Sex, Lies and Physician Supply
Why female doctors are not to blame
Among the many reasons offered for why many Canadians are increasingly facing difficulties finding a family physician to call their own is the fact that the workforce has become increasingly female. The argument usually goes something like this: female family practitioners work fewer hours, take time out to raise families and have shorter careers. And because the proportion of family practitioners who are male continues to decline — about 60% of new medical students are female — we can look forward to the problem of accessing care getting worse.
This argument turns out to be simple, compelling, and for the most part, wrong.
The number of female family doctors in Canada has been increasing steadily since the late 1950s, and women have outnumbered men in Canadian medical schools since 1999. Importantly, the proportion of female medical students choosing to specialize in family medicine has also been increasing over that same period.
But does the rhetoric of ‘the part-time female family doctor’ truly match reality? Our recent systematic review, which examined a wealth of existing studies and was published in Human Resources for Health, suggests that the story is more complicated than a simple difference in work hours.
Although female physicians do work somewhat fewer hours than male physicians — and indeed work differently in general — there is no strong evidence that this difference has or will have any significant effect on the overall effective supply of family practitioners in Canada.
Rather, the dominant trends affecting overall supply into the foreseeable future are the recent rapid increase in medical school capacity in the country, and the fact that both male and female family doctors are increasingly focused on attaining a healthy work-life balance, while still providing high-quality and accessible care for their patients – a laudable goal. In practice, this means that we will have more family doctors, and that they will, on average, be working fewer hours than their older counterparts in the years to come.
In fact, one recent Canadian study found that the number of hours of direct patient care male physicians are providing has been declining, and that this trend has had a far more substantial impact on overall effective supply than the difference in work hours and patterns between males and females.
But it turns out hours of work is an overly simplistic and misleading indicator of service delivery volume or quality anyway. Several studies we examined found that female physicians spend more time with each of their patients, and deal with more problems in a single appointment. They also write fewer prescriptions for medications, while being more likely to provide patients with counseling, and to refer them on to specialists or for laboratory tests.
We did find one cause for concern. Our analysis found that female physicians are less likely to provide care in settings other than the office (home, hospital or long-term care), or outside of regular office hours. This could increase the reliance on already-stretched emergency departments and walk-in clinics as a source of primary health care.
Female physicians in general, and female family practitioners specifically, continue to maintain a different set of unpaid work and family responsibilities than their male counterparts. One recent study found that female family doctors who have children work more than 90 hours per week if unwaged household responsibilities are included. This was considerably more than the fewer than 70 hours worked by male family doctors who have children. Another study reported that the reduction in work time caused by having children under the age of 18 is twice as large for women as is it is for men. Female family physician s are also more likely to be involved in the care of elder family members.
According to surveys conducted by the Canadian Medical Association, physicians in Canada report attaining a healthy balance between personal and professional responsibilities as the most important factor for running a successful and satisfying medical practice. These same surveys show that physician burnout is experienced by a significant proportion of family physicians, affecting both the quality of care they are able to provide to their patients, and their own health and wellbeing.
The quality of debate about physician supply in this country would be improved substantially if we could put behind us the simple-minded rhetoric about an increasingly female physician workforce being a problem affecting overall supply, and focus on changes to workforce trends that are actually affecting our access to care.
By: Lindsay Hedden & Morris Barer
Lindsay Hedden is a Doctoral Candidate in the School of Population and Public Health at the University of British Columbia (UBC). Morris Barer is an expert advisor with EvidenceNetwork.ca, a Professor at the Centre for Health Services and Policy Research and the School of Population and Public Health at UBC.