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Male and female physicians: Family and career comparisons
0277-9536 90 53.00 + 0.00 Copyright % 1990 Pergamon Press plc
Sot. SC;. Med. Vol. 30, No. 3, PP. 373-378. 1990 Printed in Great Britain. All rights reserved
RESEARCH NOTE
MALE AND FEMALE FAMILY AND CAREER PETER UHLENBERG*
Carolina
Population
Center,
University
PHYSICIANS: COMPARISONS
and TERF.SA M. CooNEYt
of North
Carolina
at Chapel
Hill, NC 27599,
U.S.A.
article compares career and family characteristics for male and female physicians aged 30-49 in the United States. Despite women’s increased presence in the profession, male physicians still outearn and work more hours than their female counterparts. Males are also more often involved in families than are females. Compared with the U.S. population, male physicians are more likely to marry and parent, while the opposite is true for female physicians. The work-family interface also provides dramatic gender differences. Marriage and parenting, which might be expected to impinge on physicians’ careers, actually seem to spur men’s work commitment and earnings, but have the reverse effect for women. A review of research findings from other industrialized countries reveals similar gender differences in physicians’ work and family patterns. The consequences of women’s increased presence in the medical profession are discussed in light of these marked gender contrasts in work and family life. Abstract-This
Key words-family
life, medical careers, gender differences
INTRODUCI’ION
Several important changes are altering the medical profession in industrialized countries, not the least of which is a marked change in sex composition. In the United States, the proportion of medical degrees being conferred to females increased from 6% in 1960 to over 30% by 1985 (11, while in Australia the change was from 14% in 1960 to 38% by 1980 [2]. In Britain, the proportion female among entering medical students grew from 25% in 1968 to 38% in 1978 [3]. As women comprise an increasing proportion of the medical profession, it becomes increasingly interesting to inquire into how they differ from their male counterparts. In this research note we first examine gender differences in career and family experiences of U.S. physicians aged 3049 in 1980. Then we compare the situation existing in the United States with that in Australia, Britain and Sweden. PREVIOUS RESEARCH IN THE UNITED STATES
With the dramatic influx of women into the labor force and professions in the last few decades, the interface of work and family life has become a popular research issue. Increasingly, researchers have documented bidirectional relationships among family experiences and work schedules and work histories [4]. Still, only a few empirical studies have focused on this issue regarding physicians. One recent study *Address correspondence to: Peter Uhlenberg, Department of Sociology, 219 Hamilton Hall 07OA/CB No. 3210, University of North Carolina, Chapel Hill, NC 27599,
U.S.A. tsupport for the second author is provided by a postdoctoral research fellowship from the National Institute for Child Health and Human Development, grant No. 5T32HD07168, awarded to the Carolina Population Center. SSM 30.&H
examines the effects of having children on hours worked for female physicians, but has no comparable information for males. Another study compares work patterns and income for male and female physicians, but includes no analysis of family experiences. The several studies that do look more broadly at workfamily connections for physicians involve small select samples of physicians with limited generalizability to the profession as a whole [5-71. One exception, however, is a 1965 survey of physicians, conducted by the American Medical Association, the Association of American Medical Colleges, and the American Women’s Medical Association [8]. Data from this survey reveal major differences among male and female physicians’ work hours, employment histories, and marital and family experiences. Yet, this study has several limitations. First, although differences in work schedules and career patterns for married, single, and childless women are considered, male physicians are viewed as a total group. Thus, it is not clear how marital and family experiences are related to men’s medical careers. Second, although physicians receiving degrees over a 25year period (1931-1956) were surveyed, age differences were not considered in examining work and family experiences. Since younger physicians are likely to be launching their careers and building families, age may be an important factor in the relationship between physicians’ work and family experiences. Finally, the study is fairly dated; social changes occurring since the mid 1960s-for example, the women’s movement-suggest that the workfamily relationship may have changed for both women and men since the 1965 survey. In combination, these problems point to a need for more research on this important and timely issue. The present study overcomes many of these limitations by using more recent data for a nationally representative sample of men and women physicians aged 30-49. In addition,
373
374
PETERUHLENBERG and
it compares the U.S. situation other industrialized countries.
TERESA
M. COO~TY
with that in several
150
140 METHODS
The data analyzed in the next section of this paper were drawn from the 5% Public-Use Microdata Sample of the 1980 United States Census of the Population. Person records were selected for analyses based on three criteria: age, education, and occupation. All individuals between the ages of 30 and 49, who had completed at least 3 years of graduate education and reported their occupation asphysician, were selected for the study. Person records of spouses were also retrieved and appended to the physicians’ records so that spouse characteristics could be examined. This procedure produced information on spouses for all currently married physicians residing with their spouses in their own households.* These selection criteria resulted in a final nationally representative sample of 1159 female and 8820 male U.S. physicians.
130 120 110 loo 90
Earnings
80
in thousands
70 60 50 40 30 20
FINDINGS
Career characteristics
Compared with their male counterparts, female physicians earn less money and work fewer hours per week. While this finding may surprise no one, the magnitude of the gender gap is striking. The earnings quartiles of male and female physicians in several different age categories are graphed in Fig. I.7 Among those aged 35-39, the 1980 median earnings of males is exactly twice that of females ($60,000 vs S30,OOO).In the older age groups the discrepancy is slightly less, with median income of females being 60% as large as that of males for those aged 45-19. The first quartile earnings of females is about 45% that of males, except in the youngest age group (where earnings may be skewed by many who are still in residency programs). Gender differences in number of hours worked per week are shown in Fig. 2. At every age, females are about five times more likely than males to be working part time (less than 35 hr per week). At the other end of the distribution, the proportion of males working more than 55 hr per week is consistently more than twice that of females (after age 35). On average, male physicians are working about 35% more hours per week than females (55.4 vs 41.1 hr). Thus, it appears that large differences in length of work week may explain part but not all of the gender differences in
0’
1
I
’
30-34
35-39 40-44 4549 Age Group Fig. 1. Earnings quartiles of male and female physicians, by age, 1980.
earnings. Differences in areas of specialization, type of practice, and lingering sex discrimination would need to be examined to account more fully for the earnings differential. Census data, however, do not allow us to examine such factors.
0 m
<35 HRdWK 45-54 HRdWK
35-44 HRS/wu 55+ HRrAW
I
IOO90 -
80 70 60 50 40 -
*Married physicians residing with their spouses in someone else’s household were eliminated from the sample because of the expense involved in matching the records of husbands and wives who comprise subfamihes in household records of the census. It appears that only approx. 0.5% of physicians were omitted because of this problem. tTota1 individual earnings were calculated by adding income from wages and salary and self-employment income. For both types of income the highest amount reported by The Census Bureau is $75,000 and above. So, the maximum earnings possible in these data is $150,000. Therefore, there may be a ceiling effect in the earnings data reported here, but it is the same for males and females.
30 20 10 o-
,
II
MF 30-34
I
,
,I
MF 35-39
,
,
I,
MF 40-44
,
45-49
Gender and Age Fig. 2. Percent distribution of hours worked per week by male and female physicians, by age, 1980.
Research Note
Using these cross-sectional data from the 1980 U.S. Census, it is impossible to determine whether gender differences in earnings and hours worked have declined over time. However, a look at the experience of younger women is sufficient to indicate that a very substantial gap still exists. Further, the gender differences in earnings are greater among younger physicians than among older ones (the gap in median income is $30,000 at ages 35-39, compared with $26,000 at ages 4549), while gender differences in proportion working part time are fairly constant across age categories. In addition to these persistent differences in career characteristics, male and female physicians also continue to differ in their family experiences. The next section discusses several of these differences. Marriage,
LIVING’
375 Alone with Spouse & Children
70 -
VjO B B 50a”
4030 20 10 O-
30-34
35-39 Gender and Age
aged 40-49 who are mothers have born only one child, while 22.6% have born four or more. Among all mothers aged 40-49, 10.6% have stopped with one child, while 38.2% have had four or more. Comparable figures for the wives of male physicians who are mothers are 9.0 and 28.0%, respectively. Among younger women, the low fertility of female physicians is even more pronounced. As a consequence of their distinctive marriage and child-bearing patterns, female physicians experience living arrangements that differ markedly from those of their male counterparts. A comparison of the proportion living in various types of households by age and gender is shown in Fig. 3. At every age, a much higher proportion of women physicians are living alone or with a spouse only. In contrast, more male physicians are living in families with children
1980
Male
Female
Physicians U.S. population
14.4 14.9
23.8 10.7
Physicians U.S. population
79.6 76.4
6.0
35-39 Male
40-49
Female
Male
Female
5.7 8.7
16.9 6.8
2.8 6.4
13.8 5.2
68.4 78.0
87. I 82.7
75.2 81.3
89.6 85.8
73.6 83.8
7.8 11.3
7.2 8.6
7.8 II.8
7.6 7.8
12.6 11.1
Never married (%)
Divorced
Physicians U.S. population Median crgeot mcrrriaget Physians U.S. population
8.7 24 22
25 20
40-49
Fig. 3. Percent distribution by composition of household, for male and female physicians, by age, 1980.
30-34
Currently married
with Spouse only Other
80 -
1.Marital characteristics of physicians and the U.S. population, by xx and age,
Marital status*
m 0
90-
children, and living arrangements
Consider first marital status and timing of marriage. Gender differences in marriage patterns among physicians are not only larger than those for the total population, but they are also in the opposite direction. Females in the United States tend to marry earlier than males and, at each age, a higher proportion have ever married. Among physicians, however, the reverse is true (Table 1). Substantially more female than male physicians are never married at each age, and the median age at marriage for those who do marry is higher for females than males. The experience of those aged 40-49 is a good indicator of the ultimate proportion who ever marry, since few who arrive at age 40 unmarried will subsequently marry. In this age category, nearly five times as many females as male physicians are never married. Also, more females than males are currently divorced, reflecting the lower rate of remarriage for females. At every age, a much smaller proportion of females than males have the status ‘currently married’. In addition to relatively low marriage rates, female physicians are characterized by below average rates of child-bearing. The proportion of ever-married female physicians over age 40 who are childless (13.7%) is about twice that of either all women in the same age bracket (7.2%) or wives of male physicians in this age category (7.2%). Further, female physicians who have children tend to have fewer than other women. For example, 13.3% of female physicians Table
=
. I loo-
25 22
26 20
‘Widowed are excluded since there are so few in these ages. tMedian age at first marriage for those who have ever-married.
25 23
27 20
376
PETER UHLESBERG and
present. At age 30-34, 60.9% of males, compared with 48.8% of females, are living in a traditional family (i.e. a family with two parents and at least one child), while at age a9 the gender contrast is even greater (78.9 vs 58.8%). Clearly, male physicians are more likely than female physicians to combine families and careers. Indeed, compared with the larger population, male physicians appear to be exceptionally familistic (a larger proportion marry, a lower proportion have childless marriages, and a lower proportion divorce and remain divorced). The family orientation of female physicians, relative to other women, is just the opposite. Work-family connections
It is now widely recognized that work and family are not entirely separate domains of life. What goes on at home affects what goes on at work, and vice versa. But how are work and family connected for American physicians? And how does this relationship for females differ from that of males? Several interesting relationships between household arrangements and career characteristics are shown in Table 2. For males, the lowest earnings and the fewest hours worked occur among those living alone, while the highest earnings and the most hours worked occur among those who are living in families with children. Indeed, the differences are quite substantial at all ages, with men living in households with children present averaging incomes that are from 15 to 50% higher than other men of the same age. In general, it appears that involvement with a family may spur men on to greater work commitment. Among females, the relationship between family and work is the opposite to what it is for males. The highest earnings and longest hours worked occur among women who live alone or with a spouse only. Women most involved with families, on the other hand, have the lowest earnings and are most likely to be working part time. The negative relationship between children and career involvement is stronger among women under age 40, probably reflecting the difficulty that many female physicians encounter in combining work with care of young children, In sum, Table 2 illustrates that compared with their male counterparts, females who live alone have somewhat less lucrative careers. But, among those living in
TERESA
M. COOP.~Y
families with children, the gap between male and female physicians is vast. Some insight into why the relationship between family and career for females is the reverse of what it is for males is gained by examining characteristics of spouses for those who are married. With few exceptions, dominance of the male physician’s career is unchallenged by his spouse. Less than 5% of the men are married to women who earn as much as they do, and only about 7% have wives who work as many hours per week as they do. Of male physicians, 64.3% have wives who are not in the labor force, despite most being college educated. In contrast, almost no married female physicians have husbands who are not also pursuing professional careers. Female physicians are among the most elite women in American society in terms of education, occupational status, and income. Nevertheless, within their profession and their marriages, they tend to experience relative inferiority. That is, they earn less money and work fewer hours than male physicians and tend to have husbands who are older and equally educated, and, in approx. 70% of the cases, their husbands earn more money and work more hours. While about 60% of male physicians exceed their wives in age, earnings, hours worked, and education, only 2% of female physicians exceed their husbands on all of these variables. Hence, despite substantial changes in recent years in women’s access to medical careers, the role of gender continues to loom large within the medical profession in the United States. One final example of the relevance of gender comes from examining situations in which both husband and wife are physicians. Slightly more than half (51%) of all married female physicians aged 30-49 are married to physicians, while 6% of male physicians in this age group have wives who are also physicians. For these men and women, family characteristics are obviously identical. Yet, in 73% of these situations the husband earns more than the wife, while in only 16% the wife earns more. Similarly, husbands are working more hours in 63% of the cases, and wives are working more in only 15%. Clearly, the tradition of the husband’s career taking priority over the wife’s is maintained in a large majority of two-physician marriages today.
Table 2. Earnings and hours worked per week by male and female physicians, by household composition and age, 1980 Median earnings (a) Age and household composition
% Working < 35 hr
% Working > 55 hr
Male
Female
Male
Female
18,ooo
7.0
17,100 18,000
6.5 3.5
9.4 9.3 33.2
51.3 49.7 56.9
44.2 37. I 20.7
36,000 39,500 30,OQO
6.3 4.8 3.6
17.2 10.8 31.2
44.1 52.4 57.0
40.6 43.2 19.0
12.9 4.9 4.5
22. I 18.0 21.2
38.2 43.4 54.0
29.4 24.0 17.4
Male
Female
3&34 Living alone Living with spouse only Living with spouse and children
25,cQO 26,500 37,000
35-39 Living alone Living with spouse only Living with spouse and children
48,000 45,200 60,ooo
40-49 Living alone Living with spouse only Livinn with soouse and children
54,OOil 6o.ooo 69.000
Research CROSS-COUNTRY COMPARISONS
Are the family and career contrasts between male and female physicians found in the United States unique to North America, or are they common across industrialized countries? Studies asking many of the same questions as those asked in this research were conducted in three countries in the late 1970s: Australia, Britain, and Sweden [2, 3,9]. Comparing findings from those studies, one finds remarkable similarities in gender differences among physicians across these three countries. Further, the pattern in each of these countries is nearly identical to that found in the United States. Career characteristics
In each country, female physicians were working fewer hours than their male counterparts. The differences range from females working 85% as many hours as males in Sweden to only 65% as many hours in Australia. Further, in each country a much greater proportion of females than males are classified as working part time. Comparative data on earnings are not available, but almost certainly large gender gaps in income do exist as a result of women working fewer hours and being concentrated in less specialized areas of medicine. Marriage and child-bearing
The U.S. pattern of female physicians being less involved in families is also found in Sweden and Australia. In Sweden, female physicians were more than twice as likely as males to be never married (18% vs 7%), while in Australia the contrast is even larger (22% vs 7%). One-fourth of the male physicians in Sweden had three or more children, while 15% of the female physicians had this many. In addition, twice as many females as males were childless. Among physicians in Australia who have children, the average number for females is 1.9 compared with 2.7 for males. It is clear that combining families and careers is more challenging for female than male physicians across all industrialized countries where this topic has been studied. Work-family connections
The opposite effects of family on work for females compared with males is strikingly consistent across countries. In each case, the hours worked by unmarried men and women are very similar. But marriage and having children have opposite effects for males than females. In Sweden, unmarried men work an average of 39 hr per week while unmarried women work an average of 38. Among those with three or more children, however, males are working 30% more hours than females (47 vs 36). In Australia, Fett writes: Among male doctors, increasing numbers of preschool children are associated with successive increases in hours of medical work. Parenthood of preschool children is thus associated with longer working hours by medical fathers, and with shorter working hours by medical mothers [2, p. 361. Similar results are found in Britain, where physicians
Note
317
were asked about the impact of children on their careers. Forty-seven per cent of men but only 3.6 per cent of women felt children had made no difference. For 56 per cent of women and 6 per cent of men children had interrupted careers [3, p. 1201. The differential impact of marriage and children on careers of males and females is directly related to gender differences in domestic responsibilities. In
Australia, 6% of male physicians with young children participated in child care compared with 87% of female physicians. As Fett reports: The sex-linking of household work is clear. Women doctors do not, because they are doctors, load, but. because they are women, the women married to their male mostly full-time housewives [2, p. After examining concludes:
relinquish this domestic carry almost as much as colleagues and who are 331.
the same issue in Sweden,
Frey
The main reason for the lower output of the women is obviously family responsibilities [9, p. 1491.
The same situation is found in Britain, where the great majority of male and female physicians experience “a family traditional pattern with women having responsibility for the majority of household tasks” (3, p. 1211. Less than 2% of married male physicians indicated that they do the shopping or the cooking in their households, but over 80% of the married female physicians report that they do these tasks without any assistance from spouse or hired help. One further similarity across these countries is worth noting: an exceptionally large proportion of married female physicians have spouses who are also physicians. The proportion of female physicians married to a physician is 54% in Australia, 52% in Britain, and 40% in Sweden. As in the United States, it seems likely that the husband’s career most often takes precedence over the wife’s in these two-career couples. Whether one focuses on aggregate statistics or individual situations, consistent differences between male and female physicians are found across industrialized countries. CONCLUSION
Large differences in work and family experiences of male and female physicians exist in Australia, Britain, Sweden, the United States, and probably other industrialized countries. A disproportionately large number of female physicians forego marriage and child-bearing altogether. The work experiences of these females are not very different from those of unmarried males. But a majority of women are combining motherhood and career. Compared with their male counterparts, these women have greater domestic responsibilities and lower levels of career involvement. For female physicians, marriage and child-rearing clearly are associated with reduced hours worked and lowered earnings, while for men the effects of marriage and children are just the oppposite. A majority of female physicians have spouses whose careers take priority over their own, in contrast with male physicians who have spouses who support their careers.
378
PETER UHLENBERG
and
It is not clear what consequences the increasing number of female physicians might have on the future of the medical profession. One possibility is that current gender differences might persist, with women working fewer hours than men in order to combine motherhood and career. If this route is followed, then a greater number of physicians will be required to maintain a given level of medical care. Another possibility is that greater gender equality will be achieved. But this could occur as a result of two very different processes. Women’s careers could become more similar to men’s as they reduce the time they spend in child-bearing and domestic work. Or, male physicians could reduce their career involvements to become more involved with activities occurring within their households. The medical professions has removed many barriers to gender equality among physicians, and most would agree that it should continue to press for complete equality of opportunity. Whether efforts beyond these should be made to eliminate gender differences, however, is likely to be a hotly debated issue in coming years.
TERESA >I. COONEY REFERENCES
I. United States Bureau of the Census. Statistical Abstract of rhe cnited Stares. Washington, D.C., 1988.
2. Fett I. The future of women in Australian medicine. Med. J. AUSI. Suppl. 2, 33-39, 1976.
3. Elston M. A. Medicine: half our future doctors? In The Careers of Professional Women, (Edited by Silverstone R. and Ward A.), pp. 99-139. Croom-Helm, London, 1980. 4. Kanter R. M. Work and Family in the United States: A Critical Retiew and Agenda for Research and Policy.
Sage. New York, 1977. 5. Lopate C. Marriage and medicine. In The Professional Woman (Edited by Theodore A.), pp. 494-515. Schenkman. Cambridge, Mass., 1971. Mandelbaum D. R. Women in medicine. Signs: J. Women Cult. Sot. 4, 136-145, 1978. Rosow I. and Rose K. D. Divorce among doctors. J. .Liarriage Furn. 34, 587-597,
1972.
Powers L., Parmelle R. D. and Wiesenfelder H. Practice patterns of women and men physicians. J. med. Educ. 44, 481491,
1969.
9. Frey H. Swedish men and women doctors compared. Med. Educ. 14, 143-153,
1980.
Sot. SC;. Med. Vol. 30, No. 3, PP. 373-378. 1990 Printed in Great Britain. All rights reserved
RESEARCH NOTE
MALE AND FEMALE FAMILY AND CAREER PETER UHLENBERG*
Carolina
Population
Center,
University
PHYSICIANS: COMPARISONS
and TERF.SA M. CooNEYt
of North
Carolina
at Chapel
Hill, NC 27599,
U.S.A.
article compares career and family characteristics for male and female physicians aged 30-49 in the United States. Despite women’s increased presence in the profession, male physicians still outearn and work more hours than their female counterparts. Males are also more often involved in families than are females. Compared with the U.S. population, male physicians are more likely to marry and parent, while the opposite is true for female physicians. The work-family interface also provides dramatic gender differences. Marriage and parenting, which might be expected to impinge on physicians’ careers, actually seem to spur men’s work commitment and earnings, but have the reverse effect for women. A review of research findings from other industrialized countries reveals similar gender differences in physicians’ work and family patterns. The consequences of women’s increased presence in the medical profession are discussed in light of these marked gender contrasts in work and family life. Abstract-This
Key words-family
life, medical careers, gender differences
INTRODUCI’ION
Several important changes are altering the medical profession in industrialized countries, not the least of which is a marked change in sex composition. In the United States, the proportion of medical degrees being conferred to females increased from 6% in 1960 to over 30% by 1985 (11, while in Australia the change was from 14% in 1960 to 38% by 1980 [2]. In Britain, the proportion female among entering medical students grew from 25% in 1968 to 38% in 1978 [3]. As women comprise an increasing proportion of the medical profession, it becomes increasingly interesting to inquire into how they differ from their male counterparts. In this research note we first examine gender differences in career and family experiences of U.S. physicians aged 3049 in 1980. Then we compare the situation existing in the United States with that in Australia, Britain and Sweden. PREVIOUS RESEARCH IN THE UNITED STATES
With the dramatic influx of women into the labor force and professions in the last few decades, the interface of work and family life has become a popular research issue. Increasingly, researchers have documented bidirectional relationships among family experiences and work schedules and work histories [4]. Still, only a few empirical studies have focused on this issue regarding physicians. One recent study *Address correspondence to: Peter Uhlenberg, Department of Sociology, 219 Hamilton Hall 07OA/CB No. 3210, University of North Carolina, Chapel Hill, NC 27599,
U.S.A. tsupport for the second author is provided by a postdoctoral research fellowship from the National Institute for Child Health and Human Development, grant No. 5T32HD07168, awarded to the Carolina Population Center. SSM 30.&H
examines the effects of having children on hours worked for female physicians, but has no comparable information for males. Another study compares work patterns and income for male and female physicians, but includes no analysis of family experiences. The several studies that do look more broadly at workfamily connections for physicians involve small select samples of physicians with limited generalizability to the profession as a whole [5-71. One exception, however, is a 1965 survey of physicians, conducted by the American Medical Association, the Association of American Medical Colleges, and the American Women’s Medical Association [8]. Data from this survey reveal major differences among male and female physicians’ work hours, employment histories, and marital and family experiences. Yet, this study has several limitations. First, although differences in work schedules and career patterns for married, single, and childless women are considered, male physicians are viewed as a total group. Thus, it is not clear how marital and family experiences are related to men’s medical careers. Second, although physicians receiving degrees over a 25year period (1931-1956) were surveyed, age differences were not considered in examining work and family experiences. Since younger physicians are likely to be launching their careers and building families, age may be an important factor in the relationship between physicians’ work and family experiences. Finally, the study is fairly dated; social changes occurring since the mid 1960s-for example, the women’s movement-suggest that the workfamily relationship may have changed for both women and men since the 1965 survey. In combination, these problems point to a need for more research on this important and timely issue. The present study overcomes many of these limitations by using more recent data for a nationally representative sample of men and women physicians aged 30-49. In addition,
373
374
PETERUHLENBERG and
it compares the U.S. situation other industrialized countries.
TERESA
M. COO~TY
with that in several
150
140 METHODS
The data analyzed in the next section of this paper were drawn from the 5% Public-Use Microdata Sample of the 1980 United States Census of the Population. Person records were selected for analyses based on three criteria: age, education, and occupation. All individuals between the ages of 30 and 49, who had completed at least 3 years of graduate education and reported their occupation asphysician, were selected for the study. Person records of spouses were also retrieved and appended to the physicians’ records so that spouse characteristics could be examined. This procedure produced information on spouses for all currently married physicians residing with their spouses in their own households.* These selection criteria resulted in a final nationally representative sample of 1159 female and 8820 male U.S. physicians.
130 120 110 loo 90
Earnings
80
in thousands
70 60 50 40 30 20
FINDINGS
Career characteristics
Compared with their male counterparts, female physicians earn less money and work fewer hours per week. While this finding may surprise no one, the magnitude of the gender gap is striking. The earnings quartiles of male and female physicians in several different age categories are graphed in Fig. I.7 Among those aged 35-39, the 1980 median earnings of males is exactly twice that of females ($60,000 vs S30,OOO).In the older age groups the discrepancy is slightly less, with median income of females being 60% as large as that of males for those aged 45-19. The first quartile earnings of females is about 45% that of males, except in the youngest age group (where earnings may be skewed by many who are still in residency programs). Gender differences in number of hours worked per week are shown in Fig. 2. At every age, females are about five times more likely than males to be working part time (less than 35 hr per week). At the other end of the distribution, the proportion of males working more than 55 hr per week is consistently more than twice that of females (after age 35). On average, male physicians are working about 35% more hours per week than females (55.4 vs 41.1 hr). Thus, it appears that large differences in length of work week may explain part but not all of the gender differences in
0’
1
I
’
30-34
35-39 40-44 4549 Age Group Fig. 1. Earnings quartiles of male and female physicians, by age, 1980.
earnings. Differences in areas of specialization, type of practice, and lingering sex discrimination would need to be examined to account more fully for the earnings differential. Census data, however, do not allow us to examine such factors.
0 m
<35 HRdWK 45-54 HRdWK
35-44 HRS/wu 55+ HRrAW
I
IOO90 -
80 70 60 50 40 -
*Married physicians residing with their spouses in someone else’s household were eliminated from the sample because of the expense involved in matching the records of husbands and wives who comprise subfamihes in household records of the census. It appears that only approx. 0.5% of physicians were omitted because of this problem. tTota1 individual earnings were calculated by adding income from wages and salary and self-employment income. For both types of income the highest amount reported by The Census Bureau is $75,000 and above. So, the maximum earnings possible in these data is $150,000. Therefore, there may be a ceiling effect in the earnings data reported here, but it is the same for males and females.
30 20 10 o-
,
II
MF 30-34
I
,
,I
MF 35-39
,
,
I,
MF 40-44
,
45-49
Gender and Age Fig. 2. Percent distribution of hours worked per week by male and female physicians, by age, 1980.
Research Note
Using these cross-sectional data from the 1980 U.S. Census, it is impossible to determine whether gender differences in earnings and hours worked have declined over time. However, a look at the experience of younger women is sufficient to indicate that a very substantial gap still exists. Further, the gender differences in earnings are greater among younger physicians than among older ones (the gap in median income is $30,000 at ages 35-39, compared with $26,000 at ages 4549), while gender differences in proportion working part time are fairly constant across age categories. In addition to these persistent differences in career characteristics, male and female physicians also continue to differ in their family experiences. The next section discusses several of these differences. Marriage,
LIVING’
375 Alone with Spouse & Children
70 -
VjO B B 50a”
4030 20 10 O-
30-34
35-39 Gender and Age
aged 40-49 who are mothers have born only one child, while 22.6% have born four or more. Among all mothers aged 40-49, 10.6% have stopped with one child, while 38.2% have had four or more. Comparable figures for the wives of male physicians who are mothers are 9.0 and 28.0%, respectively. Among younger women, the low fertility of female physicians is even more pronounced. As a consequence of their distinctive marriage and child-bearing patterns, female physicians experience living arrangements that differ markedly from those of their male counterparts. A comparison of the proportion living in various types of households by age and gender is shown in Fig. 3. At every age, a much higher proportion of women physicians are living alone or with a spouse only. In contrast, more male physicians are living in families with children
1980
Male
Female
Physicians U.S. population
14.4 14.9
23.8 10.7
Physicians U.S. population
79.6 76.4
6.0
35-39 Male
40-49
Female
Male
Female
5.7 8.7
16.9 6.8
2.8 6.4
13.8 5.2
68.4 78.0
87. I 82.7
75.2 81.3
89.6 85.8
73.6 83.8
7.8 11.3
7.2 8.6
7.8 II.8
7.6 7.8
12.6 11.1
Never married (%)
Divorced
Physicians U.S. population Median crgeot mcrrriaget Physians U.S. population
8.7 24 22
25 20
40-49
Fig. 3. Percent distribution by composition of household, for male and female physicians, by age, 1980.
30-34
Currently married
with Spouse only Other
80 -
1.Marital characteristics of physicians and the U.S. population, by xx and age,
Marital status*
m 0
90-
children, and living arrangements
Consider first marital status and timing of marriage. Gender differences in marriage patterns among physicians are not only larger than those for the total population, but they are also in the opposite direction. Females in the United States tend to marry earlier than males and, at each age, a higher proportion have ever married. Among physicians, however, the reverse is true (Table 1). Substantially more female than male physicians are never married at each age, and the median age at marriage for those who do marry is higher for females than males. The experience of those aged 40-49 is a good indicator of the ultimate proportion who ever marry, since few who arrive at age 40 unmarried will subsequently marry. In this age category, nearly five times as many females as male physicians are never married. Also, more females than males are currently divorced, reflecting the lower rate of remarriage for females. At every age, a much smaller proportion of females than males have the status ‘currently married’. In addition to relatively low marriage rates, female physicians are characterized by below average rates of child-bearing. The proportion of ever-married female physicians over age 40 who are childless (13.7%) is about twice that of either all women in the same age bracket (7.2%) or wives of male physicians in this age category (7.2%). Further, female physicians who have children tend to have fewer than other women. For example, 13.3% of female physicians Table
=
. I loo-
25 22
26 20
‘Widowed are excluded since there are so few in these ages. tMedian age at first marriage for those who have ever-married.
25 23
27 20
376
PETER UHLESBERG and
present. At age 30-34, 60.9% of males, compared with 48.8% of females, are living in a traditional family (i.e. a family with two parents and at least one child), while at age a9 the gender contrast is even greater (78.9 vs 58.8%). Clearly, male physicians are more likely than female physicians to combine families and careers. Indeed, compared with the larger population, male physicians appear to be exceptionally familistic (a larger proportion marry, a lower proportion have childless marriages, and a lower proportion divorce and remain divorced). The family orientation of female physicians, relative to other women, is just the opposite. Work-family connections
It is now widely recognized that work and family are not entirely separate domains of life. What goes on at home affects what goes on at work, and vice versa. But how are work and family connected for American physicians? And how does this relationship for females differ from that of males? Several interesting relationships between household arrangements and career characteristics are shown in Table 2. For males, the lowest earnings and the fewest hours worked occur among those living alone, while the highest earnings and the most hours worked occur among those who are living in families with children. Indeed, the differences are quite substantial at all ages, with men living in households with children present averaging incomes that are from 15 to 50% higher than other men of the same age. In general, it appears that involvement with a family may spur men on to greater work commitment. Among females, the relationship between family and work is the opposite to what it is for males. The highest earnings and longest hours worked occur among women who live alone or with a spouse only. Women most involved with families, on the other hand, have the lowest earnings and are most likely to be working part time. The negative relationship between children and career involvement is stronger among women under age 40, probably reflecting the difficulty that many female physicians encounter in combining work with care of young children, In sum, Table 2 illustrates that compared with their male counterparts, females who live alone have somewhat less lucrative careers. But, among those living in
TERESA
M. COOP.~Y
families with children, the gap between male and female physicians is vast. Some insight into why the relationship between family and career for females is the reverse of what it is for males is gained by examining characteristics of spouses for those who are married. With few exceptions, dominance of the male physician’s career is unchallenged by his spouse. Less than 5% of the men are married to women who earn as much as they do, and only about 7% have wives who work as many hours per week as they do. Of male physicians, 64.3% have wives who are not in the labor force, despite most being college educated. In contrast, almost no married female physicians have husbands who are not also pursuing professional careers. Female physicians are among the most elite women in American society in terms of education, occupational status, and income. Nevertheless, within their profession and their marriages, they tend to experience relative inferiority. That is, they earn less money and work fewer hours than male physicians and tend to have husbands who are older and equally educated, and, in approx. 70% of the cases, their husbands earn more money and work more hours. While about 60% of male physicians exceed their wives in age, earnings, hours worked, and education, only 2% of female physicians exceed their husbands on all of these variables. Hence, despite substantial changes in recent years in women’s access to medical careers, the role of gender continues to loom large within the medical profession in the United States. One final example of the relevance of gender comes from examining situations in which both husband and wife are physicians. Slightly more than half (51%) of all married female physicians aged 30-49 are married to physicians, while 6% of male physicians in this age group have wives who are also physicians. For these men and women, family characteristics are obviously identical. Yet, in 73% of these situations the husband earns more than the wife, while in only 16% the wife earns more. Similarly, husbands are working more hours in 63% of the cases, and wives are working more in only 15%. Clearly, the tradition of the husband’s career taking priority over the wife’s is maintained in a large majority of two-physician marriages today.
Table 2. Earnings and hours worked per week by male and female physicians, by household composition and age, 1980 Median earnings (a) Age and household composition
% Working < 35 hr
% Working > 55 hr
Male
Female
Male
Female
18,ooo
7.0
17,100 18,000
6.5 3.5
9.4 9.3 33.2
51.3 49.7 56.9
44.2 37. I 20.7
36,000 39,500 30,OQO
6.3 4.8 3.6
17.2 10.8 31.2
44.1 52.4 57.0
40.6 43.2 19.0
12.9 4.9 4.5
22. I 18.0 21.2
38.2 43.4 54.0
29.4 24.0 17.4
Male
Female
3&34 Living alone Living with spouse only Living with spouse and children
25,cQO 26,500 37,000
35-39 Living alone Living with spouse only Living with spouse and children
48,000 45,200 60,ooo
40-49 Living alone Living with spouse only Livinn with soouse and children
54,OOil 6o.ooo 69.000
Research CROSS-COUNTRY COMPARISONS
Are the family and career contrasts between male and female physicians found in the United States unique to North America, or are they common across industrialized countries? Studies asking many of the same questions as those asked in this research were conducted in three countries in the late 1970s: Australia, Britain, and Sweden [2, 3,9]. Comparing findings from those studies, one finds remarkable similarities in gender differences among physicians across these three countries. Further, the pattern in each of these countries is nearly identical to that found in the United States. Career characteristics
In each country, female physicians were working fewer hours than their male counterparts. The differences range from females working 85% as many hours as males in Sweden to only 65% as many hours in Australia. Further, in each country a much greater proportion of females than males are classified as working part time. Comparative data on earnings are not available, but almost certainly large gender gaps in income do exist as a result of women working fewer hours and being concentrated in less specialized areas of medicine. Marriage and child-bearing
The U.S. pattern of female physicians being less involved in families is also found in Sweden and Australia. In Sweden, female physicians were more than twice as likely as males to be never married (18% vs 7%), while in Australia the contrast is even larger (22% vs 7%). One-fourth of the male physicians in Sweden had three or more children, while 15% of the female physicians had this many. In addition, twice as many females as males were childless. Among physicians in Australia who have children, the average number for females is 1.9 compared with 2.7 for males. It is clear that combining families and careers is more challenging for female than male physicians across all industrialized countries where this topic has been studied. Work-family connections
The opposite effects of family on work for females compared with males is strikingly consistent across countries. In each case, the hours worked by unmarried men and women are very similar. But marriage and having children have opposite effects for males than females. In Sweden, unmarried men work an average of 39 hr per week while unmarried women work an average of 38. Among those with three or more children, however, males are working 30% more hours than females (47 vs 36). In Australia, Fett writes: Among male doctors, increasing numbers of preschool children are associated with successive increases in hours of medical work. Parenthood of preschool children is thus associated with longer working hours by medical fathers, and with shorter working hours by medical mothers [2, p. 361. Similar results are found in Britain, where physicians
Note
317
were asked about the impact of children on their careers. Forty-seven per cent of men but only 3.6 per cent of women felt children had made no difference. For 56 per cent of women and 6 per cent of men children had interrupted careers [3, p. 1201. The differential impact of marriage and children on careers of males and females is directly related to gender differences in domestic responsibilities. In
Australia, 6% of male physicians with young children participated in child care compared with 87% of female physicians. As Fett reports: The sex-linking of household work is clear. Women doctors do not, because they are doctors, load, but. because they are women, the women married to their male mostly full-time housewives [2, p. After examining concludes:
relinquish this domestic carry almost as much as colleagues and who are 331.
the same issue in Sweden,
Frey
The main reason for the lower output of the women is obviously family responsibilities [9, p. 1491.
The same situation is found in Britain, where the great majority of male and female physicians experience “a family traditional pattern with women having responsibility for the majority of household tasks” (3, p. 1211. Less than 2% of married male physicians indicated that they do the shopping or the cooking in their households, but over 80% of the married female physicians report that they do these tasks without any assistance from spouse or hired help. One further similarity across these countries is worth noting: an exceptionally large proportion of married female physicians have spouses who are also physicians. The proportion of female physicians married to a physician is 54% in Australia, 52% in Britain, and 40% in Sweden. As in the United States, it seems likely that the husband’s career most often takes precedence over the wife’s in these two-career couples. Whether one focuses on aggregate statistics or individual situations, consistent differences between male and female physicians are found across industrialized countries. CONCLUSION
Large differences in work and family experiences of male and female physicians exist in Australia, Britain, Sweden, the United States, and probably other industrialized countries. A disproportionately large number of female physicians forego marriage and child-bearing altogether. The work experiences of these females are not very different from those of unmarried males. But a majority of women are combining motherhood and career. Compared with their male counterparts, these women have greater domestic responsibilities and lower levels of career involvement. For female physicians, marriage and child-rearing clearly are associated with reduced hours worked and lowered earnings, while for men the effects of marriage and children are just the oppposite. A majority of female physicians have spouses whose careers take priority over their own, in contrast with male physicians who have spouses who support their careers.
378
PETER UHLENBERG
and
It is not clear what consequences the increasing number of female physicians might have on the future of the medical profession. One possibility is that current gender differences might persist, with women working fewer hours than men in order to combine motherhood and career. If this route is followed, then a greater number of physicians will be required to maintain a given level of medical care. Another possibility is that greater gender equality will be achieved. But this could occur as a result of two very different processes. Women’s careers could become more similar to men’s as they reduce the time they spend in child-bearing and domestic work. Or, male physicians could reduce their career involvements to become more involved with activities occurring within their households. The medical professions has removed many barriers to gender equality among physicians, and most would agree that it should continue to press for complete equality of opportunity. Whether efforts beyond these should be made to eliminate gender differences, however, is likely to be a hotly debated issue in coming years.
TERESA >I. COONEY REFERENCES
I. United States Bureau of the Census. Statistical Abstract of rhe cnited Stares. Washington, D.C., 1988.
2. Fett I. The future of women in Australian medicine. Med. J. AUSI. Suppl. 2, 33-39, 1976.
3. Elston M. A. Medicine: half our future doctors? In The Careers of Professional Women, (Edited by Silverstone R. and Ward A.), pp. 99-139. Croom-Helm, London, 1980. 4. Kanter R. M. Work and Family in the United States: A Critical Retiew and Agenda for Research and Policy.
Sage. New York, 1977. 5. Lopate C. Marriage and medicine. In The Professional Woman (Edited by Theodore A.), pp. 494-515. Schenkman. Cambridge, Mass., 1971. Mandelbaum D. R. Women in medicine. Signs: J. Women Cult. Sot. 4, 136-145, 1978. Rosow I. and Rose K. D. Divorce among doctors. J. .Liarriage Furn. 34, 587-597,
1972.
Powers L., Parmelle R. D. and Wiesenfelder H. Practice patterns of women and men physicians. J. med. Educ. 44, 481491,
1969.
9. Frey H. Swedish men and women doctors compared. Med. Educ. 14, 143-153,
1980.