1992, Heymans and Du Moulin, 1996, Keizer, 1996).

This article will focus on preferred career plans of full-time and part-time practitioners in five different specialties in the Netherlands: psychiatrists, ophthalmologists, anaesthesiologists, specialists in internal medicine and general practitioners. The distinction between part-time and full-time working is based on regular working hours, excluding extra duties or hours ‘on call’. Career studies traditionally focus on the fit or negotiation between individuals and organizations or work environments (Betz et al., 1989). Specifically, concentration has been on the succession of jobs, vertical mobility or formally organized career paths. However, initial career theories and models have been largely built on male models of success and work. With large numbers of women entering and leaving the workforce at different ages, new patterns are emerging (Dalton, 1989). The most important reason for this more integrated perspective is based on women's wish to balance work and family responsibilities (Ferrier et al., 1989, Wakeford and Warren, 1989, Noordenbos and Winants, 1994, Redman et al., 1994, Royal College of Physicians, 1994). One of the dominant topics is their requests for part-time arrangements or reduced work loads. In the medical world gender-based differences in career paths have become a topical issue recently. In the Netherlands system of medical care most medical specialists are working in a hospital setting, but usually not employed by the hospital. They are self-employed working together with colleagues of the same specialty. As independent entrepreneurs they offer their professional services to one or more hospitals. Working part-time in the hospital in addition to private practice is financially not attractive. So, most medical specialists are working full-time if they work in a hospital setting. An exceptional position is taken by a small proportion psychiatrists and ophthalmologists, who are working in private practices. Furthermore, most general practitioners in the Netherlands work in private practices. Only a relative small proportion of GPs are employed in the private practices of colleagues or in health centers. Two specific specialisms are performed in public services: prevention and advisory care for children and medical officers in companies. These two types of specialism are not involved in this study.

This article will focus on gender differences in determinants for preferred career paths and the fit between actual and preferred career paths among medical specialists (MDs). What are preferred working hours at different stages in their careers and what determinants in the home and work domains influence those preferences? The underlying idea is that individual choice is directed by the work–family-balance: not only by organizational and work domain arguments, but also by home domain aspects (Zedeck, 1992, Frone et al., 1997, Van Schie, 1997, Van Vianen, 1997). The home domain aspects are based on theories of socialization and gender-identity (Reichel, 1985, Fassinger, 1990), in addition to workload and responsibilities in the home domain. Work domain aspects imply structural or organizational standards (Glass and Camarigg, 1991) and professional codes expressing the culture of the work setting (e.g. hospitals) (Noordenbos and Winants, 1994, Heymans and Du Moulin, 1996), which can differ within distinguished types of specialism.

The central question addressed is: What characteristics of the home domain and the work domain predict preferences in career plans of medical specialists and what are the consequences at the level of specialties?

Four specific questions will be examined: (1) What gender differences can be found between actual and preferred career plans in respect of working hours? (2) What characteristics of home domain and work domain predict career preferences for male and female medical specialists (MDs)? (3) To what extent can a fit between actual and preferred working hours be found? (4) What are the effects of individual preferences in working hours at the level of the specialties?