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Feminization of the Physician Workforce: Implications for Health Human Resource Planning

Internationally, there are increasing numbers of women entering the physician workforce and enrolled in medical school and residency programs. In Canada, 60% of family practice trainees are women and the number of female physicians increased by nearly 23% between 2007 and 2011 alone (compared to a 9% increase in the number of male physicians over the same period). This shift in physician workforce demographics has been labeled the "feminization of medicine."

doctors-patientThe increasing proportion of women practicing medicine may potentially contribute to a shortage in service supply. If female physicians are less productive, have shorter overall careers, see a restricted patient population, or deliver a more restricted basket of services compared to their male counterparts, then the increasing feminization of the work-force may well necessitate an increase in overall physician numbers to adequately meet population needs.

A recent comprehensive knowledge synthesis of over 130 academic and grey literature sources published between 1990 and 2012 investigated the impact of an increasing proportion of females in the physician workforce on levels of service provision and human resources planning.

Common Themes in the Literature

The bulk of the literature in this area focuses on differences in the amount of work completed by male versus female physicians. Differences in practice style, patient mix, service mix, and broad workforce trends are featured much less prominently. The majority of articles examine primary care, which is not surprising given that primary care has the largest proportion of women among specialities.

Activity and Workload

Compared to their male counterparts, female physicians:

  • are more likely to have engaged in part-time work, or intend to do so at some point during their career. The majority of female physicians currently working part-time are under age 45 (corresponding with years of childbearing), while, the majority of male physicians who work part-time are over age 54 (likely correspond-ing to a decline in service provision as retirement approaches). The few longitudinal studies note that the gap in hours worked between male and female physicians seems to be narrowing both over time and as the physician cohort ages.
  • work, on average, five to twelve fewer hours per week.
  • work similar hours when they have no dependents.
  • see fewer patients. This gap is largest in primary care where they complete approximately 45 fewer visits per week and smallest in some specialties where it drops to between 8 and 23 visits per week. Women in anaesthesiology, dermatology, general practice, psychiatry, internal medicine, paediatrics, neurology, obstetrics, ophthalmology, general surgery and radiology see fewer patients or deliver fewer services on average than their male counter-parts.

However, female physicians still work more, on average, than the rest of the country's employed population. Issues of work-life balance, caregiving and child-rearing responsibilities warrant significant attention. Physicians, regardless of sex, should work in an environment that supports balance, without compromising the quality of, and access to, care.

Practice Patterns

Male and female physicians practice medicine differently.

Females are less likely than males to:

  • choose to work in rural practice; and
  • provide house calls or out-of-office care;

and are more likely to:

  • work in partnership or group-based practice rather than solo.

In general practice, when compared to males, female physicians:

  • tend to see a higher proportion of female patients and a lower propor-tion of elderly ones;
  • are more likely to see patients with complex psychosocial problems;
  • are equally likely to see patients with complex medical problems;
  • see more gynaecologic problems, pregnancies, family planning, and endocrine/metabolic problems; and
  • see fewer musculoskeletal, respiratory and male genital system problems.

Speciality Choice

Female physicians remain much less likely to select surgical specialities and much more likely to select primary care, paediatrics, and obstetrics compared to their male counterparts. Thus, because the proportion of female physicians is rising, specialities with very low rates of female participation may experience shortages.

Research Gaps and Priorities

Studies are needed to examine:

  • whether differences in activity levels between male and female physicians could result in shortages or surpluses in specific specialities;
  • reasons for speciality selection;
  • physician and practice variation; and
  • differences in patient and service mix.

Much of the literature relies on one-time, cross-sectional surveys, collecting self-report data on work practices and patterns. This type of research has some substantial methodological limitations, including low response rates, selection bias, recall bias, a high degree of random error, and an inability to measure trends over time.

Implications for Human Resources Planning

More robust measures that account for sex differences in volume, but also on the implications of the differences in patient mix, service mix, and practice style between male and female physicians need to be developed and used. Other demographic and work-force factors (e.g., the impact of physician age and cohort) should also be considered. Health human resources modeling must always also focus on the health needs of the population. Accurate measures of physician and service supply that account for the impact of feminization and other demographic shifts are not sufficient in-and-of themselves.

Reference: Feminization of the Physician Work-force: Implications for Health Human Resource Planning. CHHRN Knowledge Synthesis.

Health Canadacihr logo1This initiative has been generously funded by grants from Health Canada and the Canadian Institutes of Health Research. The views expressed here do not necessarily reflect those of the funders.