Written by Jason Lesnick
Spoon Feed
On average, female EM physicians leave clinical practice 12 years younger than their male counterparts, after fewer years of practice, and the amount of time spent in the workforce is decreasing over time. We need to identify and implement systemic fixes to stop this.
We need to support our colleagues
Diversity matters and improves patient outcomes. This study showed a higher mortality for female patients with heart attacks when cared for by a male physician and when male physicians had more exposure to female physicians, these differences were smaller. There’s evidence patients cared for by female internists have lower mortality and 30-day readmissions compared to male internists.
The study we’re reviewing today utilized CMS and ABEM data to analyze rates of attrition in EM physicians from 2013-2020 by gender (the data set uses gender and sex interchangeably), age, and median number of years since residency graduation. In 2013 there were 24,832 (6,753 female, 18,079 male) practicing EM physicians and by 2019 there were 30,442 (9,135 female, 21,307 male) practicing EM physicians.
Of those, 8,368 EM physicians (2,463 female, 5,905 male) met the definition of leaving the workforce (defined here as an absence for at least 3 consecutive years). The female physicians left the workforce at a median age of 44.0 years (IQR 38.0-53.9) while the male physicians left at a median age of 56.4 years (IQR 44.5-65.4).
The authors found that being categorized as female was associated with attrition from the workforce (aOR = 2.30, 95%CI: 1.82 to 2.91). Of those who left, the median amount of time post-residency that female physicians spent in the workforce prior to leaving was 10.5 years (5.5-18.5) compared to 17.5 years (9.5-22.5) for males. 1 in 10 females left within five years of residency graduation compared to 1 in 13 for males.
They also identified that the median age for both female and male EM physicians exhibiting attrition decreased considerably from 59.2 and 45.6 years in 2013 to 53.5 and 43.7 years in 2019, significantly below prior estimates that generally physician retirement occurs between the ages of 60-69. Keep in mind this data is pre-COVID, and we know that early on in COVID the rates of attrition went from about 5% to 8.2%.
The authors offer some reasons why female EM physicians are leaving: promotion discrepancies, salary deficits, burnout, traditional societal ‘norms’, sexual harassment, mistreatment, and gender bias in the workplace.
How will this change my practice?
Thankfully, some organizations are working to combat this problem and have developed resources that are, in my opinion, a good place to start so we can learn how to help support our female emergency physician colleagues.
Bottom line – this is bad for our colleagues, our patients, and our future. We all need to do what we can to fight this systemic issue.
Source
Emergency medicine physician workforce attrition differences by age and gender. Acad Emerg Med. 2023 Jun 14. doi: 10.1111/acem.14764. Online ahead of print.
I mean, we all already know this. Here’s what I think: that is so awesome for them. If my wife had an awesome job that paid all the bills, I would leave full time EM in a heartbeat. It would be extremely rare for women to leave the EM job early if their family was dependent on their salary, but for all the women leaving early, or at least leaving full time early, the fact of the matter is that they don’t need the money. Their spouse is most likely a physician and brings home the bacon well enough that they don’t need the dual income.
This SINGLE fact trumps all the “reasons” the authors gave. Most physicians don’t want a promotion (additional responsibility where I have to work more outside of my shifts not thanks). Most of us younger ER docs deal with salary discrepancies (we make less than the men who are in their 60s who are group partners). Burnout…that is felt among every dingle ER doctor. Traditional society “norms”: ya that is a thing…but at the same time you know how often I hear about female doctors and nurses just clamoring for marrying a man rich enough so that they don’t have to work anymore: all the time.
So in short, the primary reason women leave is because of gender bias, because if she can leave the workforce because their spouse makes enough money, then they do. They are smart for doing so because you know what job is worse than staying at home: being an ER doc. Hands. Down.
Sweden has one of the highest proportions of working women in the world and a commitment to gender parity that’s close to a national religion. In addition to child care, the country offers paid parental leave that includes two months specifically reserved for fathers. Yet moms still take four times as much leave as dads do. Far more women than men work part-time; almost half of all mothers are on the job 30 hours a week or less. The gender wage gap among full-time workers in Sweden is 15 percent.
In the Netherlands, over 70 percent of women work part-time and say that they want it that way. According to the Netherlands Institute for Social Research, surveys found that only 4 percent of female part-timers wish that they had full-time jobs. In the United Kingdom, half of female GPs work part-time, and the National Health Service is scrambling to cope with a dearth of doctor hours. Interestingly enough, countries with higher GDPs tend to have the highest percentage of women in part-time work. In fact, the OECD reports that in many of its richest countries, including Denmark, Sweden, Iceland, Germany, the U.K., and the U.S., the percentage of the female workforce in part-time positions has gone up over the last decade.
Isn’t it just the least bit possible that women, on average, just don’t want to work as much or for as long as men?