Makiko Arima
Background: Gender-role attribution is still prevalent in Japanese physicians’ working environments. Indeed, 70% of female physicians forgo promising careers because of difficulties in raising children and balancing family life and a career. The proportion of male Japanese physicians taking paternity leave is only 2.6%, which is quite low. Female physicians with children are sometimes compelled to do most of the child-rearing, no matter how much they wish to continue their careers. This situation often leads female physicians to reduce their total work and research hours and to work as parttimers. This study investigated factors related to openness towards improving gender-role attitudes in academic hospitals. Improving Japanese Physicians’ Gender-Role Attitudes: Career Education and Adjusted Work Systems Makiko Arima, MPH, Ph.D Assistant Professor, Gender Equality and Career Development Division, Tokyo Medical and Dental University, Tokyo, Japan Yoko Araki, MD, Ph.D President, Araki Occupational Health Consultancy, Tokyo, Japan Sachiko Iseki, DDS, Ph.D Professor, Tokyo Medical and Dental University, Tokyo, Japan Chieko Mitaka, MD, Ph.D Professor, Juntendo University, Tokyo, Japan Nobuhide Hirai, MD, Ph.D Associate Professor, Tokyo Medical and Dental University, Tokyo, Japan Yasunari Miyazaki, MD, Ph.D Professor, Tokyo Medical and Dental University, Tokyo, Japan What is known? 1. With the Japanese population aging and the number of Japanese physicians per 1,000 population well below other developed countries’ average, but patient visits being two times higher, Japan needs its female physicians to practice medicine. 2. However, 70% of female physicians in Japan forgo promising careers because of difficulties in raising children and balancing family life and a career. 3. Traditional gender-role attitudes that ‘females stay home and males go out and work’ still prevail in clinical medicine. Early career education on such topics as overcoming the obstacles of pregnancy and child-rearing to the practice of medicine, how others overcome those obstacles, might help female physicians design their life’s career, prevent turnover among them and enable men to be more active in the household. What this paper adds: 1. Female physicians with no children, whose spouses’ were ‘non-working’, who agreed on providing career education on life events to young physicians, and who graduated within the last 1–10 years showed greater openness toward improving gender-role attitudes in academic hospitals. 2. Male physicians who agreed with providing career education on life events to young physicians and who agreed with optimizing adequate work hours showed greater openness toward improving gender-role attitudes in academic hospitals. 3. Of all factors, providing career education on life events to young physicians was considered most effective in improving gender-role attitudes in the clinical field. Optimizing working hours could also help improve gender-role attitudes and overall workplace diversity in medical settings. 189 Makiko Arima Background As an occupation, being a physician requires high expertise and professionalism, based on each physician’s knowledge and skills. Therefore, in the discipline of medicine, there should be no gender disparities in physicians’ salaries or treatment (Tanebe K, 2008). However, studies have revealed gender differences in physicians’ pay (Jagsi R, 2012). Similarly, in Japanese medical settings, gender disparities are prevalent in the workplace. In a previous survey, 70% (N = 2,931) of female respondents reported that they had to forgo promising careers because of difficulties raising children and balancing family life and a career (Japan Medical Association Committee on Gender Equality, 2014). Japanese women’s work participation rate follows an ‘M-shaped curve’, indicating that during their 30s, a child-bearing age period, overall work participation decreases and then increases again near their 50s (Ramakrishnan A, 2014). This trend includes ‘M-shaped curve’ for female physicians. In addition, 70% of Japanese female physicians are married to male physicians (Kataoka H, 2012). Because physician-husbands also work long hours, asking them for sufficient support in household or child-rearing duties is difficult. Furthermore, the proportion of Japanese male physicians taking paternity leave is only 2.6% (N = 4,286) (Japan Medical Association Committee on Gender Equality, 2014). Therefore, female physicians with children are sometimes compelled to do most of the childrearing, no matter how much they wish to continue their careers as physicians. In other words, traditional gender-role attitudes that ‘females stay home and males go out and work’ still prevails in clinical medicine. However, early career education on such topics as overcoming the obstacles of pregnancy and childrearing to the practice of medicine, how others overcome those obstacles, organizational support systems available and how men can be supportive in the household and with child-rearing might help female physicians design their life’s career, prevent turnover among them and enable men to be more active in the household. This proposal is compatible with the current reform of the educational curriculum for undergraduate and graduate students, regulated by the Japanese Ministry of Education, Culture, Sports, Science and Technology, to implement career education in Japanese universities (Inagaki K, 2014). Introduction Because female physicians with children have time constraints, they are sometimes not able to work night shifts or to be charged with inpatient care. This situation might compel them to reduce their work and research hours, choose to work as part-timers or resign their positions; such actions might decrease overall career motivation and cause a loss of expertise. Practically, 15.6% (N = 20,792) of female physicians work fulltime in regular employment, 36.4% (N = 1,286) work part-time in regular employment and 23.0% (N = 7051) work part-time in irregular employment (Japanese Ministry of Health, Labour and Welfare, 2010). That many female physicians choose to work part-time helps to explain the imbalance and inequality in working patterns among both female and male physicians. Female physicians’ high turnover rate leads to an uneven distribution in specialties and a shortage in the absolute number of physicians. Those specialties with a high rate of female physicians, such as ophthalmology, dermatology, paediatrics and OBGYN, have suffered damage from their absence (Yoshida A, 2011). The Organisation for Economic Cooperation and Development (OECD) shows the average number of physicians per population of 1,000 people is 3.2; however, in Japan it is 2.3, much lower than that average (OECD Health Statistics, 2014). At the same time, the number of patient visits in Japan per capita is 13.2, two times higher than the average among other developed countries (The Statistics Portal, 2013). To respond adequately to high health-care demands, a higher number of physicians, including females, should be practising medicine. Indeed, uneven gender distribution eventually helps cause longer working hours and overwork among physicians; this requires optimization of their total work hours or work patterns. To improve gender-role attitudes in medical settings and changes in work systems, providing career education seems necessary. This will lead to greater overall diversity in clinical medicine, which is necessary because diversity is key to improving organizational performance, and patient and employee satisfaction (Victoria State Government, Australia, 2012). Methods: A cross-sectional, self-administered questionnaire with 34 items was distributed to 2,159 medical school alumni in 2011. The primary outcome measure was ‘openness towards improving gender-role attitudes in academic hospitals’. Findings: Statistically significant relationships were identified using chi-square tests. A total of 484 responses were received: 71.6% of females and 55.3% of males approved improving ‘gender-role attitudes’ in academic hospitals. Logistic regression analysis showed that female physicians with no children (OR: 13.292, p < 0.004) showed greater openness towards improving gender-role attitudes in academic hospitals than those with children. Female physicians whose spouses were ‘non-working’ (OR: 26.710, p < 0.035) showed greater openness than those whose spouses were physicians or had other occupations. Female physicians who graduated within 1–10 years showed greater openness than those who graduated within 11–20 years (OR: 0.185, p < 0.006) and within 21–30 years (OR: 0.105, p < 0.012). Female physicians who agreed on providing career education on life events to young physicians (OR: 4.745, p < 0.008) showed greater openness than those who disagreed. Male physicians who agreed on providing career education on life events to young physicians (OR: 4.073, p < 0.000) showed greater openness than those who disagreed. Male physicians who agreed on optimizing adequate work hours (OR: 4.236, p < 0.001) showed greater openness than those who disagreed. Conclusions: Of all factors, providing career education on life events to young physicians in academic hospitals was considered most effective in improving gender-role attitudes in the clinical field. Optimizing working hours could also help improve gender-role attitudes and overall workplace diversity in medical settings. Keywords: gender
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