The Negative Effect of the “Physician In Chief System” (On Work-And-Life

Balances of Japanese Female Doctors” 2012/6/15

University of Toyama

Mayumi Nakamura

mayumi.nakamura8@gmail.com

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１．Objective of this presentation ・This presentation focus on specialty choices and

work status of Japanese female medical doctors. ・I argue that, “Physician in chief” system, which

require a physician who work full-time at a hospital to be on call 24 hours-a-day

causes: ⇒crowding of woman physicians in specialties

which deals with chronic malady ⇒woman physicians to leave full-time positions

at hospitals for clinics or part-time jobs ⇒both lead to the shortage of physicians (at

hospitals)

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2. Situation in Japan The “shortage of physicians”

・Shortage of physician has attracted attention, and came to be considered as a grave social problem in mid 2000s. ・Chains of incidents, in which patients transported by ambulance was declined by hospitals due to the shortage of physicians in emergency rooms ・In 2006, for instance, a pregnant woman in Nara who had cerebral hemorrhage was transported by an ambulance, was turned down by 18 hospitals, before she finally accepted 6hours later (she died). (Mainichi Newspaper Osaka Branch 2006) ⇒Particularly, shortage of physicians in obstetrics and surgery, and in pediatrics was considered problematic.

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2. Situation in Japan The “shortage of physicians”, continued.

• The shortage of physicians is believed to be caused partially by the increase of woman physicians, since:

• 1) women physicians crowd in certain specialties;

• 2) women physicians leave hospital career earlier;

• 3) Women more likely to work as part-time.

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4. Physician in chief system in Japan *Most hospitals have the “physician in chief (PIC)” system. *Usually, one physician (full-time physician who works for the hospital) become PIC for a patient. *PIC is fully responsible for the patient, and on-call for the patient 24 hours a day, 7days a week. *Full-time physicians who work for hospitals (during the day) also needs to take night shifts for an emergency room. ⇒Hospitalist system is not common in Japan. The same physician at the hospital care for incoming patients and hospitalized patients.

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4. Physician in chief system in Japan, continued

*If you have a family, or intend to have one, being on call for 24 hours a day poses a problem.

*In this presentation, I argue that, to avoid getting summoned to a hospital during the night, woman physicians:

⇒choose specialties with chronic malady

⇒leave full-time job at a hospital for a part-time job or positions in clinic.

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2. Relation to “shortage of physicians”

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Gender Composition of Specialties, Japan (2008)

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Source: Ministry of Health, Labour and Welfare, 2008. Ishi Yakuzaishi chosa. This graph only includes physicians who works for hospitals.

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The similarities and differences between 2 countries

*Similarities: more ♀physicians in pediatrics, gynecology, dermatology

*Differences: Japanese ♀physicians more likely to crowd in areas which deals with chronic malady – Dermatology, Ophthalmology, Endocrinology, Allergy and immunology

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2．Previous studies Sociological research on work life balance of med

ical doctors：

Works are done in the U.S. （Boulis 2004, Boulis and Jacobs 2008）, but little sociological studies have been done in Japan.

Studies done by medical doctors themselves.

But, previous studies on Japanese female medical doctors have not paid attention to the differences by specialization, work status, and types of employers, nor paid attention to gender-role values, and human capital.

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４．Data

7 married female medical doctors

Among them, 5 are female doctors with child(ren)

Telephone interview with snowball sampling

Included 2 married male medical doctors

Age range 35~49

Research funded by JSPS

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４．Data

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Name Gender Age Specialization Place of Work Work Status# ofchildren

Spouse

DoctorA Female Late 30s

InternalMedicine(internalsecretion/psychosomatic medicine)

Private Hospital Part-time 1 M.D.

DoctorB Female Late 40sInternalMedicine(Reumatism)

University Hospital Full-time 2 M.D.

DoctorC Female Late 30sInternalMedicine(internalsecretion)

Clinic Part-time 3 Other Professional.

DoctorD Female Early 40s Pathology University Hospital Full-time None Other ProfessionalDoctorE Female Early 40s Neurology Public Hospital Full-time 2 Other Professional

DoctorF Female Early 40sInternal Medicine(internal secretion)

University Hospital Part-time 2 M.D.

DoctorG Female Late 30s Other University Hospital Executive None Company employeeDoctorH Male Early 40s Psychiatry University Hospital Full-time None M.D.

DoctorI Male Late 30sInternalMedicine(Digestiveorgans)

University Hospital Full-time 1 M.D.

５．Analysis

Why do female medical doctors choose certain types of specialization and/or working as part-time, and/ or at clinics (rather than hospitals)?

→Introduce some of the findings

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(1)Compatibility with family life Most frequently given answer was, compatibility with their family

lives. Key word was sudden change. ・Doctor A: At those specializations which deal with chronic

ailment such as diabetic and psychiatry, doctors are less likely to deal with sudden change in patient conditions.

・Doctor B: I avoided surgery since you get called at night (due to sudden change in patient conditions)

⇒full-time doctors working for a hospital has to be a “physician in charge” , get telephone calls and get summoned to the hospital during night and weekends

⇒Avoid those specializations with sudden change in patient conditions

⇒Choose part-time , and/or clinics ⇒Not the length of work hours, but the intervention by work while

you are at home is the problem…

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(2)Choose specializations with less skill atrophy (human capital)

Doctor C: The reason why I pick diabetes as my specialization is that, I can study at home. My skills will not atrophy while I am taking a child care leave. In those specializations, such as endoscope, which require hand skills, you lose your skills while you are gone. But, with diabetes, you can increase your skills at home (while you are caring for children).

・Doctor D: Skills and knowledge in Pathology will not

change largely while you are gone (during child-care leave.) On the other hands, in those specializations which require hand skills (手技）, new skills emerges very fast while you are gone. So, you have to study if you have a blank in your career (due to child-care leave).

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Relation to Human capital Zellner(1975)and Polachek(1979, 1981,

1984, 1985)：those women who plan to have a blank in their career will choose jobs of less skill appreciation and depreciation.

→Doctor C’s choice

→Doctor C also choose specialization due to skill appreciation during child-care leave →aspect not seen before

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(3)Discriminations by employers Doctor F: By a professor in Surgery , I was told, “ If it is

possible, please do not apply for surgery (for a residency)”.

Doctor B: If someone gets pregnant (during residency),

they tell her “You get pregnant at such a busy time!”. They tell female doctors, “ We all have been praying so that you won’t get pregnant”.

→these discrimination comes not so much from prejudice

based on gender role values any longer, but from the need to carry out tight rotation among doctors…

⇒Relation with the system

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(4)Problem with the system （１）Influence of professors (senior member) in medical office Doctor C: When I chose a specialization, I chose the one

whose professor is understanding. A person with a family, child-rearing experience. I have avoided all those difficult places and people.

⇒The treatment of female doctors are not determined by

formal rules or rights ⇒ but individually decided by professors who leads those

specializations ⇒Which poises difficulty for female doctors to continue

working as full-time doctor at a hospital.

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(4)Problem with the system (2) limitation of application of child-care

leave system At a university hospital, they only allow

child-care leave for full-time (and non-executive) doctors

Exclude those who are part-time, and executives

But, most female doctors are part-time, therefore it was not applicable for majority of women there.

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