PERSONAL,
PROFESSIONAL AND FINANCIAL SATISFACTION AMONG AMERICAN WOMEN UROLOGISTS
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CIARA S. MARLEY,
LORI B. LERNER, GEORGIA PANAGOPOULOS, ELIZABETH KAVALER
Department
of Urology (CSM, GP, EK), Lenox Hill Hospital, New York, USA and VA Boston
Healthcare System (LBL), West Roxbury, USA
Clinical
Urology
Vol. 37 (2):
187-194, March - April, 2011
doi: 10.1590/S1677-55382011000200005
ABSTRACT
Purpose:
Although nearly half of American medical school classes are comprised
of women, less than 5% of female medical students enter the surgical subspecialties
compared to nearly 20% of male students. Many women are concerned that
a career in a surgical field will limit their personal choices. In an
effort to evaluate if urology is conducive to a satisfying lifestyle,
we surveyed all 365 board certified women urologists in the United States
in 2007 to find out how satisfied they are with their choice of urology.
Materials
and Methods: A 114 item anonymous survey was mailed to all 365 American
Board Certified female urologists in 2007. Results were analyzed.
Results:
Of the 244 women (69%) who responded, 86.8% (211) reported being satisfied
with their decision to enter urology. Given the choice to repeat the decision,
81% (198) said that they would remain in medicine and 91.4% (222) would
choose a surgical subspecialty again. The majority of respondents who
stated they would choose a career outside of medicine also stated their
family life had been significantly compromised by their career. Those
who did not think their family life was compromised reported they would
remain in medicine. There was a positive correlation between the level
of satisfaction with the work itself and with income level (p = 0.006).
Conclusions:
Despite the small number of women who choose a career in urology, the
number of satisfied women indicates urology is a career conducive to having
a balanced and fulfilling life; professionally, personally and financially.
Key
words: urology; urologists; women; clinical practice
Int Braz J Urol. 2011; 37: 187-94
INTRODUCTION
The
surgical subspecialties continue to remain desirable and competitive residencies
among American medical students of both genders (1). Over the last 3 decades,
female medical students have entered the surgical subspecialties in escalating
numbers. However, women are not entering these highly competitive professions
at nearly the rate of their male counterparts. Despite the fact that half
of American medical school classes are comprised of women, less than 5%
enter the surgical subspecialties (1).
Women
still only constitute 13% of all surgeons in total (2). There has been
a recent surge of interest across surgical fields concerning the level
of satisfaction among women surgeons, with an effort to understand the
implications of an evolving field for females considering a surgical career
(2). Having women adequately represented among the surgical subspecialties
offers a more diverse workforce, reflecting the society in which we live
and serve.
Like
most surgical fields, urology remains a male-dominated profession. In
urology the number of women applying for residency positions has increased
over recent years, yet the number of male applicants far outweighs the
number of female applicants, (271 male applicants vs. 77 female applicants
-28%- in 2007 match). Data for 2007 show that women fill approximately
21% of the urology residency positions (211 out of 985 total residents).
The reasons for this gender discrepancy are not fully understood. In one
recent study, 84% of women medical students cited lifestyle during residency
as influencing their career decision. Sixty-three percent of women selected
other factors, including practice lifestyle and length of training (3).
In fact, lifestyle considerations were the only significant factor influencing
the decision about surgical training affecting women more than men (4).
In
an effort to evaluate if the field of urology is conducive to a fulfilling
lifestyle for women, we surveyed all 365 board certified women urologists
in the United States to assess how satisfied they are with their choice
of urology professionally, personally and financially.
MATERIALS AND METHODS
We
obtained a list of all 365 American board certified women urologists from
American Board of Urology and the Society of Women in Urology. The 114-item
survey was mailed to all women in May and July 2007. Given the personal
nature of the survey, including questions on institutional policies, no
respondent identifier or tracking mechanism was used. A pre-addressed
stamped return envelope was included. For tracking purposes an included
pre-addressed response postcard was to be returned separately. Approval
was granted from the Institutional Review Board of the VA Boston Healthcare
System. The survey methods have been described in further detail in previous
publications (5,6).
Demographic
data concerning marital status, family life, and financial compensation
were obtained, as well as detailed information regarding training and
overall satisfaction. The data were then entered into an online software
program, Zoomerang (www.zoomerang.com), for further analysis.
Descriptive
statistics were used to characterize demographic data and overall responses
to the survey. Percentages reflect the total responses for each individual
question as not all respondents answered every question. Relationships
amongst categorical variables were examined with the Fisher’s exact
test. We developed a logistic regression model to predict career satisfaction
utilizing the following six variables as predictors: age; marital status;
number of years in training; fellowship training; the number of hours
worked per week; and income. A p < 0.05 was considered a priori to
indicate statistical significance. Statistical analyses were performed
with SPSS version 16.0.2 (SPSS, Chicago, IL).
We
utilized responses to satisfaction questions (Table-1) as well as questions
regarding the degree to which the respondents’ careers compromised
their family and personal lives and vice versa. Selection choices for
satisfaction questions included: very satisfied; moderately satisfied;
moderately dissatisfied; very dissatisfied. Statistical evaluation for
satisfaction included the very and moderately satisfied groups. Dissatisfaction
included both the very and moderately dissatisfied groups, unless otherwise
indicated. We also explored respondents’ willingness to choose urology
again if given the opportunity to alter their career decisions.
RESULTS
Of
the 365 women on our mailing list, addresses were available for 354. Two
mailings culminated in a 69% response rate (n = 243). The average respondent
age was 43 years of age (range 31-77 years). The majority of the respondents
were married (n = 197, 81%), with most being in their first marriage (n
= 181, 74%). Divorce and separation rates combined were 8% (n = 20) among
respondents. The survey identified 163 women (67.4%) who delivered a total
of 331 biological children. Six percent (n = 15) of respondents were single
parents at the time of survey completion. Years of training, practice
environment, academic affiliation and hours worked are listed in Table-2.
Satisfaction with life, salary, time management, and marriage are listed
in Table-3.
The
survey revealed that the number of years in training, the numbers of hours
currently spent working, and private versus academic practice had no bearing
on satisfaction rates. In addition, the logistic regression model did
not identify any predictors of career satisfaction (p > 0.25). Satisfaction
appears to be independent of the number of years spent training (p = 0.30)
and independent of the type of practice entered once training is complete
(p = 0.529). The number of hours spent working, both in and out of the
operating room, does not appear to influence career satisfaction level
(p = 0.569).
There
was a positive correlation between the number of hours worked and financial
compensation. The highest earners reported working 41-60 hours per week.
The hardest workers (and not necessarily the highest earners) worked more
than 80 hours per week [4% (n = 9)]. There was a positive correlation
between financial compensation and the level of reported satisfaction
p = 0.006, however, it was not true that dissatisfied women earned less.
Three
percent (n = 7) of respondents indicated that their personal life and
family responsibilities have compromised their careers to a great extent.
Eleven percent (n = 26) of respondents indicated that their career had
greatly compromised their family and personal lives. Ninety percent (19/21)
of the moderately (20) to very (1) dissatisfied urologists reported a
moderate to great degree of compromise of their personal life due to their
career. A total of 63% (137/216) of the very to moderately satisfied urologists
reported a moderate to great level of compromise of their personal life
due to their career (p = 0.024). In spite of these realities, 81% (n =
198) would remain in medicine, and 91.4% (n = 222) would choose a surgical
subspecialty again if given the choice. Eighty-seven percent (n = 211)
of respondents indicated that they were happy with their decision to enter
urology. As expected, there was a positive correlation between those women
who felt their family life was compromised by their career and those that
would choose a career outside of medicine if they had the choice to do
it again (p = 0.002).
Female
urologists who worked more hours achieved greater financial compensation,
(p = 0.005) and those that are compensated well report a higher level
of career satisfaction, (p = 0.006). When asked if their spouse/partner
expected his/her career advancement to take priority over her own, 82%
(n = 176) answered no, 13% (n = 27) answered yes and 6% (n = 12) were
uncertain. Fifty-seven percent (n = 128) of respondents stated they shared
the household responsibilities equally with their partner. In our survey,
76% (n = 181) of respondents decided on their career path during medical
school.
COMMENTS
There
has been a growing interest in the assessment of female surgeon’s
self-perceived quality of life. In 1990, female surgeons in Canada were
surveyed in an effort to evaluate their ability to combine their careers
with their personal and family lives (7). Our study is the first to specifically
target American women urologists in assessing satisfaction with career
choice - professionally, personally, and financially. Overall satisfaction
in this study group was very high.
In a recent publication by Troppmann et
al. (2), 3507 general surgeons were surveyed regarding career and lifestyle
choices. Twenty-three percent of the respondents were women. Both genders
stated they would choose their profession again (women 82.5% and men 77.5%).
Overall, 83.5% of women would recommend surgery to other women (p <
0.001). Not surprisingly, women were more strongly in favor of part-time
work opportunities for surgeons, perhaps due to the additional parenting
responsibilities of women surveyed. The researchers found a growing interest
by both genders for child care facilities at work, highlighting one of
the many changes in the evolving surgical workplace. The results of their
study suggest that maximizing recruitment and retention of women surgeons
will include giving serious consideration to alternative work schedules
and optimization of maternity leave and childcare opportunities.
Two studies utilizing a survey, one from
which ours was adapted, revealed that career satisfaction is greater among
women urologists than that seen in women specializing in other surgical
fields, including ophthalmology and otolaryngology (Table-4) (8,9). In
one study, 75% of female ophthalmologists reported they would again choose
a career in medicine if given the choice and 79% reported they would choose
a surgical specialty, compared to 81% and 91.4% of our cohort. When asked
if they felt that their career had compromised their family or personal
lives, surgeons in the various specialties had significantly different
responses. Only 40.3% of gynecologists and 41.9% of general surgeons reported
that their career choice resulted in “some, a little, or no compromise”
of their family and/or personal lives.
A study of otorhinolaryngologists revealed
results that were very similar to ours (9). Only 30.6% of women otorhinolaryngologists
reported that their career compromised their family or personal life to
a “great deal” or a “very great deal”, which is
similar to the 30% found in our cohort. Also mirroring our results, 83%
of women in otolaryngology would remain in medicine and 91% would choose
a surgical subspecialty again (9).
In contrast to the high rates of professional
satisfaction among female surgical sub specialists, primary care physicians
report a growing level of dissatisfaction. A 2002 study by Landon et al.
compared two satisfaction surveys among primary care physicians in 1996
and 1999. In 1996, 19.8% of physicians were somewhat or very dissatisfied
with their current practice situations versus 33.4% in 1999, an increase
of more than 50% (p < 0.001) (10). A more recent survey from 2008 found
that only 70% of family physicians said that they “agree/strongly
agree” that they would choose to practice family medicine if given
the opportunity to choose again. This represents a 4% decline compared
to data from 2001 and a 9% decline compared to 1995 (11). Although this
survey was not a random sampling of primary care physicians, a surprising
73% of respondents answered that they were sorry they went into primary
care (11).
In a recent 2008 study by Clem et al., 2502
women emergency medicine physicians were surveyed regarding their degree
of career satisfaction. Only 35.5% reported being very satisfied, 44%
were satisfied, 11.1% were neutral, and 9.4% were not/very unsatisfied
(12). Similarly, in a 2001 survey of 5704 general pediatricians, subspecialty
pediatricians, general internists, internal medicine subspecialists, and
family physicians, only 44% combined would encourage their children to
pursue a career in medicine (13).
Competition for placement in urology is
among the highest for all residencies. There are 112 non-military accredited
urology programs in the United States. In 2008, there were 247 positions
in 110 non-military accredited urology resident programs with 246 vacancies
matched. Four hundred and four applicants submitted preference lists resulting
in 158 unmatched applicants. Of senior medical student applicants, 70
percent were matched (4). Despite the growing number of competitive women
candidates applying for positions, it does not appear that they are choosing
surgical fields (4,13). Lifestyle considerations appear to drive the specialty
choice of female medical students (6).
If lifestyle considerations are the deterrent
for many female (or male) medical students, then results such as ours
refute the misconception that all surgical fields affect lifestyle. Most
respondents were moderately to highly satisfied with their career and
personal lives and did not feel that their personal and/or family lives
were compromised. One of the explanations for this high rate of satisfaction
is that the type of woman who is drawn to the demands of a surgical lifestyle
has a different idea of quality of life versus a woman drawn to a primary
care field. Some consideration must be given to the difference in personalities
between women and their choice of medical field.
Like all survey - based studies, our analysis
has limitations. First, the survey is not validated, however it has been
used by three other specialties resulting in multiple publications, (8,9).
Secondly, the study is retrospective and respondents were asked to remember
important factors from several years ago, thus there is likely some degree
of recall bias. A prospectively administered survey would address this
weakness. It is also possible that the responders represent a more satisfied
group than the 31% of non-responders, therefore revealing the role of
self-selection of participants (the volunteer effect). In addition, respondents
may have felt compelled to provide professionally desirable responses.
A surgical career requires a significant time and financial commitment.
Having made these sacrifices, physicians may not freely admit to negative
feelings about their career choice.
It would have been interesting to compare
responses of women urologists to their male counterparts and this is another
limitation of the study. This would have resulted in stronger conclusions
and was given great consideration and investigation by the authors. However,
it proved to be logistically difficult to identify a database capable
of selecting an appropriate male group (age and year of residency completion)
and labor intensive. It is the hopes of the authors that publication of
the current study will promote the importance of a future study that includes
both men and women.
The strength of our study was the high response rate (69%). Research on
survey responses by physicians report rates of 54%, which is lower than
ours (13). Additionally, we had a national sample of board certified women
urologists, thus providing a representative selection.
CONCLUSIONS
Despite
the small number of women who choose a career in urology, our study reveals
that urology can provide a fulfilling career, a satisfying personal life,
and sufficient financial rewards to the women who choose this subspecialty.
While many female medical students may be concerned that a career in a
surgical field will limit their personal choices, our study refutes this.
Competitive female medical students who are interested in surgical careers
should be educated about the growing opportunities in urology and the
high level of satisfaction personally, professionally, and financially
among women in this field.
CONFLICT
OF INTEREST
None
declared.
REFERENCES
- AAMC GME
Track (2007 data); AMA (1997 data). AAMC Data Warehouse. available at:
http://www.aamc.org/members/gwims/statistics/stats08/table02.pdf
- Troppmann
KM, Palis BE, Goodnight JE Jr, Ho HS, Troppmann C: Women surgeons in
the new millennium. Arch Surg. 2009; 144: 635-42.
- Wendel
TM, Godellas CV, Prinz RA: Are there gender differences in choosing
a surgical career? Surgery. 2003; 134: 591-6; discussion 596-8.
- McCord
JH, McDonald R, Leverson G, Mahvi DM, Rikkers LF, Chen HC, et al.: Motivation
to pursue surgical subspecialty training: is there a gender difference?
J Am Coll Surg. 2007; 205: 698-703.
- Lerner
LB, Stolzmann KL, Gulla VD: Birth trends and pregnancy complications
among women urologists. J Am Coll Surg. 2009; 208: 293-7.
- Lerner
LB, Baltrushes RJ, Stolzmann KL, Garshick E: Satisfaction of women urologists
with maternity leave and childbirth timing. J Urol. 2010; 183: 282-6.
- Mizgala
CL, Mackinnon SE, Walters BC, Ferris LE, McNeill IY, Knighton T: Women
surgeons. Results of the Canadian Population Study. Ann Surg. 1993;
218: 37-46.
- Mackinnon
SE, Mizgala CL, McNeill IY, Walters BC, Ferris LE: Women surgeons: career
and lifestyle comparisons among surgical subspecialties. Plast Reconstr
Surg. 1995; 95: 321-9.
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JR, Gooding WE, Zamboni BA, Wagener MM, Drenning SD, Miller L, et al.:
The gender gap in a surgical subspecialty: analysis of career and lifestyle
factors. Arch Otolaryngol Head Neck Surg. 2004; 130: 695-702.
- Landon
BE, Aseltine R Jr, Shaul JA, Miller Y, Auerbach BA, Cleary PD: Evolving
dissatisfaction among primary care physicians. Am J Manag Care. 2002;
8: 890-901.
- Young
R, Webb A, Lackan N, Marchand L: Family medicine residency educational
characteristics and career satisfaction in recent graduates. Fam Med.
2008; 40: 484-91.
- Clem
KJ, Promes SB, Glickman SW, Shah A, Finkel MA, Pietrobon R, et al.:
Factors enhancing career satisfaction among female emergency physicians.
Ann Emerg Med. 2008; 51: 723-8.
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____________________
Accepted
after revision:
July 30, 2010
_______________________
Correspondence
address:
Dr. Ciara S. Marley
Department of Urology
Lenox Hill Hospital,
100 East 77th Street
New York, NY 10075, USA
Fax: + 1 212 434-2000
E-mail: ciaramarley@hotmail.com
EDITORIAL
COMMENT
“Life,
liberty and the pursuit of happiness” are cited as unalienable rights
in the United States Declaration of Independence. This study by Marley
and co-workers examines the “pursuit of happiness” in personal,
professional and financial satisfaction in female American Board Certified
Urologists. This is a comprehensive study that reports that these urologists
are in general a satisfied cohort, both at work and at home. The vast
majority of women would enter a surgical subspeciality, and would choose
medicine as a career if given the choice again. Despite careful analysis,
there were no clear predictors of satisfaction analyzed from working pattern,
years of training and type of practice. There are relevant comparisons
drawn between studies of women in other surgical subspecialties who have
reported similar rates of satisfaction to these urologists; and specialists
such as general surgery and general medicine where satisfaction with career,
and medicine in general were much lower (1,2).
Of note was the high response rate from
the urologists surveyed (69%) which the authors rightly note may reflect
“satisfaction bias”. Interestingly, this was almost exactly
the same number of respondents as replied in two studies of pregnancy
and maternity carried out by one of the co-authors of the same cohort
of urologists (3,4) It could be presumed this is a particularly well-motivated
cohort of women, or are particularly sympathetic to questionnaire based
research.
Fundamentally, it is difficult to separate
whether the lifestyle of surgical specialties is particularly conducive
to satisfaction both professionally and personally; or whether the personalities
drawn to these specialities have shaped their lives around work practices.
The authors have noted this, and the difficulty in asking individuals
to remember and critically assess decisions in retrospect with the possibility
of recall practice. The independence of satisfaction from the multiple
variables assessed demonstrates what a complex and personal subject satisfaction
is to analyze.
Clearly with men forming the vast majority of American Board Certified
Urologists, this study should create considerable interest in repeating
the analysis to examine the satisfaction rates in male urologists. As
the authors rightly note, the much larger numbers, and potentially lower
response rates (2) would make a follow-on study of male urologists a considerable
undertaking. However, consideration of a longitudinal prospective study
of recently certified male and female urologists would allow comparison
between the sexes, and over the course of a career. Hopefully interest
generated by this article may encourage the American Urology Association
and the American Board of Urology to continue research into satisfaction
and quality of life amongst its members.
In summary, Marley et al. (5) have provided
a comprehensive analysis of high rates of personal and professional satisfaction
among female urologists. However, bearing in mind Abraham Lincoln’s
quotation “most folks are about as happy as they make up their minds
to be” it remains unclear if the high rates of fulfillment are due
to the lifestyle provided by urology as a specialty, or a matter of selection
and adaptation in the “pursuit of happiness”. Hopefully this
study will ignite interest in comparing satisfaction in a cohort of newly
certified urologists, both male and female.
REFERENCES
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E, McMurray JE, Linzer M, Elon L: Career satisfaction of US women physicians:
results from the Women Physicians’ Health Study. Society of General
Internal Medicine Career Satisfaction Study Group. Arch Intern Med.
1999; 159: 1417-26.
- Zutshi
M, Hammel J, Hull T: Colorectal surgeons: gender differences in perceptions
of a career. J Gastrointest Surg. 2010; 14: 830-43.
- Lerner
LB, Stolzmann KL, Gulla VD: Birth trends and pregnancy complications
among women urologists. J Am Coll Surg. 2009; 208: 293-7.
- Lerner
LB, Baltrushes RJ, Stolzmann KL, Garshick E: Satisfaction of women urologists
with maternity leave and childbirth timing. J Urol. 2010; 183: 282-6.
- Marley
CS, Lerner LB, Panagopoulos G, Kavaler E: Personal, professional and
financial satisfaction among American women urologists. Int Braz J Urol.
(in press)
Dr. Sarah
Ramsey
Department of Urology
Gartnavel General Hospital
Glasgow, United Kingdom
E-mail: sara_l_ramsey@ntlworld.com
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