Physician Gender, Physician
Marriage and the Supply and
Distribution of Medical
Services
Ann Boulis
Ideas and Research on
Gender and Medical Service
Supply & Distribution
Women physicians work less.
Women physicians are less likely to live
in metropolitan areas.
3. The unique behavior of women physicians
stems from their unique approach to work
and family.
1.
2.
Key Articles
z Cull,
WL, HJ Mulvey, KG O'Connor, DR
Sowell, CD Berkowitz, and CV Britton.
2002. "Pediatricians working part-time:
past, present, and future." Pediatrics
109:1015-1102.
z Colwill, JM and JM Cultice. 2003. "The
future supply of family physicians:
implications for rural America." Health
Affairs 22:190-8.
Study Goals
z
z
– Track trends in work effort and practice location of
ALL physicians by gender.
– Track trends in the work effort and practice location of
MARRIED physicians by gender.
– Use logistic regression to consider how spousal
characteristics influence the behavior of male and
female physicians.
Figure 1: The Percent of
Physicians Reporting
Employment
Data and Variables
z
z
z
z
Sample: 1980, 1990 and 2000 5% Census Samples
in the Integrated Public Use Microdata Series
Variables: Physicians are those who self identify
and indicate that they have professional level
education.
Married physicians are living with their spouse
and legally married.
Resident Proxies Excluded
Evaluate prevailing wisdom about women
physicians and medical service supply and
distribution.
Specifically:
1.20
1.00
.98
1.00
0.96
0.94
0.95
0.95
.98
0.95
0.93
0.80
Men
0.60
Women
0.40
0.20
0.00
1980
1990
2000
1
Figure 2: The Average Work
Week for Employed
Physicians
Figure 3: The Percent of
Employed Physicians Working
<35 Hours Per Week
60
.86
51
.88
52
53
.92
20%
48
50
18%
46
44
2.42
17%
2.00
2.00
16%
16%
16%
40
14%
Men
30
Women
12%
Men
10%
8%
20
Women
8%
8%
7%
6%
4%
10
2%
0%
0
1980
1990
1980
2000
Figure 4: The Percent of
Employed Physicians Working
50+ Hours Per Week
1990
2000
Figure 5: The Percent of
Employed Physicians in NonNonMetropolitan Areas
25%
70%
.60 .60
63%
.63
65%
65%
.74.74
60%
.77.77
.75
.73
20%
20%
19%
50%
16%
50%
44%
15%
15%
38%
40%
Men
Men
12%
12%
Women
Women
30%
10%
20%
5%
10%
0%
0%
1980
1990
2000
1980
Figure 6: The Percent of
Employed Physicians who are
Married
0.90
0.85
0.70
2000
Figure 7: Female/Male
Average Work Week by
Marital Status
1.00
0.85
.76
0.80
1990
.81
0.68
0.98
0.83
.82
0.95
0.94
0.95
0.68
0.65
0.90
0.89
0.60
0.86
0.50
Men
0.85
0.83
Women
0.40
0.80
0.30
0.75
0.20
1980
1990
2000
0.10
Married Female/Male Work Week
0.00
1980
1990
Unmarried Female/Male Work Week
2000
2
The Effect of Spousal Employment on
the Average Weekly Work Week for
Employed Married Physicians
Male Physicians
Unadj
Adj
Models
Models
1980
1990
2000
1.12 ***
2.31 ***
1.59 ***
The Effect of a Having a Spouse with a NonMedical Graduate
Degree on Locating Outside Metro Area
Male Physicians
Unadj
Adj
Models Odds
Models Odds
B Ratio
B Ratio
Female Physicians
Unadj
Adj
Models
Models
-0.92 *
-1.54 ***
-2.25 ***
2.72
1.68
-1.13
-4.58 *
-8.38 ***
-8.04 ***
Note: Adjusted models control for: spousal education,
spousal age, physician age, if spouse is a
physician, hours spouse works for pay and
spousal earned income.
***p<.001, **p<.01 *p<.05
1980
1990
2000
-0.27 0.76 ***
-0.43 0.65 ***
-0.59 0.55 ***
-0.75 0.47 *
-0.99 0.37 ***
-1.08 0.34 ***
-0.74 0.48 ***
-0.94 0.39 ***
-0.92 0.40 ***
Note: Adjusted models control for: spousal education, spousal age, physician age,
if spouse is a physician, hours spouse works for pay and spousal earned income.
***p<.001, **p<.01 *p<.05
R2 approximately .06
Conclusions: All Physicians
z Employment:
-0.36 0.70 ***
-0.47 0.63 ***
-0.63 0.54 ***
Female Physicians
Unadj
Adj
Models Odds
Models Odds
B Ratio
B Ratio
Conclusions: All Physicians
z
Long & Short Work Weeks
– The gender difference in employment is VERY
– Between 1980 and 2000, the frequency of ‘short’ weeks
limited.
– Most physicians work regardless of gender.
– The frequency of ‘long’ weeks increased slightly for
z Average
Work Week:
changed little for men or women.
men and substantially for women.
z
Location:
– The gender difference in average work week is
– Between 1980 and 2000, the gender gap in the odds of
closing slowly for all physicians.
– Women’s work week is coming to more closely
resemble men’s rather than the reverse.
– Both the percent of men and the percent of women in
Conclusions: Married
Physicians
z Spousal Employment:
– Women physicians’ work effort is more sensitive then
rural practice closed somewhat.
rural areas declined between 1980 and 2000.
EXTRA SLIDES
men’s to spousal employment.
– Men physicians’ work effort is growing more sensitive
to spousal employment.
z Spousal Education:
– Women physicians’ location is more sensitive to
spousal education.
– Men physicians’ location is growing more sensitive to
spousal education.
3
Figure 2: The Average Work
Week for Employed
Physicians < Age 65
Figure 1: The Percent of
Physicians <65 Reporting
Employment
120%
100%
99%
98%
98%
95%
98%
97%
97%
60
85%
52
98%
94%
86%
54
46
45
80%
89%
55
49
50
40
Men
60%
Women
20
20%
10
0%
Men
30
40%
Women
0
1980
1990
2000
1980
The Percent of Employed
Physicians <65 Working <35
Hours Per Week
18%
1990
2000
Figure 4: The Percent of
Employed Physicians <65
Working 50+ Hours Per Week
16%
16%
15%
15%
80%
73%
14%
70%
12%
72%
68%
60%
51%
10%
Men
Women
8%
6%
4%
50%
45%
Men
37%
40%
Women
30%
3%
3%
3%
20%
2%
10%
0%
0%
1980
1990
2000
1980
The Percent of Employed
Physicians <65 Living Outside of
a Metro Area
1990
2000
The Percent of Employed
Physicians <65 who are
Married with Spouse Present
25%
61%
20%
76%
90%
74%
85%
85%
82%
80%
20%
69%
18%
70%
66%
69%
16%
15%
60%
15%
12%
11%
Men
Women
10%
50%
Men
Women
40%
30%
20%
5%
10%
0%
0%
1980
1990
2000
1980
1990
2000
4