Women physicians in transition: Navigating the early- to mid-career process

In this episode of Moving Medicine, Geneen Gin, DO, reveals the findings of a qualitative research project focused on the career development of female physicians. Female physicians face unique obstacles as they advance in their careers, navigate career progression, and seek a balance between professional and personal responsibilities. Furthermore, there remains a growing need for best practices at the individual, institutional, and system levels to address such physician gender disparities. Listen in to learn more.

Speaker

• Geneen Gin, DO, board-certified family medicine physician, associate professor in the University of California Department of Family Medicine.

Host

• Todd Unger, Chief Experience Officer, American Medical Association

Listen to the episode on the go on Apple Podcasts, Spotify, or wherever podcasts are available.

Unger: In recognition of Women in Medicine Month, the AMA brings you this episode with Dr. Jeanine Jean, who takes us through the results of a qualitative research project focused on the career development of women physicians.

All participants, partnered or alone, with or without children, described tensions felt between work and non-work responsibilities. The result of these competing demands leads to border control between living areas that exist and terminate in a limited space. Multiple participants described continuous boundary control to prevent personal needs from interfering with intended career goals. — Dr. Jin

Dr. Jeanine Jean is an associate professor in the Department of Family Medicine at the University of California. The research team, which Dr. Jin describes as “some of the smartest and brightest” doctors he knows, includes Dr. Tiffany Lung, principal investigator at Maastricht University in the Netherlands, Dr. Tammy Lin, who has a private practice in San Diego as an internist, Dr. Karen Wang of Yale University School of Medicine and Dr. Seema Pendharkar of Jersey City Medical Center and Dr. Angie Chen of Stanford University.

This is Dr. Jin.

Dr Jin: Good day. Thank you for inviting me to talk about women in medicine, the early to mid-career transition. I’m Jineen Jin, I’m an associate professor in the Department of Family Medicine at UCLA.

The project really had two components. The first component was launching a podcast called The DEI Shift, and DEI is an acronym for Diversity, Equity and Inclusion. And then a qualitative research project called Women Physicians in Transition Learning to Manage the Early to Mid-Career Process. The DEI Shift podcast has 37 episodes and all five-star reviews. The podcast began its planning stages in November 2019, with Dr. Tammy Lynn as executive producer. It launched in March 2020 and the AMA Giambalvo grant was a co-sponsor for the first two seasons. We couldn’t do the podcast without our dedicated team of 20 team members who range from pre-meds to residents to attending physicians, many of whom are female physicians.

Our qualitative research project, Women Physicians in Transition Learning to Navigate the Early- to Mid-Career Process, focuses on this key fulcrum between early and mid-career. Women account for nearly half of medical school applications and more than half of the physician workforce in certain specialties. However, there is a disparity in the career progression of female doctors. Women hold fewer executive positions than men. And in academic medicine, 38% of lecturers, 21% of full professors and 16% of deans are female doctors.

There are often competing non-work demands that temporarily coincide with this early to mid-career transition. And women who face these demands make choices that can change their career trajectory, such as deciding to leave a position in industry or academic medicine. And women are beginning to realize the impact of work-life balance, mentoring opportunities, leadership support, and institutional culture on career satisfaction.

To be successful in the transition from early to mid-career, women physicians develop one or more of the following. They learn how to integrate their work and non-work demands. They learn to mentor their peers or junior faculty. They develop a support network to advance their careers. They begin to take on leadership roles locally, nationally or internationally and recognize the need for self-care, whether it’s recognizing burnout, recognizing physical issues, or recognizing mental issues. Developing best practices for this career transition is essential because it is such a fulcrum.

Initially, the main objective of this project was to develop best practices for career transition. Once the project started, it became clear that the data we collected was very rich and we wanted to spend more time analyzing and understanding this data. The aim of the project then became to focus on understanding the early to mid-career journey and using this as a future basis for deriving best practice.

Our participants were recruited through social media postings on professional networks, listservs, and discussion forums. Inclusion criteria were self-identified female physicians in the process of or recently completing the transition from early to midcareer. Potential participants completed a four-question form to determine whether they met the inclusion criteria. In addition, he asked for demographic information, the specialty, and the type of practice in which the physician is located.

Purposive sampling was conducted with attention to career and major, and participants had a semi-structured Zoom interview. Interview transcripts were analyzed using open coding to develop a current code structure. The results of our participants—they were selected for both specialty diversity and region—they self-identified where they were in their transition stage, either unclear, in process, or recently completed transition. Each participant completed a 50- to 100-minute interview and was offered compensation with a $100 gift card.

Coding has now reached saturation, and based on the codes developed in the analysis of the transcripts, these are the emerging themes: competing demands, boundary control, need for resources, and moving from assertiveness to self-activation.

Competing demands are the tensions that result from the time limit divided between the demands of a doctor’s career and personal demands. These quotes from participants illustrate the tension between career goals and personal goals. “I just can’t travel, you know, or I can’t go somewhere and give a lecture. And I feel like I’m letting it go. And the pressure to balance personal and professional. I don’t know if I’ve ever fully achieved nirvana and found the perfect balance.”

All participants, partnered or alone, with or without children, described tensions felt between work and non-work responsibilities. The result of these competing demands leads to border control between living areas that coexist and terminate in a limited space. Multiple participants described continuous boundary control to prevent personal needs from interfering with intended career goals.

Women sought resources to manage competing demands and control of boundaries. In the non-work environment, women seek resources to help them redistribute domestic responsibilities, freeing up time for additional responsibilities such as childcare. The women used a variety of resources, including organizational tools, a support network that included family, friends, daycare providers, and outsourcing when they could, such as having their groceries delivered, childcare at home, and hiring a housekeeper to help them with housework.

One participant described what she called a master schedule, which was a calendar that outlined the schedule of the seven household members, which were the participant, her husband, and their five children. She distributed this master calendar to her support network and to each of her five children who could manage a calendar. She described this document or this calendar as important, and if it wasn’t on the calendar, it wasn’t happening.

In the non-work environment, women are not seeking time management resources per se, but rather to fill the knowledge gap between career stages and how to achieve them. One participant says, “Nobody tells you what to do or how to get promoted,” and she had no idea she should be looking for a promotion until a senior colleague recommended she apply for a promotion.

Resources come from a variety of sources, including personal mentoring, institutional and special professional development programs, leadership courses, books, and social media. One participant noted that she found a community on Twitter with other physicians in her specialty that helped support her transition.

Once resources were allocated, there was a shift from assertiveness to self-activation. Many participants described a self-realization, or awareness, or recognition of her expertise in her craft and her reputation that led to an outside activity that forwarded her career trajectory.

There were limitations with the study in that there was limited transferability because the study was limited to female physicians in the United States only. Two regions, New England and the Rockies, were not part of the interview cohort. And recruitment and interviews coincided with the pandemic, so the target population was engaged in pandemic care and the pandemic may have influenced participants’ response.

Future investigations include expanding the recruitment of women outside the United States to examine the impact of a different type of health care system or medical training program or culture on career transitions and conducting the same interview process with male physicians to examine the role of gender in career transition.

For our qualitative research project, we saw emerging themes: competing demands, boundary control, need for resources, and moving from self-reliance to self-activation. Our coding is complete and our final analysis is underway. And recently, our study protocol and preliminary findings were published in the Journal of Medical Internet Research.

Unger: This talk was recorded at the 2022 AMA Annual Meeting. If you’re a physician, resident, or medical student, you can get access to more great events like this by becoming an AMA member. Visit [the AMA website]. This is Moving Medicine. You can subscribe to this and other great AMA podcasts wherever you listen to yours, or visit ama-assn.org/podcasts.

Thanks for listening.

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Disclaimer: The views expressed in this podcast are those of the contributors and/or do not necessarily reflect the views and policies of the AMA.