Work-pattern differences between male and female orthodontists

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    benate her career when she has children3,4 or whencombined family income is high.5 However, current

    aFoHeabAsAngPerMPRepOrtepaSub088Copdoiecialties, including orthodontics, has increased dra-tically in recent years.1 Because men and womend to assume different levels of responsibility atme, especially in child rearing, practice patterns ofle and female orthodontists might differ. Therefore,rk patterns should be evaluated so that our schools

    n produce enough providers for the future. If femalehodontists work fewer hours than their male coun-parts, current supply studies might underestimate theed for new orthodontists. The limited amount ofailable data compounds the difficulty of assessing thepact of the ongoing sex shift in orthodontics.It is sometimes assumed that a professional wom-

    s commitment to work is less reliable than a mans,2

    evidence suggests that women are redefining dentalpractice options to better integrate a professional careerwith parenting responsibilities.6 Nevertheless, the rela-tionships among family roles, professional work ethic,and productivity have not been well studied. Fewstudies address the issue of orthodontic care providers,thus leaving the specialty to speculate whether maleand female orthodontists practice similarly.

    The goal of this study was to determine the impactof more female practitioners on the future of orthodon-tic health-care delivery. The findings could affect den-tal education, continuing education, and the overallsupply of orthodontists in the United States. The specificaims of this project were to examine the demographic andfamilial patterns of male and female orthodontists, exam-ine the economic and practice characteristics of men andwomen, discuss sex-specific trends in orthodontic practicepatterns, and determine what, if any, impact the increasingnumbers of women will have on the future of orthodonticcare.


    A mail survey was chosen as the appropriateresearch tool to collect information from a large sampleof orthodontists in the United States. Questionnaires

    rmer resident, Department of Orthodontics, University of Connecticutlth Center, Farmington, Conn; private practice, South Burlington, Vt.sistant professor, Section of Orthodontics, UCLA School of Dentistry, Loseles, Calif.

    formed at University of Connecticut Health Center for the first authorsH degree.rint requests to: Eung-Kwon Pae, UCLA School of Dentistry, Section of

    hodontics, 10833 Le Conte Ave, Los Angeles, CA 90095-1668; e-mail,, May 2004; revised and accepted, September 2004.9-5406/$30.00yright 2005 by the American Association of Orthodontists.


    283ork-pattern differencemale orthodontists

    ffrey J. Blasiusa and Eung-Kwon Paeb

    rmington, Conn, and Los Angeles, Calif

    roduction: Traditionally, most orthodontists have beemen in dentistry and dental specialties, including ortctice patterns of male and female orthodontists might dn produce enough providers for the future.Methods:Quponse rate was 68.8%. Questions about practice behaference with respect to age, marital status, and numberbe a good predictor of days worked per week and lenglo practitioners dominate the field of orthodontics, irresly than men to be practice owners, only 20% of the wommen were slightly more likely to be involved in a groupd they employed fewer full-time and part-time people. Fves of absence. Overall, women worked slightly fewerect patient care. Annually, they devoted 25 fewer days tabsence, men and women worked similar numbers of wrk patterns of men and women differ somewhat, but thetors; more study is required. (Am J Orthod Dentofacia

    ntil the 1960s, women comprised about 1% ofetween male and

    . In recent years, however, the number oftics, has increased dramatically. Becausehey should be evaluated so that our schoolsnaires were mailed to 798 orthodontists; thed productivity were designed to assess sexdren. Results: Number of children appearedleaves of absence for female orthodontists.e of age or sex. Although women were lesssponding were not in an ownership position.tice, they worked in fewer offices than men,nonowners were more likely to take longerer week and spent fewer hours per week intice than men, but, when adjusted for leavesn 1999. Conclusions: Among orthodontists,ferences might not be as significant as otherp 2005;128:283-91)

    cause she is more likely to take time off or subordi-

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    American Journal of Orthodontics and Dentofacial OrthopedicsSeptember 2005

    284 Blasius and Paere mailed to a stratified random sample of 798hodontists. Each mailing included a questionnaire,addressed and stamped return envelope, and a

    nd-signed cover letter explaining the purpose of thervey (Appendix). Recipients were told that respon-nt confidentiality would be respected and that respon-nts could receive a copy of the final report. Eachestionnaire had an identification marker in the upperht corner, used to differentiate respondents fromnrespondents. Nonrespondents were mailed a secondrvey 2 months after the first mailing.

    Access 2000 (Microsoft, Redmond, Wash) data-ses were identifier-blinded to maintain respondentnfidentiality. The questionnaire was designed to elicitormation about demographics, practice characteris-s, leaves of absence, vacations, and current workuations. Additionally, the survey asked respondentsir reasons for choosing orthodontics, their expectedirement age, and their past employment history.spondents who were not current practice ownersre asked how long they planned to continue in thatde and what their plans for the future were. Currentctice owners were asked to provide information

    out overhead, numbers of employees and associates,d any sex preference of future associates. At the endthe survey, any additional comments were wel-

    med.A random sample of orthodontists was extracted

    m the American Association of Orthodontics (AAO)99 biannual directory. The AAO is a national orga-ation that comprises 97% of all orthodontists in theited States. On March 30, 1999, the directory listed48 active, practicing orthodontists in the 50 states2 women, 6786 men). Pages cut from the directoryex were selected at random, photocopied, and then

    t apart into individual names that were groupedcording to sex. Orthodontists who completed trainingtween 1975 and 1998 were included in the sample.

    From the 7648 practicing orthodontists in the AAOectory, we calculated that an adequate sample size

    statistical power was 830 (415 men and 415men) including 3% to allow for incorrect addresses.e actual final sample size was 798 orthodontists (396men and 402 men), and 549 questionnaires wereurned. Each survey was labeled with a respondentmber, allowing confidentiality to be maintained.ta from each returned survey were recorded in ancess database file.

    atistical analysis

    Statistical analysis was performed with SPSS 10.0

    hicago, Ill). Descriptive statistics were generated,luding means, standard deviations, ranges, and total

    prasecmber of respondents for each question. Cross tabu-ions for each category with sex as the independentriable were used when appropriate. Contingencyles were formulated, and chi-square values (Pearson

    i-square or Fischers exact test where appropriate)d probabilities were to determine statistically signif-nt differences in proportions. In the analyses, erroratistical significance) was set at the level P .05. Incomparison of means, analysis of variance (ANOVA)

    s used to test statistical significance between the sexes.hen multiple means were compared, 1-way ANOVA innjunction with the Scheff test was used.SULTS

    From the final sample of 798 orthodontists (396men and 402 men) who received the survey mail,9 questionnaires were returned, for a response rate of.8%. The male response rate was 283/402, or 70.6%,d the female response rate was 265/396, or 66.9%.e average age of the group was 42.3 years with andard deviation of 7.0 years. The average age of theale respondents was 39.6 years (median 39.0) with

    tandard deviation of 6.3 years. The average age ofmale respondents was 44.9 years (median 45.0

    ars) with a standard deviation of 6.6 years.The years of graduation from undergraduate, dentalool, and orthodontic residency were markedly sim-

    r for men and women. For both, the median agesre 26 years at graduation from dental school and 29ars for orthodontic training. When asked why theyose orthodontics, both men and women most oftenected career suits abilities, followed by profes-nal autonomy.Of the 212 married women who responded, 189%) had a spouse who was employed full-time,

    mpared with only 47 of the 265 (18%) married meno responded. Male respondents spouses were mostely to be not currently employed (57%), followed byployed part-time (25%), and employed full time%). Female respondents spouses were most likely

    be employed full time (89%) and much less likely toemployed part time (6.5%) or not at all (4.2%).Men had more children (mean, 2.4 children, SD) than women (mean, 1.4 children, SD 1.2); thisference was statistically significant (P .01). Thedian number of children for both groups was 2. The

    e at which women had their first (31.9 3.8) andond (34.3 3.6) children was significantly (P ) higher than the age at which men had theirs (30.04.7 and 32.7 4.7, respectively).Men and women were most likely to work as solo

    ctitioners (66.5% and 50.2%, respectively). Theond most common practice type for both sexes was

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    American Journal of Orthodontics and Dentofacial OrthopedicsVolume 128, Number 3

    Blasius and Pae 285a group limited to orthodontics (27.5% and 31.3%).e mean number of offices that the respondentsrked in exhibited a statistically significant difference .01): 2.4 1.2, median 2.0 for men and 1.7 0.9,dian 1.0 for women.A statistically significant difference (P .01) was

    ntified in the proportion of male and female respon-nts who owned all or part of a practice; 5% of then and 20% of the women respondents were not in annership position at the time of the survey. Notistically significant difference emerged when over-ad was evaluated (women, 54.5% 11%, median%; men, 53.9% 9%, median 55%). The number ofployees differed significantly (full-time employees, .01; part-time employees, P .05) between thees (women, 4.91 4.9 full-timers, median 4.0, and9 1.8 part-timers, median 2.0; men, 7.61 5.8l-timers, median 6.0, and 2.6 3.6 part-timers,dian 2.0).A statistically significant difference (P .01) was

    served in the sex preference of potential futureociates by all respondents. Most respondents repliedt the sex of any future associates did not matteren, 84%; women, 67%). However, among those whod a preference, 65% preferred a female associate and% preferred a male associate. Various reasons wereted for a sex preference.When the data were analyzed by the number of

    ildren, women with 1 or 2 children and those with 34 worked fewer days than women with no childrend all men (P .05) (Table I). No statistical differ-ce was found between women with no children andy subgroup of men.

    Men with 3 or more children saw an average of 15re patients per day (P .01) than any of the

    bgroups of women, approximately 10 more patientsr day (P .05) than men with 1 or 2 children, and 15re patients per day than men with no children (nottistically significant). Men with 3 or more childrenrted an average of approximately 120 more cases .01) than did women in any subgroup (0, 1 to 2,3 or more children) and more cases (but not

    tistically significant) than men with fewer than 3ildren.

    The total number of weeks of leave of absence inrespondents lifetime was significantly correlated

    th number of children. Women with 3 or moreildren took leaves of absence that were significantly .001) longer than any other group: they took 52re weeks of leave than men with any number of

    ildren, 48 more weeks than women with no children,

    d 41 more weeks than women with 1 or 2 children.

    statistically significant differences could be attrib- prad to the number of children in relation to projectedirement age for any group.The lengths of the leaves of absence did not

    nificantly differ between the sexes. The most com-n reasons women took leaves of absence were child

    aring and maternity. The most common reason menk a leave of absence was personal illness and not

    ving a job.Age was categorically defined as 29-36, 37-44, and

    -64 years for both sexes (Table II). Women in all agetegories worked fewer days per week than men in anye category (P .05). The differences ranged from7 to 0.75 fewer days per week. The smallest differ-

    ce was between women aged 45-64 and men aged-64, and the largest difference was between women-44 and men 29-36. Men 37-44 and 45-65 alsomonstrated a statistically significant difference (P ) from all women when the dependent variable wasmber of patients seen per day. Men older than 37-44 and 45-64) saw 11 more patients a day thanmen in any age category. Men 29-36 saw more

    tients per day than women, but the difference was nottistically significant.


    At the time of the survey, the men were an average45 years old and about 15 years beyond their

    hodontic education. The women averaged 40 yearsage and about 10 years beyond their schooling. Thus,th groups were in their prime years of practice, with

    women slightly younger. Practice experience wasnificantly higher than in many previous studies,ich tended to focus on women who were newer tospecialty.Most women had spouses who were employed fulle, and over 80% of them were professionals (den-

    ts, physicians, or nonhealth-care professionals). Mostn had spouses who were not currently employed orre employed part time. This factor could be veryportant for future studies, because part of the moti-tion to work revolves around the need to support the

    ily financially. If the combined family income ofale orthodontists is higher than that of men, then

    mens work patterns might differ significantly fromns as they age.6Female respondents had 1 child fewer than men,

    d the average age at which they had their first andond children was 2 years older than mens. Thisght indicate that women are putting off havingildren until they are more established in theirreers2 to 4 years after their orthodontic...


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