Climate Change for the
Medical Workplace
Lessons on physician work-life balance from
around the world
Janet Dollin MDCM, FCFP
Kathleen Gartke, MD, FRCSC
Barbara Lent MD, FCFP
Cheryl Levitt MBBCh, FCFP
Outline
1. Current situation in Canada
2. International Experience
3. Planning for the future
1.Current situation in Canada

Introduction - brief overview of data on women in medicine
and in med school as it relates to Canadian workforce issues

FMWC Needs Assessment 2008 & Customizing Balance
call for stories- shining the light on perceptions of women in
the Canadian medical workforce-what we want

Work Life Policies for Canadian Medical Faculty 2009
FMWC -shining the light on what we now have in place
1. Current situation in Canada
Introduction
Women comprise:
 70% of students in some med schools
 65% of new Fam Med grads
 58% of medical students overall
 50% of all Cdn physicians < age 35
 30% of the Canadian medical workforce


18% of full professors of medicine
13% of department chairs
1.
Current situation in Canada
Women physicians comprise








83% first year trainees in ob/gyn
65% first year trainees in family medicine
14% first year trainees in cardiac surgery
50% of geriatricians
48% of pediatricians
37% of gp/family physicians
7% of orthopedists
5% of urologists
1.
Current situation in Canada
Gender Distribution of Physicians, by Physician Type, Canada, 1978 to 2008
1.

Current situation in Canada
BC Physician Health Program
Position Statement 2010
Medicine and Motherhood: Can We Talk?
http://www.physicianhealth.com

Workplace climate (accommodation) will impact
 Maternal and fetal health.
 Mother and child well-being during pregnancy and
postpartum.
 Female physicians career progression, career choices
and practice patterns.
 HHR planning
1. Current situation in Canada
National Physician Survey 2007

Major responsibility for children or other dependents
Significant differences (p<0.05) by sex and by age for females
1. Current situation in Canada
National Physician Survey 2007
In the last year, have you been absent from work
due to maternity or paternity leave?
Men 2.3%
Women 7.8% ( consider absolute #s)

For men who take parental leave: 95%<16 wks
For the women who do so:
75%>16 wks

We need to plan for that

1. Current situation in Canada
National Physician Survey 2007
Hours worked per week by type of dependents (excluding on call)
-No significant difference in work hours for men and women when no dependants
-Having dependent children alters work hours differently for men and women
Overall 47:52 hrs F:M
Trends in the Work Hours of Physicians in the United States
Douglas O. Staiger, PhD; David I. Auerbach, PhD; Peter I. Buerhaus, PhD, RN
JAMA. 2010;303(8):747-753.
% Change for US Physician hours Between 1996 and 2008

All physicians
(54.9 hrs-51 hrs)
−7.2 %

Men
(54.4-51.7 hrs)
−5.0 %

Women
(46.7-44.4 hrs)
−5.1 %

Lawyers
(45.9-44.9 hrs)
−2.4 %

Engineers
(43.6-43.0 hrs)
−1.4 %

Registered nurses
(36.7-37.3 hrs)
+1.6 %
Generation Effect?
 Boomers (1945-1962)
-Work hard out of loyalty
 Generation X (1963-1983)
-Work hard if balance allowed
-Expect long-term job
-Expect many job searches
-Pay dues
-Dues not relevant
-Self-sacrifice is virtue
-Self-sacrifice may have to be
endured, occasionally
-Respects authority
-Questions authority
 Millenials (mid 1980’s up)
-Plugged in 24/7-tech and media
savvy
-Work hard but demand flexible
schedules and a better work/life
balance
-Value teamwork and
responsibility, desire to shape
their jobs to fit their lives rather
than adapt their lives to the
workplace
-Achievement oriented and
confident but question authority,
assertively seek more feedback
1.Current situation in Canada
FMWC Needs Assessment 2008

The FMWC -a unified voice for Canadian female physicians



promote interests of female physicians
improve management of women’s health issues
The 2008 Needs Assessment was an online survey
of its members designed to understand the priority
issues for women in medicine and to aid in design of
its new website. It offers us a glimpse at the
concerns these women have about the current
situation in Canada…
1.Current situation in Canada
FMWC Needs Assessment 2008
Improve workplace flexibility, job sharing, part-time work
and ensure this flexibility is equitably available across
all specialties
Increase physician resources in Canada and stop
identifying women in medicine as the cause of human
health resource problems
The increasing number of healthcare trainees dictate the
need for more faculty – especially women advancing to
leadership positions
Customizing Personal Balance within Medicine
Call for stories 2008
the questions:

How have you customized things to balance your job and personal life?

Tell us about your personal experience of less than full time work, job
sharing, parental leave, re-entry experiences, Stop the clock, promotion
policies, etc.

What policies within your institutions have supported you? What policies
have not?

Was it a personal or group negotiation that got you what you needed to
create balance?

What is it about your particular specialty that makes it easier or harder to
achieve what you need?
Customizing Personal Balance within Medicine
Call for stories 2008
the answers by theme:
1.Balance: Was it planning or serendipity?:

Act to not allow our institutions to repeat bad
experiences. Train for resilience. Mentor: seek and
be a role model. Act to make ‘opting in’ the better
choice. Flexible workplaces will keep the medical
workforce balanced.
2.Thoughts on having children:

Attitudes towards raising families while having a
career in medicine need updating. Workplaces need
to be more family and caregiver friendly, which
includes but is not limited to parental and caregiving
leave, stop the clock advancement policies, re-entry
Customizing Personal Balance within Medicine
Call for stories 2008
the answers by theme:
3.The importance of personal health:

We all need time for self care, a supportive
community of friends and work environments that
can adapt to our health needs as care providers and
that will support our indirect journeys.
4.Thoughts on careers:

Help our institutions to value less than full time and
flexible work and to create more of these lifestyle
friendly work opportunities. Act to allow women to
lead in medicine and use their “Take charge” talents.
Work-Life Policies at
Canadian Medical Schools
(An FMWC & CMA Collaborative Project)
Kathleen Gartke M.D. FRCSC
Aaron Gropper B.Sc. Hon
Monika MacClaren M.B.A.
From the JOURNAL OF WOMEN’S HEALTH
Published by Mary Ann Liebert, Inc, New Rochelle, NY
Rationale

Is there a problem?

Lots of literature – nothing Canadian


What is our situation?
How do we compare?

Modeled after an American study (Bristol et al
2008 – top 10 schools (US News & World
Report 2006))

Advocacy begins by defining the problem
Work-Life Policies at Canadian
Medical Schools

Maternity Leave

Paternity Leave

Adoption Leave

Extension of Probationary Period for Birth or Adoption

Part time / Reduced Work Load Appointments

Job Sharing

Child Care
Work-Life Policies at Canadian
Medical Schools

Data gathering
• Web search
• Email
• Phone

Compilation

Legislation

Scoring

Analysis / Comparison
Legislation

Canadian

Federal
• 17 weeks EI benefits (+35 wks unpaid parental)

Provincial (universities)
•  15 weeks EI benefits (+35 wks unpaid parental)

American

FMLA
• 1993
• 12 weeks of unpaid, job protected leave for specific family
& medical reasons
Work-Life Policies at Canadian
Medical Schools

Up to 45% of faculty (USA) have expressed
thoughts of leaving (often related to concerns
about balance)

Generation X (1963 – 1981)

Ability to control job outweighs salary & prestige

John Hopkins – policies to retain more women
led to increased retention of men (66% & 57%)
Work-Life Policies at Canadian
Medical Schools

Results

Canadian schools have much more generous
maternity, paternity & adoption leaves

Wide variation in these (paid)

French language schools: most generous

University of Alberta : least generous
Work-Life Policies at Canadian
Medical Schools

Results

Extension of probationary period: Canadian
schools more uniformly generous than US

All offer at least one year extension

Some allow unlimited repeats, others not

No Canadian school has eliminated the pretenure period (gone to merit based promotion)
Work-Life Policies at Canadian
Medical Schools

Results
 Part time or work reduction programs: available at
most Universities

Some offer only to tenured faculty

American schools : slightly better part time or work
reduction policies

Job sharing: much more common in American
schools
Work-Life Policies at Canadian
Medical Schools

Results

Childcare: Most have on campus childcare and
often offer referrals +/- financial

Northern Ont School of Medicine: no childcare

Canadian Schools: generally better than American
School
Total Score
Average Scores
(out of a possible 21)
(across all policies)
University of
Western
Ontario
University of
Manitoba
16
2.29
15
2.14
University of
Saskatchewan
14
2
University of
British
Columbia
Dalhousie
University
14
2
14
2
Université de
Laval
13
1.86
Queen's
University
13
1.86
Memorial
University of
Newfoundlan
d
McMaster
University
13
1.86
13
1.86
McGill
University
13
1.86
University
of Ottawa
12
1.71
Université
de
Sherbrooke
12
1.71
Université
de
Montreal
12
1.71
University
of Toronto
11
1.57
University
of Alberta
11
1.57
University
of Calgary
10
1.42
Northern
Ontario
School of
Medicine
7
1
American Schools
John Hopkins
Total Score of all
policies (out of
possible 21)
15
University of California, San Fransisco
15
Harvard University
14
Duke University
13
Yale University
13
Stanford University
9
University of Washington
9
Baylor College of Medicine
9
Washington University in
St Louis
7
University of
Pennsylvania
6
Work-Life Policies at Canadian
Medical Schools

Standouts

U of Western Ontario:
• Highest score
• Has a unique “work-life balance” section on website
• Frequently addresses issues of balance

Northern Ontario School of Medicine
• Lowest score
• Least generous policies in several areas
Work-Life Policies at Canadian
Medical Schools

Conclusions

Canadian medical schools are committed to helping staff
achieve work-life balance

Policies have improved (quality & accessibility)

Further improvement possible & desirable

Culture change

Attract & retain the best
“Although we may define ourselves first by
what we do, it is those personal relationships
outside of work that make us whole”
John Curtis
(Academe, Nov/Dec 2004)
2.International Experience
Making Part Time Work-2008 UK MWF and EU working time
alliance
Women Doctors:Making a Difference-2009 UK MWF report
Achieving gender equity from within:Wonca WPWFM HER
statement & “Gender Equity Standards for Scientific
Meetings”
2.International Experience UKMWF
Making Part Time Work-2008
1.Recommendations on attitudes to part time working
• Systemic attitude changes through role models, mentors and case studies as well as form
consultation with those doctors trying new work plans
2.Recommendations on part time career grade posts
• Royal College guidance sought and leadership from Medical
Directors needed to create flexible teaching positions
3.Recommendations on career development for pt doctors
• Formal re-entry after career break, formal feedback with those
who are in part time posts
4.Recommendations on part time training posts
• Medical directors should promote innovative job design as well
as informing and supporting those part time workers using them
• Colleges and employers must collaborate to ensure coverage
2.International Experience UKMWF
Making Part Time Work-2008

European Working Time Directive

In 2008 the maximum # working hrs per week
recommended by the EWTD was 56

In 2009 it was reduced to 48 (35 in France!)

Opens debate about the negative impacts of long
hours on performance vs the needs for “putting in the
hours” needed to learn

Setting a ceiling on maximum work time is only part
of the story
2.International Experience-UKMWF
Women Doctors:Making a Difference-2009

Previous reports focused on desired
outcomes rather than the necessary
levers of change to achieve them

Narrow and targeted recommendations:
2.International Experience UKMWF
Women Doctors:Making a Difference-2009
1.
Improve existing structures so that there is better
advancement to certain critical career turning
points as well as different ways of working
2.
Ensuring that new processes (such as
revalidation) have the flexibility and capacity to
accommodate doctors who may not be
conforming to the usual work patterns
3.
Providing additional support for the practical
realities of caring for a child or dependent relative
2.International Experience UKMWF
Women Doctors:Making a Difference-2009
1.
Improve access to mentoring and career advice
2.
Encourage women in leadership
3.
Improve access to part time working and flexible training
4.
Ensure that the arrangements for revalidation are clear and explicit
5.
Women should be encouraged to apply for Clinical Excellence Awards
6.
Ensure medical workforce planning apparatus takes account of increasing
number of women in the medical profession
7.
Improve access to childcare
8.
Improve support for carers
9.
Strenuous efforts should be made to ensure that these recommendations are
enacted through the identification of champions
Sir Liam Donaldson
Chief Medical Officer,England
“The issues raised are not new, nor perhaps
are they unexpected. But to tackle them is
going to require a step change in how the
medical workforce as a whole behaves. It
will require an acceptance of alternative
and differing patterns of working and
training for all medical staff, not just
women…”
2.International Experience Achieving
gender equity from within:
Successes and challenges in
promoting the perspective of the
Wonca Working Party
on Women and Family Medicine
Barbara Lent
Cheryl Levitt
Wonca Singapore 2007
Goals

To describe how a small group of very committed
women family physicians from around the world came
together worked “from within” to ensure their
international, organized body better reflected their
experiences

To delineate key successes

To describe the factors that helped to make their
efforts successful

To discuss lessons learned from this work
Background

Individually and in informal small groups, women family
doctors recognize that organized medicine (particularly,
family medicine):

Lacked adequate representation of women in leadership
positions

Did not provide them with adequate education/training to address
their women patients’ concerns

Did not accommodate their family/household responsibilities well

Convened scientific meetings with few women physicians as
experts and few sessions addressing clinical issues from a
gender issues perspective
Key Accomplishments

The HER statement (Hamilton Equity Recommendations)


10 Steps to Gender Equity in Health


describes fundamental issues, taking into account particular social
circumstances facing women
Gender Equity Statement for Scientific Meetings


addresses governance issues within Wonca
articulates key principles for organizing committees to consider
Monograph/Literature Review

a comprehensive review of articles in international scientific literature
addressing particular issues facing women physicians/medical
trainees in educational, clinical and organizational settings
Publications

Peer-reviewed professional journals (scientific articles,
news items, commentary)

relevant professional newsletters (Wonca News; newsletter
of Federation of Medical Women of Canada)

Website: womenandfamilymedicine.com

Self-publication: large brochure distributed to colleagues to
highlight group’s activities/successes
Drivers of Success (1)
1. Working within existing Wonca organizational
structure (from informal lunch-time meetings to
Special Interest Group to Working Party)
2. Fostering relationships with like-minded physicians
from around the world
3. Building capacity and leadership development
through pre-conferences and special workshops at
regular meetings, with particular attention to needs of
younger physicians
Drivers of Success (cont’d)
4. Consistently applying an evidenced-based
approach
5. Using technology to enhance communication
(eg listserve, website, teleconferences by SKYPE)
6. Developing creative responses to financial
inequities (eg bursaries specific to WWPWFM;
travel equalization to enable participation by
members from developing countries)
Lessons Learned

Use a “bottom-up” approach so that new initiatives reflect physicians’ experiences
with patients, in organizations, with colleagues

Pursue a slow, consistent, persistent approach!

Collaborate with like-minded colleagues, recognizing that “the sum is greater than
parts”

Build on the energy and commitment that comes from long-term relationships with
like-minded colleagues

Bring relevant info/perspective from non-medical organizations

Follow/copy the path of other successful groups

Frame discussion of gender issues in a way that is relevant to the parent
organization
3. Planning for the Future
Conclusions
Where would we like to go?