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Gail Erlick Robinson, MD, DPsych, FRCPC
University of Toronto, Toronto, Ontario

JAMA. 2004;291:635.

Studies of career satisfaction in female physicians have yielded mixed results. Although most female physicians indicate that they are generally satisfied with their careers, certain factors that are unique to or that differentially affect female physicians contribute to career stress and dissatisfaction. As the American Medical Association predicts that women will constitute one third of all US physicians by 2010,¹ researchers have attempted to identify these stressors.

The largest study of female physicians, the Women Physicians' Health Study (WPHS),² surveyed 4501 US female physicians randomly selected from the American Medical Association Masterfile (response rate, 59%) and found that 84% of respondents reported being "usually," "almost always," or "always" satisfied. Younger physicians and those with less work control, greater work stress, and more reported sexual harassment were most dissatisfied. Black female physicians were more likely to report that they worked in underserved communities, had less work control, and had higher rates of career dissatisfaction.³ Female physicians who perceived that they had more control over their work environment were the most satisfied. The findings were limited by the bias inherent in self-reported data.

The WPHS also compared women in various subspecialties. With the exception of radiology, physicians in "controllable lifestyle" specialties of anesthesiology, dermatology, and pathology reported high satisfaction compared with those in primary care specialties.² Even with long hours, less work control, and a belief that motherhood had slowed their careers, 81% of women in academic medicine were found to be satisfied with their careers.⁴ Social scientists have offered a number of possible explanations of the high satisfaction rates in professional women despite multiple stressors.^5-6 They suggest that women have lower job expectations than men, are socialized not to express discontent, and value different characteristics in a career than do men. Despite the overall high degree of career satisfaction, almost a third of the women indicated that they "might not" or "definitely would not" choose to be a physician again.²

Studies comparing levels of satisfaction in male and female physicians help delineate the specific differences between the 2 groups. The large Physician Work Life Study (PWLS)⁷ surveyed a nationally representative, random stratified sample of 5740 male and female physicians in primary care and nonsurgical specialties. Of the 2326 respondents, 32% were female (adjusted response rate, 52%; respondents were similar to nonrespondents on a number of demographic variables). Although global levels of satisfaction were similar for men and women, they differed in the factors that affected their levels of satisfaction. Women physicians were more satisfied than men with their specialty and patient and collegial relationships but were less satisfied with their levels of autonomy, relationships with the community, pay, and resources. Female physicians reported more time pressure in seeing patients, less work control, and lower income. Women had 1.6 times the odds of reporting burnout as men, with lack of work control being a strong predictor of burnout in women but not in men. The likelihood of burnout in women also increased as their work hours increased.

Linzer et al⁸ conducted a survey in the Netherlands using the same methods, and with the same limitations, as those of the PWLS. In surveying 1426 physicians in primary care and specialties (response rate, 63%; 18% women), the authors found no significant sex difference in burnout rates in Dutch physicians. They attributed the higher rates in US female physicians to working longer hours and having less work control than Dutch women physicians.

The role of children and family responsibilities in women's career satisfaction has also been debated. The WPHS concluded that women's career satisfaction was not adversely affected by time spent on domestic obligations. In a survey of 1979 faculty from 24 randomly selected medical schools (response rate, 60%), Carr et al⁹ noted that women in academia who have children have fewer publications, slower career progress, and less career satisfaction than do men with children. Although the results were limited by the cross-sectional nature of the study, the impact of family responsibilities may have been understated by its failure to examine faculty who had left academia. The differences in findings between the 2 studies may be related to individual mitigating factors such as support from spouses, the availability of flexible scheduling, and the possibility that multiple roles bring benefits that offset stress.

REFERENCES
1. American Medical Association. Women in Medicine Data Source. Chicago, Ill: American Medical Association; 1997. 2. Frank E, McMurray JE, Linzer M, Elon L, for the Society of General Internal Medicine Career Satisfaction Study Group. Career satisfaction of US women physicians: results from the Women Physicians' Health Study. Arch Intern Med. 1999;159:1417-1426. FREE FULL TEXT 3. Corbie-Smith G, Frank E, Nickens H. The intersection of race, gender, and primary care. J Natl Med Assoc. 2000;92:472-480. PUBMED 4. Frank E, Hudgins P. Academic versus non-academic women physicians: data from the Women Physicians' Health Study. Acad Med. 1999;74:553-556. PUBMED 5. Phelan J. The paradox of the contented female worker: an assessment of alternative explanations. Soc Psychol Q. 1994;57:95-107. FULL TEXT 6. Chiu C. Do professional women have lower job satisfaction than professional men? lawyers as a case study. Sex Roles. 1998;38:521-536. FULL TEXT 7. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K, for the Society of General Internal Medicine Career Satisfaction Study Group. The work lives of women physicians: results from the Physician Work Life Study. J Gen Intern Med. 2000;15:372-380. ISI | PUBMED 8. Linzer M, McMurray JE, Visser MR, Oort FJ, Smets E, de Haes HC. Sex differences in physician burnout in the United States and the Netherlands. J Am Med Womens Assoc. 2002;57:191-193. PUBMED 9. Carr PL, Ash AS, Friedman RH, et al. Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty. Ann Intern Med. 1998;129:532-538. FREE FULL TEXT

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