Gender differences in Israeli physicians' career patterns, productivity and family structure

In the three principal Israeli medical practice settings, men and women physicians in internal and family medicine, cardiology, gastroenterology, geriatrics and general practice (no specialization) were compared on a number of career pattern, productivity and family structure variables. The results revealed gender differences in the functioning and status of men and women physicians similar to those found in other countries. Processes of 'sorting and tracking' of physicians by gender, level and area of specialization and country of medical studies appeared implicated in the concentration of women in 'generalist' specialties and primary care settings and of men in higher status specialties and hospital settings. The nature of professional activities in primary care and hospital settings differed, with research-related activities more common in the hospital setting. This appeared relevant to the higher status achieved by men physicians in the Israeli medical-professional hierarchy. Family roles appeared to affect men and women physicians differently. The findings are compared to those from other countries, and explanations in the Israeli context are proffered.     

Women in medicine − is there a problem? A literature review of the changing gender composition,structures and occupational cultures in medicine

BACKGROUND: Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession. AIMS: The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession. CONCLUSIONS: This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.     

The growing number of female physicians: meanings,values, and outcomes

Throughout the developed world the proportion of women in professions such as medicine is increasing. This commentary uses Haklai et al’s nuanced report on the feminization of medicine in Israel as a starting point. I discuss whether gender shifts are an outcome of more egalitarian attitudes towards women overall, or instead arise from men choosing other professions, the extent of the shift, and its meaning for the quantity and quality of medical care. The discussion is embedded in more fundamental concepts such as the aims of medical practice and the best indicators of effective care. I reflect on concerns about lower female physician productivity at a time when the proportion of female physicians still remains below parity in almost all countries. Medicine is embedded in the principles and expectations of the community being served. The profession’s values and practices both shape and are shaped by those of that larger community. As cultures move toward equality, proportional representation of women and men in medicine will follow, while remaining limitations to gender equality will be mirrored in opportunities and restrictions for women in medicine. This is a commentary on http://www.ijhpr.org/content/2/1/37/.     

Gender in medicine - an issue for women only? A survey of physician teachers' gender attitudes

BACKGROUND: During the last decades research has disclosed gender differences and gender bias in different fields of academic and clinical medicine. Consequently, a gender perspective has been asked for in medical curricula and medical education. However, in reports about implementation attempts, difficulties and reluctance have been described. Since teachers are key persons when introducing new issues we surveyed physician teachers' attitudes towards the importance of gender in professional relations. We also analyzed if gender of the physician is related to these attitudes. METHOD: Questionnaires were sent to all 468 senior physicians (29 % women), at the clinical departments and in family medicine, engaged in educating medical students at a Swedish university. They were asked to rate, on five visual analogue scales, the importance of physician and patient gender in consultation, of physician and student gender in clinical tutoring, and of physician gender in other professional encounters. Differences between women and men were estimated by chi-2 tests and multivariate logistic regression analyses. RESULTS: The response rate was 65 %. The physicians rated gender more important in consultation than in clinical tutoring. There were significant differences between women and men in all investigated areas also when adjusting for speciality, age, academic degree and years in the profession. A higher proportion of women than men assessed gender as important in professional relationships. Those who assessed very low were all men while both men and women were represented among those with high ratings. CONCLUSIONS: To implement a gender perspective in medical education it is necessary that both male and female teachers participate and embrace gender aspects as important. To facilitate implementation and to convince those who are indifferent, this study indicates that special efforts are needed to motivate men. We suggest that men with an interest in gender issues should be involved in this work. Further research is needed to find out how such male-oriented endeavours should be outlined.     

Medical women -- towards full integration? An analysis of the specialty choices made by two cohorts of Norwegian doctors

In Norway, as in most Western countries, doctors' choice of specialty has been strongly gendered. Female physicians have tended both to specialise to a lesser degree and to enter other specialties than male colleagues. In spite of the increase of women in medicine, previous studies have not managed to show any changes in this pattern. Comparing data from two cohorts of Norwegian doctors, authorised in 1970-73 and 1980-83 respectively, this article demonstrates that changes are in fact taking place. The changes are, however, not unequivocal. Firstly, women in these cohorts specialise to a very high degree and just as much as their male colleagues. Secondly, women doctors of the 1980s cohort spread their choice of specialisation over more fields than their predecessors did. They have, for example, started to enter surgery, although still not as often as men. Thirdly, proportionally more doctors of the 1980s cohort than the 1970s cohort have chosen general practice as their main specialty, and this applies to both women and men. Fourthly, there are tendencies towards an increasing concentration of women in some disciplines such as obstetrics and gynaecology, as well as paediatrics. These changes in doctors' pattern of specialisation are discussed as consequences of socially shaped individual preferences, structural aspects of the Norwegian health system and the existence of gendered closure mechanisms within specific medical fields. Although the medical profession still appears as a gender differentiated community, the article gives a more dynamic and in some respects a more optimistic picture than earlier studies.     

A comparison of the professional values and career orientations of male and female medical students: some unintended consequences of U.S. public policy

During the 1970s, partly as a response to U.S. public policy which promoted the objective of equal opportunity for women, there was a dramatic increase in the proportion of women entering careers in medicine. Some observers have expressed the expectation that these women physicians will promote progressive changes in health care and that they will be more likely to emphasize "humanistic" aspects of treating patients. This paper presents data from a national survey of U.S. medical students which provides a comparison of several relevant characteristics of these male and female students. There are several important areas where significant differences are apparent. Women students are more likely to place greater importance on the desire to help people as a career motivation, for example, and are less likely to express satisfaction with the status quo in American health care. There are also significant male-female differences in career plans with respect to areas such as specialty choice and preference for practice setting. These findings are used to consider the question of the probable impact of increased numbers of women physicians on the future of American health care. Projections for the future are made more difficult because of important changes within the medical profession and in the context of health care organization, but it is clear that women physicians do represent some potential for progressive change in American medicine.     

Gender and the medical curriculum: a rural case study

In Australia, half the medical students are women. There is increasing evidence that women engage with medicine differently from men, and medical workforce planners are being required to consider the implications of this change, particularly in areas of medical need. Between 1996-2001, the Australian government provided funding for teaching about issues for female rural doctors to encourage female students to consider rural medical practice. This was extended to include teaching about gender issues for doctors. Introducing this teaching has required building credibility for the topic among funders, faculty and students, training tutors, and meeting the need of students for an intellectual framework within which to think about gender and medicine. Teaching about gender requires conscious leadership by senior academic women. This paper describes an initiative in the rural curriculum for medical students.     

Medicine is not gender-neutral: influence of physician sex on medical care

Many studies have shown that men and women differ in communication styles. The question is whether these differences also play a role during medical consultation. Potential differences between male and female physicians that have been investigated, are differences in doctor-patient communication, the diagnostic process and treatment. The communication style of female physicians is more patient-oriented than that of male physicians. Male and female physicians differ in their use of additional tests; notably, intimate examinations, such as prostatic or vaginal examinations, are performed less frequently for patients of the opposite sex. Male physicians prescribe medication more frequently; notably sedatives are prescribed more often by male physicians to female patients. Therefore, whether medical care is provided by a male or a female physician makes a difference: the professional role of the physician is not gender-neutral. Within the medical profession, male and female medical students are socialised differently, and professional socialisation does not overcome differences in gender roles. Patients are generally more satisfied with female physicians than male physicians. Knowledge of and insight into these processes is essential for improving the quality of care.     

Female physicians: trends and likely impacts on healthcare in Israel

Background

Female physicians have become an increasing proportion of the medical workforce in Israel. This study investigates this trend and discusses its likely impact on the quantity and quality of medical care available.

Method

Data on licensed physicians and new licenses issued to physicians were taken from a Ministry of Health database, and analyzed by gender, age, academic origin (Israeli graduates, immigrants, Israeli-born who studied abroad), and specialty for the years 1999–2011.Data on employed physicians, their population group, and work hours were taken from the Central Bureau of Statistics (CBS) annual Labour Force Survey for the years 2009–2011.

Results

The proportion of women amongst physicians aged under 65 rose from 38% in 1999 to 42% in 2011, and was even higher for younger physicians. The highest proportion of females is found amongst new immigrant physicians who studied abroad. The corresponding proportion has been rising steadily amongst Israeli-educated physicians, and is lowest amongst Israeli-born physicians who studied abroad.Similarly, among newly licensed physicians, the proportion of females has traditionally been highest among immigrants who studied abroad and lowest among Israeli-born graduates who studied abroad. Among newly-licensed physicians who studied in Israel, the proportion of females has historically been intermediate between the other two groups, but it has recently risen to 54% and now parallels the proportion of females among immigrants who studied abroad. In recent years, the mix of academic origins among newly licensed physicians has changed dramatically, with important implications for the proportion of women among newly licensed physicians.The highest percentage of females was found in family medicine followed by oncology, pediatrics and psychiatry. The greatest increase over the years in this percentage was for gynecology and internal medicine.Female physicians worked shorter hours than males, particularly at younger ages. The proportion of females among employed Arab physicians is much lower than among Jewish physicians.

Conclusions

The proportion of female physicians has been steadily rising, although in recent years the increase has leveled off. This has been due, in part, to the decline in the flow of immigrant physicians and the increase in the number of Israelis studying abroad. Future developments in medical education options and immigration will determine whether their proportion will continue rising. Planning for future medical personnel must take these results into consideration.

     

Relationship between US medical school admission policy and graduates entering family practice

Rural areas in the United States continue to lack an adequate supply of primary care doctors, particularly family physicians, despite the oversupply of physicians nationally. Previous studies have provided strong evidence that students from rural backgrounds, as well as those who expressed an interest at the time of medical school admission for a career in family medicine, are significantly more likely to eventually practise family medicine in rural areas than their peers. US medical schools were classified into three groups based on their written selection factors for preferentially admitting students into the graduating class of 1982. Of those schools with selection factors for students from both a rural background and an interest in a future career in family medicine, 23.7% of their graduates entered family medicine training programmes. This compares with 14.5% of graduates from schools with a preference for students from a rural background, and 12.4% from all other schools (P less than 0.001). Coupled with previous data which shows that family physicians from rural areas are more likely to eventually practise in rural areas than their peers, preferentially admitting students from rural backgrounds interested in a career in family medicine could help to solve the problem of the shortage of primary care physicians in rural areas in the US.     

Medical student indebtedness and the propensity to enter academic medicine

This paper considers the potential impact of medical school indebtedness and other variables on the propensity of US doctors to enter academic medicine. Probit models provide some evidence that indebtedness reduces the likelihood that physicians will choose academic medicine as their primary activity. Nevertheless, the magnitude of this effect is not large. As indebtedness may be endogenous, the probits are rerun using an instrumental variables approach. These estimates imply that over time indebtedness may have an important impact on the propensity of physicians to enter academic medicine.     

Perceived mistreatment and attitude change by graduating medical students: a retrospective study

The goal of this study was to assess types and sources of perceived mistreatment, perceived attitude change, and academic performance of graduating medical students. A total of 87 of 143 (61%) students anonymously completed a mistreatment questionnaire, an attitude questionnaire, and questions about academic performance. The percentage of mistreatment was widespread (98.9%) with psychological mistreatment (shouting and humiliating) by residents/interns being most frequent. Over half of the students perceived sexual harassment, with women reporting greater harassment than men. There was a high incidence of disparaging remarks about doctors and medicine as a profession from a variety of sources. Increased mistreatment was positively associated with a perceived increase in cynicism. The potentially adverse effects of mistreatment on the individual student, the teacher-student relationship, and the doctor-patient relationship are discussed with recommendations for improving medical education.     

"Knife before wife": an exploratory study of gender and the UK medical profession

PURPOSE: The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision. DESIGN/METHODOLOGY/APPROACH: The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved elite interviews and self-completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students. FINDINGS: The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession. RESEARCH LIMITATIONS/IMPLICATIONS: Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine. PRACTICAL IMPLICATIONS: Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies. ORIGINALITY/VALUE: The paper provides a review of literature in this area, thereby providing a longitudinal perspective of gender and the medical profession. Moreover, the research sample includes both male and female medical practitioners and medical students, which provides perspectives from both genders and from those who have experience within the medical profession and from those beginning their career in the medical profession. The research will be of value to the medical profession, the NHS and Royal Colleges of Medicine.     

Undergraduate medical education in the U.S. and Israel: contrasts and common challenges

In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education.There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students’ hands-on responsibility for their patients until year six of their undergraduate medical education.The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.     

Career perspectives of women and men medical students

In spite of the increasing number of women medical students, in many specialties the number of women actually working as doctors still lags behind the number of men working in the same profession. To define factors contributing to this discrepancy 646 medical students at the Vrije Universiteit in Amsterdam were surveyed. A questionnaire was used to obtain information about the difference between women and men medical students concerning their outlook on a future career as combined with domestic responsibilities. The questionnaire covered the items motives and career preference, barriers to reaching the profession of first choice, career planning and the combination of domestic responsibilities and a medical career. The results of this survey indicate that there are still important differences between women and men students in career perspectives. These differences need attention from medical students as well as teaching staff.     

Elitism and professional control in a saturated market: immigrant physicians in Israel

Using Israel as a case study, Che paper considers the social mechanisms by means of which the medical profession seeks to maintain its boundaries and control in a social context characterised by the recent arrival of twelve thousand immigrant physicians from the former Soviet Union. This situation poses a threat to the veteran medical profession which is described as combining elitist and proletarian elements in an uneasy balance. In the past the principal mode of resolution with regard to this duality has taken the form of demonstrative assertions of the elitist component. With the large influx of immigrant doctors, three mechanisms geared to maintain control have been utilised: (1) the formal licensing examination for general practice; (2) full control of employment options in the health care system and (3) a widespread negative stereotype regarding the level of immigrant physicians' professional skills. The paper discusses these mechanisms and their implications for the profession.     

Medicine in prospect—the first-year student's view

A sample of first-year medical students from the University of New South Wales was interviewed to determine the students' reasons for studying Medicine, their career aspirations and their views, in prospect, of the medical course and medical practice. There were some differences, in general responses, between men and women. In general the interviews revealed that at this stage of their careers the students were motivated to a high degree by humanitarian concerns.
Recent criticisms of the outcomes of medical education have featured concerns that graduating doctors do not demonstrate sufficient ability to relate to patients on a personal level or to take a holistic approach to care. Some medical educators and community spokesmen have attributed this to the selection system which, based solely on academic merit, chooses students with high academic ability and according to some critics, low social abilities and awareness. The results of this study indicate that such assumptions are false and that undesirable attitudes said to be present in graduating doctors do not appear to be present in the early stages of medical education.     

The Separation Wall and the right to healthcare

Nowadays, the concepts of soldier and war have changed due to terrorism and the war on terrorism. According to the literature, to prevent terrorism, it is possible to use more violence, but how can we grant the safety of many versus the dignity of a few? In Israel, in order to protect civilians against possible terrorist attacks, Palestinian ambulances that would reach the Israeli hospitals (or the Palestinian hospitals in East Jerusalem) must be quickly controlled. However, many times, at the checkpoint, patients have to wait for an Israeli vehicle that will take them to Israel. This procedure causes many delays in medical emergency. How to avoid that terrorists may receive better care than Palestinian civilians may just because they are already on the Israeli side of the Separation Wall? How is it possible to ensure the life and safety of many, without denying the right to healthcare to somebody? How to decide when the State requirements conflict with traditional medical duties? Is it acceptable to provide health care to a terrorist? What should be done when it is uncertain whether the ambulance transports weapons besides patients? These questions call upon the core role of the doctor and of the medical profession: taking care of all sick persons. The care is the starting point of ethics. If we do not care about other human beings we do not have a real moral comprehension of any human ideal or action. For this reason we can say that the care is the premise of morality. The rights of all citizens, including the claim to public security, grounds on the care for each individual who needs help.