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Abstract
In most Western countries, women doctors are still underrepresented in the higher positions in the medical hierarchy
and in the most prestigious specialities. A crucial question is whether family responsibilities affect female and male
career differently. The article examines how Norwegian physicians balance their work and family responsibilities and
demonstrates differences in the way doctors combine work and family obligations, between women and compared with
men. Among women doctors, the probability of becoming a specialist decreased with an increasing number of children.
Moreover, postponing the birth of the rst child increased the probability of completing hospital specialities. Although
more women than men work part-time, this was the case only for a small proportion of women doctors. Transition
from full-time to part-time work is primarily an accommodating strategy to family responsibilities, however strongly
inuenced by variations in the opportunity structure of different specialities. The ndings further demonstrate that
being married to another doctor had a positive impact on the career, especially for women doctors.
r 2003 Elsevier Ltd. All rights reserved.
Keywords: Medical profession; Woman doctors; Norway
Introduction
The medical profession has commonly been characterised by long working hours and obligations to put
patient welfare above personal needs and family
responsibilities. In the past, many women doctors have
tackled this by choosing not to marry or have children,
or they have limited their career commitment (Drachman, 1986; Uhlenberg & Cooney, 1990; Gjerberg &
Hofoss, 1995). In male doctors, combining professional
and family life has always been taken for granted, very
often because of a traditional gendered division of
labour. The demanding characteristics of medical work
still exist, although varying between specialities. However, in Norway, like most Western countries, the
medical workforce is changing. Today, 34% of professionally active Norwegian doctors are women, most of
them without the traditional ground crew that male
*Tel.: +47-23-36-92-00; fax: +47-22-56-89-18.
E-mail address: elisabeth.gjerberg@a-wri.no (E. Gjerberg).
0277-9536/03/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S0277-9536(02)00513-0
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Theoretical perspectives
There are a number of ways of combining labour
force and domestic commitments, depending on a
complex interdependence of individual preferences,
family relations and work. Several studies on womens
employment pattern in Norway (Skrede & S^rensen,
1983; Ellingster et al., 1997) and in USA and Germany
(Drobnic, Blossfelt, & Rohwer, 1999) have demonstrated that the employment status varies as life
progresses, inuenced by marital status, number of
children and age of the youngest child. When explaining
womens employment patterns, different types of models
have been offered: individual and structural. Individualoriented explanations describe womens employment
pattern as a result of individual choice of education and
career, either as a result of social emotional values based
on socialisation, or an economic rational judgement of
the priority they want to put on work in relation to
domestic commitments. For example, the high proportion of women doctors in specialities like psychiatry,
paediatrics and gynaecology is explained as a function of
gender-based interests (Bergquist et al., 1985). According to the other type of individual-oriented models,
based on human capital theories, womens employment
patterns are seen as a reection of their investments in
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Response to mailing
Of the 1805 authorised as doctors in 19801983, 86 were
untraceable. The effective study cohort therefore comprised 1719 doctors, of whom 74.5% were men and 25.5%
were women. Completed questionnaires were received
from 1142 doctors, representing a response rate of 67
(64% of the men and 73% of the women answered the
questionnaire). The article is based on an analysis of the
material from 1104 persons, 308 women, and 796 men.3
Methods
Descriptive statistics were used to characterise the
population. In order to analyse how characteristics of
the family and work domain affected four different
aspects of the medical career, both linear and logistic
regression were used. In analysing the work-time
adjustments, i.e. transitions from full-time to part-time
work throughout the career, logistic regression was used,
applying a similar technique to that described by Wei,
Lin, and Weissfeld (1989). Both trajectories and transitions were examined.4 The analysis unit, instead of being
the individual doctor, then becomes each job in the time
period covered by the investigation. Every job was
ascribed a set of variables, some of which may change
over time. An example of time-dependent variables was
having small children or not. Other variables are
constant, for instance gender.
Variables
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E. Gjerberg / Social Science & Medicine 57 (2003) 13271341
Results
Who are the doctors?
Marital status7: Signicantly more women than men
had never married or were separated/divorced (Table 1).
6
I have chosen to include psychiatry and laboratory
medicine (pathology, physiology etc.) in the category primary
care specialities, because many of those working in these elds
are employed outside hospitals. For example, about 4050% of
specialists in psychiatry work outside hospitals, either in private
practice or in outpatient clinics. In Norway, specialist training
in psychiatry takes place both inside and outside hospitals.
7
The questionnaire did not differentiate between married
and cohabitant. The term married is used to cover both
categories. The Act of same-gender partnership was passed in
1993. The intention in the questionnaire was that doctors living
in a same-gender partnership should indicate this by ticking off
in the square labelled married/cohabitants. The fact that it
was not possible to analyse the material with regard to
heterosexual and homosexual relationships could be interpreted
as a heterosexual bias. However, to simplify the text, I have
chosen to refer to the woman doctors partner as if she were
living together with a partner of opposite sex.
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Table 1
Personal characteristics of questionnaire
authorised as doctors 19801983 (percentages)
respondents
Female
Male
Age (median)
Marital status
Single
Married/cohabiting
Divorced/separated/widow
43
N 308
7.5
81.5
11.0
44
N 796
2.9
91.7
5.4
N 249
4.8
5.6
73.9
13.3
2.4
N 715
13.3
49.5
33.7
3.1
0.4
N 227
39.6
N 600
16.8
Number of children
No children
12 children
3 or more children
N 307
8.5
46.6
45.0
N 794
4.5
41.9
53.5
28
28
Specialist status I
Specialist
Not specialist
N 308
83.4
16.6
N 796
86.2
13.8
Specialist status II
Not specialist or primary-care
specialities
Hospital-based specialities
N 308
73.4
N 796
68.0
26.6
32.0
8.0
8.0
N 301
34.9
45.8
19.3
N 790
56.7
35.8
7.5
38.0
37.0
11.0
10.0
N 250
96.4
0.4
1.2
2.0
N 714
86.6
7.6
3.1
2.8
N 238
N 610
97.9
2.1
56.0
44.0
Less than 2% did not answer the question about employment status of his/her spouse. Of those with employed partners,
about 6% have not answered what kind of work their partners
have.
b
The percentage of doctors married to another doctor are
based on those who were married.
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Table 2
Logistic regression (the effect on specialisation (to specialise or not) of sex, number of children, age at birth of the rst child, married to
a physician or not; respondents authorised as doctors 19801983)
Variable (reference category)
Gender (women)
Age at birth of rst child
Number of children
Married to another doctor
(no 1; yes 2)
Constant
n
Women (N 288)
Men (N 773)
(SE)
(SE)
(SE)
0.4091
0.0058
0.1248
0.9576n
(0.1943)
(0.0233)
(0.0982)
(0.2906)
0.0533
0.6390n
1.3162n
(0.0500)
(0.1906)
(0.4453)
0.0239
0.0866
0.6980
(0.0265)
(0.1219)
(0.3843)
1.0901
(0.8422)
4.4978n
(1.7147)
0.8401
(0.9126)
Signicant at a 5% level.
Table 3
Logistic regression (the effect on specialisation in hospital-based specialities vs. primary care of sex, number of children, age at birth of
the rst child, married to a doctor or not; respondents authorised as doctors 19801983)
Variable (reference category)
Gender (women)
Age at birth of rst child
Number of children
Married to another doctor (no 1; yes 2)
Constant
n
Women N 281
Men N 759
(SE)
(SE)
(SE)
0.240
0.070n
0.024
0.0324
3.325n
(0.161)
(0.017)
(0.080)
(0.1870)
(0.660)
0.167n
0.079
0.253
5.719n
(0.043)
(0.177)
(0.308)
(1.499)
0.047
0.079
0.6980
2.308n
(0.019)
(0.090)
(0.3843)
(0.687)
Signicant at a 5% level.
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Table 4
Linear regression. The effect of sex, number of children, age at birth of rst child, being married to another doctor or not and type of speciality on length of time to complete
specialist training
(A) All doctors
Women N 325
Men N 658
(SE)
(SE)
(SE)
0.613*
0.013
0.313
0.070
(0.214)
(0.024)
(0.235)
(0.192)
0.097n
0.063
0.791n
(0.051)
(0.364)
(0.385)
-0.002
0.521
0.146
(0.026)
(0.303)
(0.221)
8.535n
R2 0:02
(0.865)
6.768n
R2 0:072
(0.965)
8.134n
R2 0:005
(0.930)
Signicant at a 5% level.
(SE)
(SE)
(0.070)
(0.273)
(0.443)
(2.269)
0.049
0.373
1.313n
11.128n
R2 0:09
(0.067)
(0.164)
(0.558)
(2.750)
0.159
1.396n
0.527
0.961
R2 0:16
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Gender (women)
Age of birth of rst child
Married to another physician (no 1; yes 2)
Type of speciality (Primary care 1
Hospital-based specialties 2)
Constant
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Table 5
Logistic regression (the effect of gender, having children aged 06 years, and type of speciality on employment status in present job;
working full-time or more 1; working part-time 0)
Variable (reference category)
Women (N 221)
Men (N 598)
(SE)
(SE)
(0.315)
(0.340)
(0.321)
(0.406)
(0.695)
1.194n
0.099
1.468n
0.3298
0.463
0.407
(0.583)
(0.5982)
0.269 (0.538)
1.102n (0.491)
0.646 (0.573)
2.672n (0.6196)
Gender (women)
1.610*
Children 05 years (no 0; yes 1)
0.809*
Married to another doctor (no 1; yes 2)
0.308
Type of speciality (primary care 1; hospital-based specialities 2) 1.051*
Constant
0.822
n
(SE)
Signicant at a 5% level.
Table 6
Doctors employment status during their career (per cent) (based on the total number of jobs in different specialities. Doctors
authorised 19801983)
Women
Number
of jobs
Full-time
Part-time
81.1
97.6
98.1
96.3
97.1
19.0
2.4
1.9
3.7
2.9
705
124
214
427
312
Men
Number
of jobs
Full-time
Part-time
96.6
100.0
99.2
99.5
97.3
3.4
0.8
0.5
2.2
2404
130
896
1126
503
Discussion
Like most Norwegian women educated at the beginning of the 1980s, women doctors do not choose
between a career and children, they have it both ways.
Only a small proportion have adjusted their personal or
family lives to benet from a continuous full-time career
by remaining single/divorced and childless. However,
there are still persisting differences between women and
men in how family responsibilities affect their medical
career. Career patterns differ not only between women
and men, but also between women in different types of
specialities. Although most women doctors in this study
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Table 7
The effect of family and work characteristics on the probability
of changing from full-time to part-time work (women doctors)
Variables
OR
CI
Age
Children l year or younger
Number of children
Marital status
Married to another doctor
Specialist
Type of speciality
General practice
Internal medicine
General surgery
Psychiatry
0.81
1.89
1.36
0.83
1.82
0.54
0.451.47
1.312.71
1.081.72
0.401.71
1.122.96
0.360.82
4.39
1.43
0.49
0.95
2.019.57
0.464.47
0.073.18
0.233.96
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Conclusion
Women doctors who qualied at the beginning of the
1980s did not have to renounce family life to have a
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