Abstract
BACKGROUND:
Research has explored the problems that women encounter during a medical career; however, the advice that experienced women physicians would give to women who have not yet entered the field is needed to reveal how the medical work landscape is evolving and to provide real-world narratives to help career seekers make informed choices.
OBJECTIVE:
By eliciting women’s perspectives on their medical careers by asking them what advice they would give to aspiring women physicians, we aimed to reveal areas for improving career satisfaction of women physicians and to inform those who advise women considering a medical career.
METHODS:
In this qualitative study, we used a phenomenological approach to conduct semi-structured one-on-one interviews with 24 women physicians to query the advice they would give to women contemplating a career in medicine.
RESULTS:
Thematic analysis of interview transcriptions revealed 10 themes that women physicians communicated as being important to consider before deciding to become a physician. Although some advice had a cautionary tone, encouraging and practical advice was also conveyed. The most abundant themes concerned the centrality of patient care, a passion for practicing medicine, and the importance of planning. Other key topics included family and friends, self-reflection, life balance, finances, ethics, maintaining presence, and two overt cautionary statements.
CONCLUSION:
Interviews revealed that meaning and purpose derived from a medical career and maintaining work-life balance are valued by some women physicians. Participants were encouraging in recommending medicine as a career choice for women, while highlighting some challenges.
Introduction
The number of women attending medical school and practicing medicine has increased greatly since the 1960 s; however, women still face many challenges within this demanding field, and inequities in pay and representation in leadership persist [1]. Women physicians have reported high career satisfaction [2], often on par with men [3], even while facing specific challenges such as discrimination and bias, lack of role models, and microaggressions [4–6]. Researchers have explored why women physicians enter or leave careers in medicine, especially academic medicine [7, 8], and a lack of role models, poor mentorship, overt bias and discrimination, and inability to find work-life balance are all reasons that women have left medical careers [9, 10]. Although quantitative studies can track measurable aspects of a medical career such as pay and number of leadership positions held, qualitative studies investigate the personal, lived experiences of women (and men) in medicine, which can reveal the social context within which doctors work, uncovering new questions to explore and monitoring cultural change over time [11]. In-depth personal narratives are needed to inform the creation of effective, up-to-date policies that will attract and retain effective and fulfilled physicians and to help inform those individuals seeking to enter the medical field. One qualitative study of women physicians in Canada has suggested that the challenges faced by women in medicine have not changed in three decades [12]. And a systematic review of 64 qualitative studies addressing disparities in the careers of women physicians concluded that medical culture and structures are still implicitly biased against women [6]. Thus, investigating the thoughts and perspectives of women physicians who have had an established career will shed light on the social and interpersonal context of the medical environment as policies and cultures are evolving, particularly in regard to difficulties in maintaining work-life balance and the need for support systems, which are ongoing issues that women face [6, 12].
Interview studies exploring the lived experiences of women in medicine have focused on specific populations, such as women who are alcoholics [13], women in leadership positions [14], women within specific medical disciplines such as otolaryngology [15] and surgery [16, 17], and especially women in academic medicine [18–21]. Indeed, qualitative studies have uncovered that while some similar workplace challenges contribute to career burnout in men and women surgeons, gender differences do exist, highlighting a need for both targeted and general strategies to improve the experience of both female and male doctors [16]. Also, interviews with successful women in academic medicine revealed a previously unrecognized coping strategy of downplaying one’s femininity in both appearance and behavior to manage workplace challenges [20]. But studies that specifically probe how physicians give career advice and the role of career advice for improving physicians’ work experiences are less commonly done. One British questionnaire study revealed that junior doctors would like to receive career advice after they enter the field, and that career advice should be planned into postgraduate training [22]. Another British survey study, which assessed types and quality of medical career advice, highlighted the importance of developing varied advice to serve an increasingly diverse healthcare workforce and suggested that career advice should be an integral part of medical training [23]. Conversely, a survey study of individuals who were interviewing for an emergency medicine residency revealed that well over half of the potential residents had received negative advice about a career in emergency medicine from non–emergency medicine faculty, suggesting a need for quality career advising processes [24]. Specifically regarding women in medicine, one large interview study asked 40 women physician leaders for advice on workplace and management strategies for those seeking leadership positions, concluding that reaching gender equity for women leaders in academic medicine will require a multi-pronged approach, one of which is to disseminate career advice from women leaders [14].
Therefore, to contribute to our understanding of the ever-changing context of women physicians’ experiences within this persistently challenging field, we sought to qualitatively investigate how women physicians who had an established medical career and were from different medical disciplines would advise women who were considering a career in medicine. This report describes findings from the first part of a multi-part qualitative interview study that aimed to explore women physicians’ perceptions of the societal and professional barriers that they have faced throughout their careers. Our aim was to generate a current, personal, intimately grounded snapshot of how experienced women physicians would advise women who have not yet entered the field to serve as a practical resource for those who advise women in career decision making and to reveal areas of focus for improving career satisfaction for women in medicine.
Methods
This study was designed with a phenomenological qualitative approach that focuses on revealing the experiential and lived aspects of women physicians. The qualitative study approach was chosen to gain an in-depth understanding of women physicians’ personal opinions based on their specific experiences during a career in medicine. One-on-one semi-structured interviews were conducted within three months of participant enrollment by one educational researcher between August 2019 and January 2020. Regarding researcher characteristics and reflexivity, the lead researcher who conducted all interviews was a PhD-level female non-physician who is interested in the professional challenges of women, and the researcher had been trained in interview techniques. Participants included 24 women from 14 different medical disciplines within a single health system (Dermatology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, Nephrology, Neurology, Neurosurgery, Ophthalmology, Pediatrics, Psychiatry, Pulmonary Critical Care, Rheumatology, and Sleep Medicine). All participants were or had been employed within a metropolitan health system that includes multiple teaching hospitals and clinics. Thus, the participants do not fit cleanly within either the academic or community physician paradigm. Inclusion criteria were being born in 1979 or earlier and current or previous employment as a physician in the United States. Date of birth in 1979 was chosen to select for participants with an established medical practice to lower the likelihood of early career physician participation. Participants were chosen by the lead researcher through personal inquiry as a purposeful, convenience sample of women physicians from different medical disciplines. Participants were selected from a range of medical specialties with no formal randomization method and were invited via personal contact (email and phone call). Potential participants were identified based on pre-existing relationships with the lead researcher and through personal referrals from other women physicians. Authors note that the term “women physicians” was used to maintain continuity of terminology with the previously published body of literature on this topic (see references). Details about sex assigned at birth or gender identity were not queried. Interviews were conducted either in participants’ homes or workplace offices, and two interviews took place via telephone. For in-person interviews, participants were asked to turn off their phones and computers. Only the interviewer and the participant were present during the interviews, which were scheduled to last one hour. Several interviews took less than 60 minutes. For interviews that went over 60 minutes, participants were alerted when 55 minutes had passed, and they were asked to complete their thoughts; the interview then ended within 10 minutes. The interviewer and participant were seated near each other at one table for in-person interviews.
This study was approved by the Institutional Review Board and the manuscript was compiled using the SRQR standards for reporting qualitative research as a guide [25]. All participants completed written informed consent and were assured of confidentiality and anonymity. Audio recordings were transcribed using OTTER.ai. Interview transcriptions were analyzed using manual thematic analysis. A code book was generated inductively through in-depth reading of the transcripts by the lead researcher after all interviews were completed. The code book was inductively constructed to reflect themes that the lead researcher felt had emerged during the encounters. Frequency, context, and tone were considered during inductive theme identification. Individual transcriptions were then coded by the lead researcher and two research assistants (one a PhD and one an EdS). Researchers read interview transcripts and identified quotations that reflected the code book themes. Two randomly chosen interviews were analyzed and coded by all three researchers to assess consistency of approach. The three researchers met to discuss consistency of approach based on the commonly coded interviews to reach agreement by consensus. The remaining 22 interviews were then each coded by one researcher. Researchers read the transcripts and inductively identified areas that reflected the major themes that were revealed by the interviewees’ answers. Analysis sought themes, bits of meaning, categories of events, behaviors, and central focal points. Audio recordings of individual participants were compared to written transcripts, as needed, when researchers had questions about context and intent. Three out of the ten major identified themes were mentioned only two times in the interviews, and the authors considered this to be a satisfactory level of saturation. No computer software was used to identify themes; rather, all analyses were done manually through careful reading as described above.
Medical specialty, age group, and retired versus employed status were assessed qualitatively for patterns. An interview coding guide is available on request. The entire interview addressed four questions, and interviews were performed in one session per participant for multiple analytical strategies for parsimony. The first three questions were the following: “What are your feelings about workplace expectations of women physicians when you began in medicine and now?”; “What kinds of significant changes do you see that have taken place over the course of your career in medicine?”; and “What changes do you think should be made in/during training of women in medicine and expectations of them?” Follow-up questions were sometimes asked per the interviewer’s discretion to clarify statements. The analysis of data for the current arm of the project, which aimed to compile the participants’ personal advice, was done on responses to the fourth question, “What advice would you give to young women going into medicine?” All data analyzed for the project reported here have been flagged as “analyzed” to prevent future repeat reporting of data because the extent of the findings could not feasibly be contained within one report. The data compiled for presentation in this manuscript was decided upon by all four researchers through discussion.
A consideration for poetic re-presentation was incorporated. According to Glesne [26], poetic re-presentation lets researchers edit transcripts into “poetic verse to bring new meaning to an academic study.” Through this method, data are filtered by the researcher, thereby reducing the number of words with the intent of maintaining entire thoughts and thematic relationships. Participants did not review poetic re-presentation before analysis. Participants completed study-generated personal information questionnaires prior to one-on-one interviews. The study was built to foster collaborative dialogue with the participants to help capture valuable information and perceptions surrounding their circumstances. Participants were instructed not to discuss the assessments or one-on-one interviews during the study’s data collection cycle.
To address potential issues of validity, several measures were used. First, a validated predictive index assessment and a study-generated personal information questionnaire were completed by participants prior to one-on-one interviews. Participants were selected from multiple medical specialties and from a range of ages that fit the target demographic of established medical practitioners.
Results
This first phase of a multi-part study addressed the interview question, “What advice would you like to give to young women going into medicine?” A total of 24 women physicians from 14 medical disciplines gave a range of answers during one-on-one semi-structured interviews. Participant ages ranged from 43 to 65 years, and the mean (standard deviation) age of participants at the start of the study was 54 (8) years. Qualitative analysis of coded transcripts of responses to this question and spontaneous comments in other parts of the interview revealed 10 major themes: (1) Patient care and personal passion; (2) Planning; (3) Family and friends; (4) Self-reflection; (5) Life balance; (6) Finance and negotiations; (7) Ethics; (8) Being present; (9) Caution; and (10) Resilience (Table 1). Qualitative assessment did not reveal any obvious correlation of themes with participant age, medical specialty, or employment status.
Ten themes identified in interviews with women physicians in response to the question, “What advice would you like to give to young women going into medicine?” N = 24 participants
Ten themes identified in interviews with women physicians in response to the question, “What advice would you like to give to young women going into medicine?” N = 24 participants
aTopics were sometimes mentioned more than once by the same participant.
The most highly represented theme involved personal passion for a career in medicine, highlighting the importance of patient care and the need for personal sacrifice and hard work. This theme was identified 27 times in the transcripts (Table 1). Many comments were encouraging, showing that the job itself and the resulting sense of meaning and purpose were considered important to the women: “Medicine is a wonderful pairing of science, math and interacting with people and providing people with care” and “There is a lot of hard work and routine, but making a difference is what matters.”
Other comments were cautionary, revealing that feelings of meaning, purpose, and fulfillment were not a constant feature of their practices: “Know that you won’t always get warm fuzzy feelings from your patients” and “There is no glory in it, no fame.” But a focus on personal motivation was clear, which highlights that the women valued a personal connection to the work: “The only way to be a physician is to love the work” and “You have to love it; Love your patients.”
The intertwining of the difficult aspects of patient care with the resulting personal sense of fulfillment or non-fulfillment indicate that the women wanted others to consider both the positive and negative aspects of a medical career. The first cautionary statement on this theme that is listed in Table 2 explicitly describes the perception that a lack of women in medical leadership is a barrier for women in medicine. Overall, the responses in this theme revealed that many of the women valued the internal rewards of a medical career, and that they felt aspiring women physicians would likely share that value.
Select, extended statements of advice by women physicians representing encouraging and cautious attitudes
Select, extended statements of advice by women physicians representing encouraging and cautious attitudes
aNumbered themes are as follows (see Table 1): 1, Patient care and personal passion; 2, Planning; 3, Family and friends; 4, Self-reflection; 7, Ethics; and 10, Resilience. bName not included to protect anonymity.
The next topics that were most represented were issues around personal planning and those involving family and friends, with planning identified 21 times and family and friends identified 15 times in the transcripts. In the realm of planning, women provided advice that highlighted the importance of focus and self-awareness: “You have to know yourself and have flexibility to be able to choose how you create your career”; “Learn when to focus. If I had focused earlier, I could have done more... [content not included to maintain anonymity].” The statement of regret, “I could have done more,” highlights a particular awareness of how a career trajectory may have been altered had the physician done something differently. Thus, this piece of advice showed a willingness to convey a perceived shortcoming that the participant felt an aspiring physician should know.
This realm of advice often hinted at a need for conscious self-determination in regard to shaping one’s career path: “Figure out what you want, what you want your role to be”; “You can guide your way \dots Think about what you want to become”; “You can shape that a bit more than by just looking at opportunities as they present themselves to you”; “When you know what you want you can make a lot happen”; “Know what you want to do and do that”; “Think through how you want your life to be and work to that end.” The extended quotations that had an encouraging tone about career planning (Table 2) emphasize that the women recognized the serious nature of considering a career in medicine and were aware that the field is changing, yet felt that these facts were positive aspects of a medical vocation.
Many of the items of advice involved multiple aspects of family considerations, ranging from thinking about partner roles and issues concerning children to general observations about family dynamics. Much of the advice about partners emphasized equality and fairness: “Choose a partner who will be equal in care of your children and home”; “Everybody needs a supportive family structure”; “If you marry, choose a partner who truly shares the load.” The emphasis around communication with partners, which is very evident in the extended quotation on this theme in Table 2, highlights that some women recognized the complexity of maintaining a work-life balance, which has increasingly been a focus of workplace wellness initiatives [27].
Less advice focused on children and included: “My daughter has to see that women work”; and “My favorite job is being a mom... my kids are the people who matter most to me.” Because the average age of our participants was 54 years, the women, if they had children, may have been more distant from the early years of child rearing, and so their comments may have had a more general tone rather than mentioning any specific issues about early career issues around having and raising children. However, the women were encouraging, if cautious, in terms of conveying issues around managing family during a career in medicine: “It is possible to juggle family and work, but it may not be that you’re going to be at the top of your game in both because that’s really hard to do” and “After young women physicians tell me I’m never going to get married, I’m never gonna have children. I tell them, of course you can get married and if you want, of course, you can have children... because that’s what you want.”
Themes 4 and 5: Self-reflection and life balance
Throughout the women’s advice, themes of both a practical and personal nature were revealed. A need to engage in self-reflection (mentioned 12 times) on a range of internal, emotional issues was clear and included comments such as: “Don’t feel guilty”; “Schedule time to think and reflect”; “Learn from [your] mistakes”; “Also have some self-compassion”; “You worry. You really worry”; and “You will make mistakes and it is a tremendous, tremendous burden.” The extended quotation on this theme in Table 2 emphasizes that mistakes in a medical career are inevitable and that a certain comfort level with being uncomfortable is not only unavoidable but also is a place of growth. In this context, the physicians may be encouraging young doctors to embrace discomfort as a normal byproduct of reflection, growth, and learning.
The self-reflection needed for handling the struggles of practicing medicine were counterbalanced with advice about how to maintain balance in one’s life (mentioned 8 times), even with some honest admittance to personal struggles: “Try to have some moderation and balance in everything”; “We only have 24 hours in a day and we have to sleep”; “I feel dishonest because I don’t have work-life balance. But I do feel it is important”; and “You have to give up or postpone some things.” In advocating the need for balance, women acknowledged the importance of having meaningful relationships and fun: “Make sure you have a good group of friends around you”; “Nurture relationships with people who are important to you”; and “It is important to enjoy life.” Overall, advice from these two themes showed that the women were at a point in their careers when they could look back and be straightforward in assessing their internal, emotional challenges during medical practice, and that they were cognizant of the ways in which they had managed these challenges. This long view, eliciting challenges without being discouraging, may be a feature of the women’s established medical careers.
Theme 6: Finance and negotiations
Themes 6 through 10 contained fewer responses than the first five themes, and they contained advice for both worldly issues as well as more internal, psychological-emotional concerns. Issues such as finance and negotiations were mentioned six times throughout the transcripts: “Live like a resident so you can pay off your loans fast,” and “In general, there’s no harm to ask for what you want” (Table 1). Overall, the financial advice included topics involved in the cost of medical training and the need for negotiation skills throughout a career, showing that the participants may have had some financial struggles during their career trajectories.
Theme 7: Ethics
Reflecting on the central role of ethical conduct during the difficult practice of medicine (mentioned 5 times), several women gave very firm advice about the importance of maintaining integrity and having a solid ethical framework: “Do what is right”; “Always do your best for your patients... This is too serious”; “Always be a good citizen. Always be a good person”; and “Integrity has to be the core of who you are.” Considering the serious nature of providing medical care, the advice given on this topic was somewhat vague, which could be indicative of the difficulty in conveying advice about a somewhat abstract topic. The extended piece of advice on this theme in Table 2 emphasized a need for having self-compassion and being realistic, suggesting a recognition of the potential for unrealistic personal standards in younger individuals who are interested in medicine. The physicians’ responses suggested that the acceptance of one’s self in the present, including limitations, is essential for continued growth and realization of one’s full potential.
Themes 9 and 10: Caution and resilience
Interestingly, two overt cautionary statements were made: “I wouldn’t recommend medicine to my children... because of the non-medical task[s]” and “Run. Run like hell. You don’t know what you’re getting yourself into.” However, these two cautionary items were balanced by two pieces of advice for maintaining resilience during the most difficult times: “This may sound harsh, but you have to have a kind of a thick skin. That helps you let things roll off your back”; and “You can also benefit from a thick skin with colleagues.” Both sets of these comments contained rather forceful statements, underlining the magnitude of difficulties often faced in a medical career that may be hard for younger individuals to imagine or predict. An extended comment in Table 2 mentions a specific workplace episode of being mistaken for a nurse. The comment includes a coping mechanism, suggesting that this occurrence may have featured prominently in the interviewee’s professional life.
Although cautionary comments were made, the transcripts consistently contained many positive, encouraging general bits of advice for aspiring women in medicine, indicating an overall positive career satisfaction: “It’s an incredibly rewarding job”; “If you’re interested in medicine or doing good, this is a great career”; “I can’t imagine a better career”; and “I completely recommend medicine. It is a great field.”
Discussion
In this qualitative study, the responses of women physicians to the question “What advice would you give to young women going into medicine?” provided an intimate portrait of how a select group of female doctors have viewed their careers. We observed that women physicians valued the sense of meaning and purpose they derived from their medical careers and were overall quite encouraging about a career in medicine for aspiring women. Interviews revealed 10 major themes of advice given by our sample of 24 women physicians, with comments that ranged from supportive to cautionary. While many studies have assessed specific, measurable issues that women face in the field of medicine [9, 28], this qualitative study probed physicians’ personal feelings about their careers by analyzing opinions in the form of advice. Our findings revealed a range of challenges, highlights, and barriers experienced by some women during a medical career and elicited some opinions, personal coping mechanisms, and emotional states that the participants felt would be helpful for aspiring physicians.
In studies of women in medicine, the types of physicians assessed have been somewhat narrow. Much research has focused on academic medicine [29], which represents a specific and particularly demanding realm of medical practice. One qualitative study of early-career women in academic medicine probed the reasons why women had left their positions [10] and uncovered some themes similar to those identified in our study of later-career physicians, including family responsibilities and work-life balance. Women physicians in academic medicine may have unique challenges compared to those encountered by women in general practice, such as frustrations with research and extreme competition [10]. Indeed, in a pointed and thorough commentary, Ludmerer contemplates why women in academic medicine are so underrepresented despite the parity of women and men in US medical schools for over two decades [29].
Unlike the abundance of studies of physicians in academic medicine, studies of physicians in private or community practice are not abundant, and sometimes, the dividing line between academic and non-academic practice is not clear, such as in our study. Authors of a recent study on physician burnout and work-life integration state that theirs was the first to assess these outcomes as a function of both gender and work setting (academic versus private) [30], underlining a need for more studies in non-academic settings and a greater appreciation for the complex interactions of physician characteristics that affect career perceptions. Physicians practice in a wide range of environments with unique features, and exploring challenges and benefits of practicing in rural, community, private, or specialty settings will likely reveal a diversity of experiences. The women in our study did not fit within a discrete academic or community practice profile; therefore, the more abundant issues raised by the women’s opinions, such as the rewarding aspects of a career in medicine, the need for careful planning, and attention to family and friends, may be more general issues relevant to both types of work environments. Issues like these should probably be prioritized when advising women who are considering a career in healthcare, and more importantly, institutions should monitor how all physicians are handling these issues in the workplace and create support systems with these issues in mind to improve physician effectiveness and well-being.
While our study sought to explore perceptions of women physicians in general, the population of “women physicians” is in fact a heterogeneous distribution of individuals [31], and multiple physician characteristics likely work synergistically in forming a career trajectory. For example, race has been shown to play a key role in women’s satisfaction with a career in medicine [32], and medical practice locale such as military service [33] may have specific effects on women physicians. Also, studies on the medical career trajectories of LGBT women physicians are woefully sparse [34, 35], and there is a great need for improvement in defining aspects of gender-identity in studies of women in medicine. Overall, the heterogeneity inherent in the population of women physicians has not been comprehensively addressed, and future studies will benefit from addressing more refined and specific groups.
A particular challenge for professional women that was not brought up in our study, but which was highlighted by Ludmerer, is the issue of “microinequities,” [5] which are subtle but real slights that have a corrosive effect on women in medicine (e.g., sexual humor, attributing women’s ideas to a man, focusing on women’s appearances). It is possible that these topics may be more difficult to discuss during personal interviews, or that women are at a loss for advice on how to handle these subtle problems. Future qualitative studies are needed to deepen our understanding of the types of microinequities that women in medicine face, how women view microinequities, how they cope with them, and how they might advise their colleagues in how to handle such a challenge.
Regarding specific themes that were identified in our study, the one that aligned most closely with other studies of women in medicine was the issue of family [7, 37]. Family challenges arise from the enormous amount of time that physicians must devote to their careers, and the problems that women face in this realm are often defined in regard to child-rearing [38, 39]. A study of differences in time spent on household activities and caring for children based on sex differences showed that female physicians spent more time on both activities than male physicians, even after adjusting for professional hours worked [40]. And a qualitative study of women physicians in Canada reported that the newly graduated women in their study said they would choose to postpone pregnancy because they thought that maternity leave would be disapproved of by their colleagues [12]. Research results like this have led some organizations to design programs to alleviate these family challenges, such as one at the University of California Davis School of Medicine, which includes provisions for on-site child care and a range of other support [41]. In our study, when giving advice about family matters, the women emphasized the important role of having a good partner, not necessarily institutional support. And the importance of a partner was mentioned not only for childcare issues, but also for sharing any work burden. Overall, the women in our study were mostly encouraging about having a family and a fulfilling medical career, and research about how to help physicians with family challenges will continue to be a rich line of inquiry.
Lastly, eliciting advice from experienced woman physicians to assist the decision making of would-be woman physicians could fit well as part of a broader theoretical approach to medical career planning based in the community of practice theory. The community of practice as a theoretical foundation would situate the practice of medicine as comprising a social network of individuals with shared values, knowledge, and experiences rooted in a common endeavor [42, 43]. These shared experiences may be positive or negative, depending on the community’s history and structures, and approaching a career medicine as a community endeavor, rather than solely as an individual endeavor, may be an eye-opening vantage point for those considering becoming healthcare workers. Much of the advice given by our interviewees focused on individual characteristics (e.g., not being afraid to negotiate for salary, being present, need to focus, sense of purpose) and likely reflect how success is predominantly seen as an individual responsibility rather than one in which a broader social context is in play. A thought-provoking perspectives article about the inadequacy of individualism for advancing women in medicine proposes that a theoretical framework away from neoliberal feminism toward one of intersectional feminism would help promote collective action to transform entire systems [44]. Importantly, Sharma and Rawal’s proposal broadens our understanding of “women in medicine” by noting that this term usually focuses on physicians, leaving behind the issues and challenges faced by nurses, respiratory therapists, laboratory staff, and other healthcare providers. Incorporating aspects of intersectional feminism, with its focus on solidarity, into communities of practice, which are by nature diverse and collective, may be a way to promote better institutional efforts aimed at improving the medical environment for all. We propose that institutions invest time and effort in regularly querying incoming women from a wide spectrum of healthcare professions on career satisfaction and performing exit interviews with women leaving the field to more deeply define the gap between career expectations and realities across multiple roles. And a key element of these studies should be explorations of advice, which can explicitly reveal elements of the medical environment that may be in need of attention.
Strengths and limitations
Because of the qualitative nature and small sample size, this study can derive insight but not generalizable findings. Participants were from a limited number of institutions in one US state. Interviews were performed by one researcher, and participants were not chosen with a randomization strategy. The code book was constructed by one researcher and so may have missed themes that other researchers may have identified. The results from the “advice” interview question discussed in the manuscript represents only some of the results due to space constraints, and so results have been chosen based on the researchers’ opinions regarding importance, which may be biased. One strength of our study was that because the women physicians had self-selected for research participation, many had a relationship with the lead researcher, which created an environment of trust and fostered honest and candid discussion.
Conclusion
Because medicine is such an intrinsically difficult field where women face unique hurdles, knowing what established women physicians perceive as the challenges and benefits of their careers and how they would advise aspiring women physicians is valuable. The women in our study revealed that the meaning and purpose they derived from their medical practice was important to them, and that they would encourage other women to pursue a medical career, even while multiple challenges are inevitable. In particular, the women emphasized the importance of paying attention to work-life balance, attending to financial matters, and knowing that mistakes are unavoidable in a medical career. Lastly, the women felt that aspiring women physicians should know that integrity is a key feature of being a physician, and attention to one’s emotional health is essential.
Exploring personal reflections and narratives from veteran women physicians may inform the career paths of future women in health care. While specific challenges for women have been identified, and constructs for making medical culture more conducive for women’s success have been attempted [36, 45], identifying themes may guide the creation of improved policies to enhance the lives of women in health care. This information may help individuals who are contemplating a career in medicine make decisions that are appropriate to their goals and values. The opinions and perspectives of women physicians suggest personal attributes that may better align with a career in medicine: a strong ethical foundation, flexibility, resilience, self-compassion, and a willingness to accept personal limitations as a growth opportunity. Greater alignment between professional demands and individual strengths may improve the quality of experiences of women physicians. The advice given by women physicians who have spent much of their lives providing health care provides valuable insight and offers guideposts for women exploring careers as physicians.
Footnotes
Acknowledgments
The authors thank the women physician interviewees for taking the time to contribute to this study and also thank Dr. Kimberly Baker-Genaw in the Department of Graduate Medical Education at Henry Ford Hospital for encouragement and feedback.
Ethical approval
The study was approved by the Henry Ford Hospital Institutional Review Board (IRB #12993).
Informed consent
All interviewees participated in the informed consent process and provided written informed consent to participate in the study.
Conflict of interest
None to report.
Funding
None to report.
Author contributions
MSK conceived the project, performed interviews, analyzed and interpreted the data, and edited the manuscript. KDP analyzed and interpreted the data and wrote and edited the manuscript. AM analyzed and interpreted the data and wrote and edited the manuscript. MMH analyzed and interpreted the data and wrote and edited the manuscript.