Are male and femaledoctors really thatdifferent?Adam Beaini, Fourth Year Medical Student, Newcastle University Medical School, UK

Weizblit N, Noble J, Baerlocher M. The

feminisation of Canadian medicine and

its impact upon doctor productivity. Med

Educ 2009; 43: 442–448

Since 1966, female medicalstudents have increasednine-fold, from 152 to 1423,whereas male medical studentshave remained roughly equal innumbers, currently 1037. From apreviously male-dominatedprofession, the numbers of femaledoctors are projected to overtakemale doctors in the coming yearsin several major countries,including: Canada, USA,Australia and the UK. This will,and is, undoubtedlychanging the set-up in medicine,but how?

It has been hypothesised thatan increased proportion of womenin medical practice may result in ashift towards a more biopsycho-social approach to patient care,changing patient–physicianrelationships, and changes tohealth care delivery itself.

This Canadian study used across-sectional survey to pursuethree main aims.

1. ‘To determine the currentfemale : male ratio enteringthe medical profession inCanada, both at the level ofmedical school and medicalpractice.’

2. ‘To evaluate the professionalpractice of female and malephysicians nationwide withrespect to the number of hoursworked, the number of patientsseen and the percentage ofphysicians taking mater-nity ⁄ paternity and sick leave.’

3. ‘To determine the current andpredicted effect of an increasein the number of women inCanadian medicine on physi-cian productivity, measured ashours spent providing directpatient care.’

Data from the National Physi-cian Survey was analysed togetherwith data from Statistics Canadaand several medical organisa-tions, such as the Canadian Med-ical Association. The authorscreated a measure of productivity,termed ‘work hours per week per

population (WHPWPP)’, to com-pare current and predicted pro-ductivity.

Results showed that there iscurrently almost a 1.5 : 1 ratio offemale : male medical students inCanada. Most females specialise inpaediatric, obstetrics and gynae-cology, psychiatry and generalpractice, whereas fewer femaleswent into surgery and emergencymedicine. In general, males werefound to work more hours perweek than females (35 hourscompared with 30 hours of directpatient care, respectively). How-ever, exceptions to this includedsurgery, endocrinology and geri-atrics.

Further analysis showed thefollowing differences to bestatistically significant.

The numbers offemale doctorsare projected toovertake maledoctors incoming years

� Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 127–133 131

• Males worked more on-callhours per month, and thiscorrelated with them seeingmore patients.

• Females took more time offfor maternity leave, as com-pared with males for paternityleave.

• Females were away from workas a result of illness or dis-ability more than males.

• Females took more ‘leave orsabbatical’ than males.

The WHPWPP measurementswere extrapolated to a theoreticalmale doctor : female doctor ratioof 1. This hypothesised a reductionin productivity, equivalent to a2.5 per cent reduction in male, or2.9 per cent reduction in female,full-time doctors, given that cur-rently there are still more malethan female doctors. According toprevious trends, the authors be-lieve this point is likely to occur inthe next 10 years. ‘Previous workhas also found similar results, withfemale doctors suffering from anincreased likelihood of stress and‘‘burnout’’ and having a highertendency to work part-time’. Theauthors make direct reference toprevious work performed mainly inCanada and the USA.

There are two solutionsdiscussed by the study authors.

1. Increase the availability ofsupport services, such aschildcare, and work flexibility,so that doctors can work longerhours if they choose to do so.

2. Accept that ‘fewer work hoursmay be beneficial for bothphysicians and patients. Thereis indeed evidence that youn-ger physicians work fewerhours compared to theircounterparts from a decadeprevious…It has been shownthat longer work hours canimpair functions such as sus-tained attention, vigilance,and simulated driving tasks’.To rectify this issue, thenumber of matriculating med-ical students would have toincrease to meet the currentlevel of productivity. They arecurrently lobbying for this inCanada.

The authors concluded thatlimitations of this study includedunderestimating the difference inproductivity between male andfemales doctors, as factors such asearlier retirement, greater vaca-tion time, greater sick-leave andthe fact that female doctors tend

to see fewer patients, were notfactored in. The assumptions madein work patterns and population,i.e. the doctor growth ratio, whichwas assumed to be fixed whenextrapolating future WHPWPPmeasurements, were also limitingfactors. Lastly, there was only a32 per cent response rate for theNational Physician Survey. Thiswas expected with a sample size of60 811; however, bias was notthought to be shown, as furtherstatistical analysis showed goodpredictive correlation. Further-more, although this study wascarried out in Canada, and all theprevious work mentioned is eitherCanadian or American, the con-clusions made here are still likelyto correlate to other developedcountries, such as the UK andAustralia, because statistically, wehave a similar ratio of male tofemale medical students. Thistheory is supported by McMurrayet al.1

Aside from this, how can oneaccurately and comprehensivelymeasure productivity, given malesand females may have diverseapproaches to a given situation? Itis more difficult to compare qualityof care than it is to compare aphysical output such as time.

Talking about the productivityof male vs. female doctors is asensitive topic, and for thisreason it is unlikely to be formallyaddressed. It may be useful forthe UK to build on currentresearch using a large sample sizesimilar to the study in Canada.This ever-evolving facet of themale : female ratio of doctors islikely to carve a new path in theset-up of medicine around theworld, and only time will tellhow this conundrum will unravelitself.

REFERENCE

1. McMurray JE, et al. The work lives of

women physicians’ results from the

physician work life study. The SGIM

Career Satisfaction Study Group. J Gen

Intern Med 2000;15:372–380.Oxford,

UK

There iscurrentlyalmost a

1.5 : 1 ratio offemale : male

medicalstudents in

Canada

132 � Blackwell Publishing Ltd 2009. THE CLINICAL TEACHER 2009; 6: 127–133