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It's just a job: a new generation of physicians dealing with career and work ideals
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0001-6897-5515
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Today, women constitute about half of medical students. However, women are still underrepresented in prestigious specialties such as surgery. Some suggest that this could be explained by women being more oriented towards work-life balance.

Aim: The overall aim of this dissertation was to explore aspects of gender in work-life priorities, career plans, clinical experiences and negotiations of professional ideals among medical students and newly graduated doctors, all in a Swedish setting.

Method: We based the analysis on data from two different sources: an extensive questionnaire exploring gender and career plans among medical students (paper I-III) and interviews with newly graduated doctors (study IV).

In paper I, four classes of first- and final-year medical (N=507, response rate 85%) answered an open-ended question about their future life, 60% were women. We conducted a mixed methods design where we analyzed the answers qualitatively to create categories that could be analyzed quantitatively in the second stage.

In paper II, five classes of final-year medical students  were included (N = 372, response rate 89%), and 58% were women. We studied their specialty preference and how they rated the impact that the motivational factors had for their choice. In order to evaluate the independent impact of each motivational factor for specialty preference, we used logistic regression.

In paper III, final-year medical students answered two open-ended questions: “Can you recall an event that made you interested of working with a certain specialty?” and “Can you recall an event that made you uninterested of working with a certain specialty?”. The response rate was 62% (N = 250),  and 58% were women. The analysis was similar to paper I, but here we focused on the qualitative results.

In paper IV, thematic interviews were conducted in 2014 and 2015. We made a purposeful sampling of 15 junior doctors, including nine women and six men from eight different hospitals. Data collection and analysis was inspired by constructivist grounded theory methodology.

Results: When looking at the work-life priorities of medical students and junior doctors it is clear that both men and women want more to life than work in their ideal future. The junior doctors renounced fully devoted and loyal ideal and presented a self-narrative where family and leisure was important to cope and stay empathic throughout their professional lives.

The specialty preferences and the highly rated motives for choosing them were relatively gender neutral. However, the gender neutrality came to an end when the final-year medical students described clinical experiences that affected their specialty preference. Women were more often deterred by workplace cultures, whereas men were more often deterred by knowledge area, suggesting that it is a male privilege to choose a specialty according to interest.

Among the newly graduated doctors, another male privilege seemed to be that men were able to pass more swiftly as real doctors, whereas the women experienced more dissonance between their self-understanding and being perceived as more junior and self-doubting.

Conclusions: The career plans and work-life priorities of doctors-to-be were relatively gender neutral. Both female and male doctors, intended to balance work not only with a family but also with leisure. This challenges the health care system to establish more adaptive and flexible work conditions.

Gender segregation in specialty choice is not the result of gender-dichotomized specialty preferences starting in medical school. This calls for a re-evaluation of the understanding where gender is seen as a mere background characteristic, priming women and men for different specialties. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2017. , 65 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1919
Keyword [en]
Medical students, junior doctors, gender perspective, medical education, graduate medical education, professional identity, career choice, gender discrimination, mixed methods
National Category
Family Medicine Other Health Sciences
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-139976ISBN: 978-91-7601-764-7 (print)OAI: oai:DiVA.org:umu-139976DiVA: diva2:1145048
Public defence
2017-10-20, Sal 135, By 9A, Enheten för allmänmedicin, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-09-29 Created: 2017-09-27 Last updated: 2017-10-16Bibliographically approved
List of papers
1. Swedish medical students' expectations of their future life
Open this publication in new window or tab >>Swedish medical students' expectations of their future life
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2011 (English)In: International Journal of Medical Education, ISSN 2042-6372, E-ISSN 2042-6372, Vol. 2, 140-146 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To investigate future life expectations among male and female medical students in their first and final year.

Methods: The study was cross-sectional and conducted at a Swedish medical school. Out of 600 invited students, 507 (85%) answered an open-ended question about their future life, 298 (59%) first-year students and 209 (41%) last-year students. Women constituted 60% of the respondents. A mixed model design was applied; qualitative content analysis was utilized to create statistically comparable themes and categories.

Results: Students' written answers were coded, categorized and clustered into four themes: "Work", "Family", "Leisure" and "Quality of personal life". Almost all students included aspects of work in their answers. Female students were more detailed than male ones in their family concerns. Almost a third of all students reflected on a future work-life balance, but considerations regarding quality of personal life and leisure were more common among last-year students.

Conclusions: Today's medical students expect more of life than work, especially those standing on the doorstep of working life. They intend to balance work not only with a family but also with leisure activities. Our results reflect work attitudes that challenge the health care system for more adaptive working conditions. We suggest that discussions about work-life balance should be included in medical curricula.

Keyword
medical students, future expectations
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-61478 (URN)10.5116/ijme.4ec5.92b8 (DOI)
Available from: 2012-11-15 Created: 2012-11-15 Last updated: 2017-10-02Bibliographically approved
2. Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students
Open this publication in new window or tab >>Few gender differences in specialty preferences and motivational factors: a cross-sectional Swedish study on last-year medical students
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2013 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 13, 39Article in journal (Refereed) Published
Abstract [en]

Background: Today, women constitute about half of medical students in several Western societies, yet women physicians are still underrepresented in surgical specialties and clustered in other branches of medicine. Gender segregation in specialty preference has been found already in medical school. It is important to study the career preferences of our future physicians, as they will influence the maintenance of an adequate supply of physicians in all specialties and the future provision of health care. American and British studies dominate the area of gender and medical careers whereas Swedish studies on medical students' reasons for specialty preference are scarce. The aim of this study is to investigate and compare Swedish male and female medical students' specialty preferences and the motives behind them. Methods: Between 2006 and 2009, all last-year medical students at Umea University, Sweden (N = 421), were invited to answer a questionnaire about their future career and family plans. They were asked about their specialty preference and how they rated the impact that the motivational factors had for their choice. The response rate was 89% (N = 372); 58% were women (N = 215) and 42% were men (N = 157). Logistic regression was used to evaluate the independent impact of each motivational factor for specialty preference. Results: On the whole, male and female last-year students opted for similar specialties. Men and women had an almost identical ranking order of the motivational factors. When analyzed separately, male and female students showed both similarities and differences in the motivational factors that were associated with their specialty preference. A majority of the women and a good third of the men intended to work part-time. The motivational factor combining work with family correlated with number of working hours for women, but not for men. Conclusions: The gender similarities in the medical students' specialty preferences are striking and contrast with research from other Western countries where male and female students show more differences in career aspirations. These similarities should be seized by the health care system in order to counteract the horizontal gender segregation in the physician workforce of today.

National Category
Educational Sciences Family Medicine
Identifiers
urn:nbn:se:umu:diva-68259 (URN)10.1186/1472-6920-13-39 (DOI)000316220000001 ()23497262 (PubMedID)
Available from: 2013-04-18 Created: 2013-04-15 Last updated: 2017-10-02Bibliographically approved
3. Choosing specialty according to interest – a male privilege?: gendered experiences in clinical training affect medical students' specialty preferences
Open this publication in new window or tab >>Choosing specialty according to interest – a male privilege?: gendered experiences in clinical training affect medical students' specialty preferences
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(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-140000 (URN)
Available from: 2017-09-28 Created: 2017-09-28 Last updated: 2017-10-02
4. "You don’t want to disturb, you want to fix it yourself": negotiations of professional identity in newly graduated doctors' narratives
Open this publication in new window or tab >>"You don’t want to disturb, you want to fix it yourself": negotiations of professional identity in newly graduated doctors' narratives
(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-140002 (URN)
Available from: 2017-09-28 Created: 2017-09-28 Last updated: 2017-10-02

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