Pediatrician’s
Practice
Choices:
Differences
Between
Part-time
and Full-time
Practice
Nancy
E. Fritz,
MD, and John
D. Lantos,
MD
From the Sections of Ambulatory Pediatrics and Chronic Disease in the Department of Pediatrics, and The Center for Clinical Medical Ethics at The University of Chicago Pritzker School of Medicine, and La Rabida Children ‘s Hospital and Research Center, Chicago, Illinois
ABSTRACT. A national survey was used to study the differences in career and family patterns of pediatricians who work part-time (PT) vs those who work full-time (FT). A questionnaire mailed to 375 members of the American Academy of Pediatrics asked about age, marital status, number of children, type of practice, hours worked in particular duties, and attitudes about their choices. Sixty-five percent (n = 216) of the questionnaires were
completed. The mean age of both the PT and FT women was 40 years, and FT men averaged 46 years. Thirty-seven percent of women had worked PT at some point in their careers; 21% were currently working PT. Only 70% of the FT women were married compared with 97% and 95% of PT women and FT men. The FT women had significantly fewer children (mean 1.27, compared with
2.34 for PT women and 2.39 for FT men). Part-time women in academic medicine tended to do little research or administrative work, but they had more teaching re-sponsibilities. Almost all the PT women were happy with their decisions and careers despite the feeling among many that they had made career compromises. Many of the FT pediatricians wanted to work less. It is concluded that many women, particularly those with children, choose PT work in order to combine career and family duties. These choices may lead to different career paths for women pediatricians. By recognizing these different career paths, it may be possible for academic institutions to benefit from the unique contributions that PT women pediatricians can make. Pediatrics 1991;88:764-69;
women, pediatric practice, health personnel.
Women’s career paths in medicine have always
been somewhat different from men’s. Various
stud-ies in the past have shown that women tend to
work fewer hours per week and they frequently
Received for publication Sep 4, 1990; accepted Dec 12, 1990. Reprint requests to (N.E.F.) Woodlawn Maternal and Child Health Center, 950 E 61st St, Chicago, IL 60637.
PEDIATRICS (ISSN 0031 4005). Copyright © 1991 by the American Academy of Pediatrics.
interrupt their careers to care for their fami1ies.4
These career choices have sometimes been
criti-cized. Even as recently as 1983, one author vocal-ized concern about the possibility of increased med-ical school openings being “awarded to part-time
professionals or misplaced housewives.”5 Some
have responded that training female physicians is
cost-effective despite their decreased productivity,6 and others have focused on the difficult choices
made by women trying to juggle both family and career.7
Recently, some have begun to document the
dis-parity between men and women with respect to
promotions, publications, and research support and to examine the reasons behind these differences.8
In spite of different practice styles, women seem
still to be judged by male standards. These are important areas of investigation, but perhaps there
are alternative ways to evaluate the contributions and productivity of women physicians.
Women make up an increasing percentage of the
medical work force. Without women applicants to
medical school, many schools would be unable to
fill their classes. Furthermore, women tend to be attracted to primary care specialties,#{176} and so they fill a very important niche in our health care
deliv-ery system. As the feminist movement matures, women physicians have become increasingly able
to admit the difficulties of simultaneous work and
parenting and to openly discuss alternative
op-tions.’#{176}2 In other professions, as well, there is more discussion of part-time (PT) practice and shared parenting options.
In the past, studies on women in medicine have
not looked separately at physicians who chose to work PT or full-time (FT), nor have they looked particularly at pediatrics, the area most affected by
pediatric interns were women. This represents an approximate doubling of female pediatric interns over the past 10 years.’3 It seems plausible that female pediatricians, as they work with colleagues who are also trying to balance careers and family, may be developing unique approaches to problems that arise from differential gender roles and
expec-tations.
This study compares a sample of women practic-ing pediatrics PT to their FT female and male colleagues and analyzes what distinguishes these women from their colleagues. We wished to esti-mate the number of pediatricians who work PT and to learn how they balance career and family
respon-sibilities, how their practices differ, and how
satis-fled they are with their choices. In so doing, we describe unique aspects of various career choices and suggest how women’s particular practice choices may affect the practice of pediatrics in the
future.
METHODS
In October 1989, 375 questionnaires were sent to randomly selected pediatricians in the 1989 Amer-ican Academy of Pediatrics directory. This source was chosen because it was the most current and reliable list of nationwide pediatric addresses of which the authors were aware. Because the goal was to isolate a sizable number of PT women, and because past studies showed that 10% to 30% of women, but only a few men, worked PT, 250 ques-tionnaires were sent to women and only 125 to men. We believed that this would give an adequate group of PT pediatricians for analysis. A second question-naire was sent out to nonresponders 6 weeks later. The survey contained 35 questions and was struc-tured to provide information about age, training, and specialization, marital status and family size,
as well as number of hours worked during the last
regular work week and a breakdown of professional duties. The questionnaires also enquired about household responsibilities and about the
respond-ent’s satisfaction with these choices.
We did not define PT or FT. Instead, we asked respondents whether they considered themselves to be working PT or FT compared with their peers. We analyzed the data by dividing respondents into three groups: PT women, FT women, and FT men. We then analyzed the distinguishing characteristics of each group. Full-time women who had once worked PT were initially included with the other FT women, but they were also subsequently isolated and compared with currently PT women. Also, those pediatricians in academic medicine were ana-lyzed separately as well, according to the above
groupings. Pediatricians in academic medicine were
defined as those who had an academic title and included people with private practice or clinic
affil-iations. Although PT men would have been an
interesting group to study, only five such men
re-sponded, so this group was not analyzed further. Categorical variables were analyzed using the
x2
test. Means between two groups were compared
using t tests. To compare means of more than two groups, we used analysis of variance. Statistical analysis was done using SAS PC software4
RESULTS
Of the 257 questionnaires returned, 41 were
ex-cluded because the address was incorrect or the
physician was retired. Two hundred sixteen
re-sponses were complete, giving a response rate of
65% (62% for men and 66% for women). One
hundred forty-seven women responded, of whom
116 were currently FT and 31 PT. There were 68
men, 5 of whom were PT. Twenty-three of the FT women and 2 of the FT men had worked PT in the
past.
Neither age, year of completion of residency, nor
geographic location distinguished the two female
groups. Both PT and FT women had an average
age of 40 years. The men were older, with an average age of 46 years.
Of the 147 women who returned questionnaires, 31 (21%) considered themselves to be working PT
currently, compared with their colleagues. Twenty-five of the 31 women listed home and child care
responsibilities as their reason for working PT; 1 listed health reasons; 2 were building up practices;
and 3, who had families with children, cited
“per-sonal preferences.” An additional 23 (16%) women
had been PT in the past, giving a total of 54 (37%) who had ever worked PT.
Five (7.5%) of the 68 men were currently working PT. In this group, 3 were semiretired, 1 was going to law school, and 1 was sharing parenting duties with his wife.
Marital Status and Family Characteristics
Part-time women were significantly more likely to be married than FT women (P = .005). Their
marriage rates were very similar to those of FT
men (see Fig. 1). Thirty (97%) of 31 PT women
were married; 1 was single. Only 81 (70%) of 116 FT women were currently married; 9 (8%) were divorced. Sixty (95%) of 63 FT men were married;
1 was divorced, 2 were single.
Most of the women, whether PT or FT, were
Percentages
PT men FT men FT men
Practice
Groups
-
married single ::: din..orced Fig 1. Marriage statistics of part-time (PT) andfull-time (FT) pediatricians.
married FT women had a spouse who worked FT, compared with 30% of the FT men. Fifty-eight percent of the husbands of PT women were physi-cians, and 46% of the husbands of FT women and 11% of the wives of FT men were physicians.
Part-time women also had significantly more children than FT women (P = .0001). The average
number of children was 2.34 for PT women corn-pared with 1.27 children for FT women. The men were very similar to the PT women, with 2.39 children. The disparity between the female groups is partially explained by the larger number of single women in the FT group. Full-time ever-married women had an average of L64 children. Neverthe-less, 22% of the married women who had always worked FT had no children, compared with 2% of the married women who had ever worked PT. Also, of the 20 women respondents who had 2 children younger than 6 years old, 65% were working PT. Some men as well were grappling with child care concerns. One man was working PT to help take care of his children; another had done so in the past. One FT woman in a two-physician family reported that her husband was working PT in order to do more child care because hers was a more lucrative subspecialty.
Productivity
As in previous studies, we found differences in productivity in the workplace. During their last
regular work week, PT women had worked an av-erage of 32 h/wk with a wide range, from 4 to 40 hI wk, not including night call. Full-time women worked 48 h/wk, and FT men worked an average of 52 h/wk (P = .009). The 4-hour difference in
productivity between men and women is less than that reported in the past4; however, the numbers in most past studies have included PT workers as well, thus decreasing the average productivity for women in general. The average numbers of nights on call were 6.9, 9.0, and 8.7 nights per month for PT women, FT women, and FT men, respectively. In academia, FT women and men worked essentially the same number of hours per week.
Child Care and Household
Duties
We found that women still carry the bulk of child care and household duties. By self-report, PT women did 81% of the child care and 83% of the other household duties compared with their spouses. (Other household duties were described as “cooking, housework, money management, etc.”) Full-time women, compared with their husbands, did 66% ofthe child care and 63% ofthe housework. Full-time men did 19% of the child care and 26% of the housework, Including families of all three study groups, 19 husbands did at least 50% of the child care and 41 husbands reported equally shared household duties. These were usually, but not a!-ways, the husbands of the FT female pediatricians.
Both groups ofwomen often hired sitters for child care. Twenty (86%) of 23 PT women with children younger than 12 years old hired baby-sitters. The remainder sent their children to day care or school systems. The sitters worked for an average of 27 hI wk. Thirty-nine (73%) of 55 FT women with chil-dren younger than 12 hired a baby-sitter for an average of 39 h/wk. An additional 16% used nursery schools or day care for child care and 11% used relatives or nobody. The FT men used outside child care less often, with 44% (11/25) hiring a baby-sitter for an average of 24 h/wk; 12% used nursery school; and 44% did not hire a child care person. Eighty-one percent of PT women hired a house-keeper compared with 61% of FT women and 48% of FT men.
Practice
Choices
and Responsibilities
Physicians in the three study groups were fairly equally represented in various practice choices (Table 1). However, PT women were more likely to be self-employed than either of the FT groups (P
= .003); and they were somewhat less likely to have
a subspecialty, although this was not statistically
TABLE 1. Practice Choices of Part-time (PT) and Full-time (FT) Pediatricians
Practice % (No.) of % (No.) of
PT Women FT Women
47 (15) 39 (45)
3(1) 5(6)
% (No.) of FT Men
48 (30) 3 (2) Private practice
Health maintenance organization
Clinic 13 (4) 5 (6) 5 (3)
Academic* 27 (9) 41 (48) 37.5 (23)
Othert 9 (3) 9 (10) 6 (4)
Total 99 (32) 99 (115) 99.5 (62)
* Includes both those with straight tracts and those with
a clinical affiliation.
t “Other” includes military appointments, Indian health service, and institutional affiliations.
TABLE 2. Academic Appointments of Part-time (PT) and Full-time (FT) Pediatricians
Appointment % (No.) of PT Women
% (No.) of FT Women
% (No.) of FT Men
Fellow 0 (0) 16 (7) 5 (1)
Instructor 33 (3) 16 (7) 14 (3)
Assistant professor 44 (4) 33 (15) 36 (8)
Associate professor 11 (1) 22 (10) 18 (4)
Professor 0 (0) 9 (4) 18 (4)
Other* 11 (1) 4.5 (2) 9 (2)
Total 99 (9) 100.5 (45) 100 (22)
* Includes deans, administrators, “lecturers.”
Percentages
admin
teaching
research
Pt care
Practice Groups
Fig 2. Percent of time spent in each of four areas of responsibility. PT, part-time; FT, full-time; admin, ad-ministrative; pt care, patient care.
PT women FT women FT men
For the pediatrician practicing outside the aca-demic setting, professional responsibilities were
primarily patient care duties with some amount of
administrative work. The group of physicians with an academic appointment was separately examined in terms of specific appointment and types of professional responsibilities. Among physicians
with academic appointments there were 9 PT
women, 48 FT women, and 23 FT men. Full-time men and FT women were very similar with respect to academic appointment (Table 2).
The appointments for the PT women tended to be at the instructor or assistant professor level. The
only PT woman associate professor was working 40
h/wk and also was the only PT worker doing re-search. There were no PT full professors. This may reflect age differences between the groups. The mean age of the PT women academicians was 37
years compared with their FT colleagues at 42 years (44 years excluding fellows). None of these
differ-ences was statistically significant, perhaps because
of the small size of each group.
Figure 2 shows the proportion of time each group spent on different academic responsibilities. All three groups spent approximately 50% of their time in patient care activities. Part-time women spent
much less time in research or administrative duties,
but they spent considerably more time than either of the other groups in teaching. Although these
numbers are small, there was a significant
differ-ence between the three groups for amount of time
spent teaching (analysis of variance, P = .01) and
for number of people in each group involved in research
(x2,
P = .04). Although most of thepedia-tricians had clinical responsibilities, 78% of the PT women listed a clinic or office practice associated with their academic appointment; only 27% of the FT academic women also listed a clinic or office practice. It seems that PT women are more likely to have a clinical appointment, rather than a full academic appointment, perhaps accounting for the differences in teaching and research.
Women
Who Worked
PT in the Past
When analyzed separately, it became clear that the women who had worked PT in the past resem-bled the currently PT group in certain ways. They had an average of 223 children. Nineteen (87%) of
22 were married. Two women (9%) were divorced; 1 was single. They were less likely to be in an
Attitudes
Fifty-three percent of the PT women said they
had made career compromises in order to work PT
but 87% responded that they were happy with their current position and hours. Two (6%) wished they had fewer hours but were too busy to cut back, and
two (6%) admitted “fair” satisfaction but planned
to continue to work PT. Sixty percent of the group
believed they would remain PT in the foreseeable
future. Sixty-eight percent of the PT women be-lieved they were paid proportionally to their FT colleagues, but 77% believed their various
respon-sibilities were not reduced proportionally.
There was no consensus among the respondents
about the value of a separate promotional track system for parents in academic medicine. Many believed this would result in a “two class” system,
defeating its purpose. Both male and female re-spondents agreed (84% and 86%, respectively) that it is currently more acceptable for a woman than for a man to work PT. Fifty-nine percent of the FT women and 43% of the FT men wished they could work PT now or in the future.
DISCUSSION
This study shows that more than a third of
women pediatricians work PT at some point in
their careers. Twenty-one percent of this sample were currently working PT, and an additional 16%
had worked PT in the past. A few caveats are
important. The definition of PT work in this study was fluid. Some women who considered themselves
PT workers had schedules that could be called FT
work. By contrast, some FT pediatricians worked
less than 40 h/wk.
Part-time women might have been more likely to respond to the questionnaire than their FT
col-leagues, which would also lead to an overestimate of the frequency of PT careers. On the other hand,
the study did not count those women just beginning
careers who would eventually work PT. In addition, the American Academy of Pediatrics sample may not be characteristic of the pediatrician population as a whole.
In spite of these caveats, it appears that there are
fewer women working PT (at least in pediatrics)
than when Powers et al2 described work patterns for women across medical specialties almost 25 years ago. However, there seems to be considerably more than reported 15 years ago by Hems et al.3
Hems and colleagues’ work was done at a time
when women were rapidly entering medicine and were eager to prove their equality in the field. Since then, the continuing concern over parenting issues
may have encouraged more women to return to PT
work.
Whatever the rate of PT practice, it is clear there
are many more women in pediatrics now,
magnify-ing the effect of PT practice choices on the pediatric work force. Since FT men and women pediatricians work very similar numbers of hours per week, dif-ferences in productivity are largely accounted for by the larger percentage of women who work PT. Whereas the Graduate Medical Education National Advisory Committee report in 198015 predicted a
surplus of pediatricians by the year 2000, the
pres-ent study would indicate that, with increasing
num-bers of female pediatricians, many of whom work
PT, there may instead be a shortage of
pediatri-cians.
The shortage of pediatricians may be most seri-ous in academic medicine. Few of the academicians who chose PT work were doing research. Instead,
PT academicians devoted a greater amount of time
to teaching. Some of these differences are likely due to personal choices; for instance, it may be that
people who choose more time with their children also like to teach. Unfortunately, teaching is less likely than research to be rewarded by promotion and tenure. The PT women were also less often
involved in administrative duties and were less
likely to have had subspecialty training. All of these factors may contribute to the difficulty women have in climbing the academic ladder, and they may lead
qualified female pediatricians to perceive PT
aca-demic positions as dead-end jobs and to leave aca-demic medicine.
Part-time women in private practice wrote of the
difficulty in achieving partner status. They also believed that their salaries were often not propor-tional to work done.
Women have always grappled with balancing
family and career needs. In spite of these difficul-ties, many women in this sample were working FT and raising families, sometimes large families. More
spouses shared equally the household responsibili-ties. However, they made compromises. Full-time
women had fewer children and were more often
single or divorced than either PT women or FT men. Many FT women wished they could lighten their schedules.
Those physicians working PT were almost all
happy with their decision. Several wrote that “it is
the best of both worlds.” However, the PT women also made sacrifices. Faced with career and family needs, they opted to work less, which many women thought compromised their careers. Some felt
pro-portionally underpaid.
Some of the FT women believed that these career
For example, it seemed unlikely to the FT workers
that anyone working PT could successfully compete
for grant funding or conduct research.
Although there is no clear reason why this would have to be true, there seem to be few PT women who attempt it. It is not clear from this study whether this is due to personal choice or to overt discouragement. Academic pediatric departments
may need to offer more creative solutions to their
physician/parents in order to attract and keep tal-ented workers. If the goal in pediatrics would be to eventually return the PT worker to FT function, including research and grant writing, this might require some type of midcareer fellowship program, offering more training in research or subspecialty
skills. This sort of program could benefit PT work-ers and anyone else interested in midlife career
changes, and it probably would be used by as many
men as women. Alternatively, equitable promotion
plans, such as “stop the clock” programs and ex-tended time to tenure, are currently being evaluated in many programs and may allow talented women to continue careers in academics.
In the meantime, if this sample is representative, PT pediatricians do more teaching than their FT colleagues. Teaching, which has historically been
somewhat undervalued and underreimbursed in
university medical settings, is nevertheless a major function of the university. By offering more PT options in academic pediatrics, the university would reap the benefit of increased teaching.
Finally, it should be recognized that many PT
women are happy with what they are doing and do
not wish to change their type of practice. At a time
when the plight of the family elicits national debate and when there is not an overwhelming doctor shortage, we might recognize this as one viable
option to providing both quality medical care and
quality child care. As it becomes more respectable for women, perhaps stereotypes will change enough
that men in greater numbers will also have the
freedom to choose such options. Ultimately both
men and women must seek a balance between
ad-vancing their careers and nurturing those they care
for. The current climate of debate is a good one to
begin discussion of creative systemic changes.
ACKNOWLEDGMENT
This work was supported, in part, by a grant to Dr Fritz from the Children’s Research Fund of Wyler Chil-dren’s Hospital.
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