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...s.s23sWhile adopting multiple methods may be challenging due to the time required to collectsdifferent types of data and the familiarity that is needed with both qualitative andsquantitative methods (=-=Creswell 2009-=-), this approach was considered the mostsappropriate for studying potential variations in the working lives of male and femalesdoctors in this thesis. The comprehensiveness of this approach enables al...

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...s.s3.2.1 Family EconomicssThe area of economics concerned with how families or households behave, describedsas ‘family economics’, emerged from Gary Becker’s work, notably ‘A Treatise on thesFamily’ (=-=Becker 1981-=-). Replacing the traditional approach of labour supply theory,swhich suggested that all non-market time was spent on leisure, Becker’s work wassimportant as it examined, for the first time, the role o...

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...ng lives to be studied. The combination of these methodssalso sought to reduce the likelihood of respondent bias as often what people say theysdo and what they do in practice may differ (Hansen 2006, =-=Corbin and Strauss 2008-=-).sThis relates to the ‘Hawthorne Effect’ which suggests that individuals in this study mayshave altered their behaviours as a result of being observed. By undertakingsobservations on multiple occasio...

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...tings. Based on the work ofsGeorge Herbert Mead, Blumer first coined the term ‘symbolic interactionism’ in 1937 tosrefer to the process that individuals go through when interacting with other peoples(=-=Blumer 1969-=-). According to Blumer (1969, p2) there are three premises that aresimportant for understanding and studying interactions:s1) Individuals behave according to meanings that they attribute to phenomenas...

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...fectionate and emotional expressivestraits that have been associated with women; whereas males are considered to holdsagentic qualities – including dominance, forcefulness, competence and aggressions(=-=Eagly 1987-=-). These stereotypes and social roles appear to affect not only the internalsfactors such as the lowered dominance that was displayed by female consultants insthis study, but also external factors suc...

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...es. Layers of information and greater contextual understandingscan be developed using this approach, giving a more complete insight as each methodsmay only give “a partial view of the whole picture” (=-=Barbour 2001-=-, p1117). Furthermore,sthis technique strengthens the validity of the research findings if similar results aresfound across more than one method.s116sTwo investigators collected data for this study as...

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... display narcissistic personality types (Banjas2005), as well as gender differences in personality traits such as narcissism (Watsonsand Biderman 1994), aggression (Hyde 1984, Eagly and Steffen 1986, =-=Feingold 1994-=-),sassertiveness (Feingold 1994) and agreeableness (Guo, Wang et al. 1995, Budaevs1999). However, there are problems in conceptualising personality traits and relianceson self-reporting in studies. Th...

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...on goals of the household,smore recent models suggest that bargaining in the household is non-cooperative insnature, with individual’s personal interests motivating their behaviours in a family units(=-=Agarwal 1997-=-).s55sThe bargaining power of an individual, that is, their ability to negotiate within the familysunit to make decisions on their own terms, depends upon their ability to thrive outsidesof marriage (...

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...onals are more likely to display narcissistic personality types (Banjas2005), as well as gender differences in personality traits such as narcissism (Watsonsand Biderman 1994), aggression (Hyde 1984, =-=Eagly and Steffen 1986-=-, Feingold 1994),sassertiveness (Feingold 1994) and agreeableness (Guo, Wang et al. 1995, Budaevs1999). However, there are problems in conceptualising personality traits and relianceson self-reporting...

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...imarily forsillustrative purposes to demonstrate the techniques that could be undertaken withs207slarger sample sizes and due to problems of multiple testing creating a risk of spurioussassociations (=-=Bland and Altman 1995-=-, Bender and Lange 2001).sThe planned analysis strategy for these multivariate models was ordinal logisticsregression as this is the most appropriate method since the response categoriess(strongly dis...

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..., where the proportion of men working part-times43shas reduced substantially, from 35% in 1975 to 10% today (Department of Healths2007b, NHS Information Centre 2012b).sThe ‘target income hypothesis’ (=-=Evans 1974-=-) can be used to explain these changes assit suggests that individuals will adjust their labour supply (e.g. work hours) according tostheir ‘target income’ level. Based on this theory, it is possible ...

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...e purposes to demonstrate the techniques that could be undertaken withs207slarger sample sizes and due to problems of multiple testing creating a risk of spurioussassociations (Bland and Altman 1995, =-=Bender and Lange 2001-=-).sThe planned analysis strategy for these multivariate models was ordinal logisticsregression as this is the most appropriate method since the response categoriess(strongly disagree, disagree, neutra...

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...nen, Bensing et al. 1998, Roter, Geller et al. 1999, Bertakis, Franks et al. 2003)spresented the sample size and p value, from which the t statistic could be calculatedsusing Student’s t test graphs (=-=Campbell and Machin 1999-=-, p194). Two studies did notsprovide data about the time of consultations for male and female doctors, so thesesstudies could not be included in the meta-analysis (Anderson and Zimmerman 1993,sTai-Sea...

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...nd Gough suggest,sreflexive research is more than just reflection, which occurs after the event, it is aboutscontinuous self-awareness of the ways that researchers may impact on the researchsprocess (=-=Finlay and Gough 2003-=-). This requires a sensitivity to the effect of asresearcher’s presence upon a research setting and data collection, as well as the effectsof a priori assumptions on data analysis (Murphy, Dingwall et...

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...008).s4.1.2 Gender and communicationsOutside of the medical consultation there is evidence across a range of settings,spopulations and research methodologies that communication styles vary by genders(=-=Aries 1996-=-). Leadership research has suggested that women in general maysdemonstrate more democratic communication style and may be more interpersonallysorientated than males (Eagly 1990). Drawing on their exte...

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...tom resolution and othersphysiological measures. In cancer patients greater participation and decision makingshas also been associated with better physiological outcomes and improved quality ofslife (=-=Arora 2003-=-). Therefore, it is possible that female doctors may achieve bettersoutcomes through a more partnership building communication style and greater patientscenteredness. However, this assumption ignores ...

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...ent-centredness (how much input the patient had during the consultation) weresstatistically significantly associated with positive ratings of quality of care, althoughsthese relationships were small (=-=Bensing 1991-=-). Patient-centred communication styleshas also been associated with greater compliance (Stewart 1984).sOng et al (1995) raised concerns that the majority of research studies in the field ofsmedical c...

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...fference reduced tos14% and after adjusting for other factors there was no pay gap. In fact, in somesspecialties (general practice and family practice) female doctors actually earned moresthan males (=-=Baker 1996-=-).sIn the UK, researchers have adopted various approaches to analysing the pay gap insmedicine. In a survey of 1162 doctors, Connolly and Holdcroft (2009) found that whilesconfounding factors such as ...

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... thatsfemale doctors face two conflicting social role expectations and Cassell describes hows67sfemale doctors become ‘iron surgeons’ and may suppress feminine traits in order tossurvive in medicine (=-=Cassell 1998-=-). It is difficult to ascertain whether these are sociallysconstructed gendered behaviours that are demonstrated in this setting or perhapssthese women behave in masculine, aggressive and dominant way...

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...ours of male and female doctors.sThese gender differences in the career choices and contracted hours of male andsfemale doctors have been well documented in the literature (Lambert and Goldacres1998, =-=Allen 2005-=-, Sanfey, Saalwachter-Schulman et al. 2006, Drinkwater, Tully et al.s2008, Elston 2009). While identifying variations in doctors’ working patterns and careerschoices is important as they may have impl...

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... may be associated withsgreater stress levels at work (Beerman and Nackreiner, 1995. In: Folkard and Hill,s2002). In the medical setting, female doctors report higher stress levels than malesdoctors (=-=Caplan 1994-=-, Cartwright, Lewis et al. 2002, Kluger, Townend et al. 2003),salthough it is not clear whether this is as a result of greater workload pressures or othersfactors.sThe relationship between workload an...

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...riarchal forces may still inhibit women’s progress. Several authors have commentedson the patronage that exists in medicine and how it discriminates against womensdoctors (Currie 1993, Hafferty 1998, =-=Davies 2003-=-, Abbott 2005). These discriminatorysforces have been linked to the historically low numbers of women in the profession:s“medicine has been held up as a particularly extreme case of patriarchal exclus...

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...ment tool, as the reviewers considered that the study participantsswere at least somewhat likely to be representative of the target populations(Meeuwesen, Schaap et al. 1991, Hall, Irish et al. 1994, =-=Bylund and Makoul 2002-=-, vansden Brink-Muinen, van Dulmen et al. 2002, Zandbelt, Smets et al. 2006, Cox, Smith etsal. 2007, Tai-Seale, McGuire et al. 2007).s95s4.4.2.3 Study DesignsThe study design item on the quality asses...

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...bserved. Analysing results at a patient level rather than doctor level withoutsadjusting for the multi-level nature of the data could cause spurious results and maysunderestimate the standard errors (=-=Altman and Bland 1997-=-). Results should also besinterpreted with caution because it is possible that the random effects model used willsgive more weight to smaller studies and less weight to larger studies (Borenstein,sHed...

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...t individuals learn and adapt tosnew social roles as society itself changes, or, when joining new social groupssindividuals learn the norms of that group and may base their own behaviours uponsthese (=-=Davidson and Gordon 1979-=-). Martin and colleagues (1988) support this andssuggest that individuals go through processes of gender socialisation as well assprofessional socialisation, whereby they learn the values and attitude...

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...est graphs (Campbell and Machin 1999, p194). Two studies did notsprovide data about the time of consultations for male and female doctors, so thesesstudies could not be included in the meta-analysis (=-=Anderson and Zimmerman 1993-=-,sTai-Seale, McGuire et al. 2007). One study did not provide any data at all so could notsbe included in the meta-analysis or forest plot (Law and Britten 1995). Analyses weresconducted in Stata® for ...

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...sult of actualsdiscrimination against women or other characteristics. While a number of studies reportslower earnings amongst female doctors compared to males, levels range from nosdifference to 17% (=-=Bashaw and Heywood 2001-=-, Connolly and Holdcroft 2009, LosSasso, Richards et al. 2011, Morris, Goudie et al. 2011, Theurl and Winner 2011).sPayment by ‘fee for service’ in settings such as the US may create different incenti...

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...he family unit act to maximise a single household utility function, assindividuals within a household may hold different wants and needs and family life doessnot benefit all in the household equally (=-=Ferber 2008-=-). Ermisch (2008) suggests thatsindividuals instead seek to maximise their own utility or welfare, and a form of intrahousehold bargaining takes place. Whereas Becker’s model suggests that cooperative...

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...een developed through the adoption of multiple methodsswhich enable the subject area to be explored from a variety of viewpoints, building asmore complete picture than if the methods were used alone (=-=Adamson 2005-=-).s9.2 Discussion of findingssNumerous sources of gender variations have been identified in this thesis and thesesmay be useful for explaining gender differences in productivity rates which have beens...

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...ported by a study of UK medical graduates, which foundsthat female doctors felt better equipped in these psychosocial skills, such as displayingsa ‘caring and compassionate nature’ compared to males (=-=Clack and Head 1999-=-,sp.101). Therefore, while both men and women in this study expressed an awareness ofsthe importance of psychosocial communication to patient care (as a result of currentsemphasis on this in medical t...

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...nt Greece, goddesses were also commonlysworshiped for the healing powers people believed they possessed, such as thesgoddess Hygieia, whose name is the basis of the word ‘hygiene’ that is used todays(=-=Bourdillon 1988-=-).s26sBy the 3rd century BC the work of Hippocrates began to be taught and this heavilysinfluenced medical tradition until the 17th century AD (Bourdillon 1988). The role ofswomen in medicine began to...

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...nt on men for economic reasons, they may be less involved in makingsdecisions and there are larger consequences of divorce for women if they are reliant onshusbands for financial security (Blau 1989, =-=Chafetz 1999-=-). This becomes a viciousscircle as women’s traditional specialisation in non-market work leads to them spendingsless time in the labour market, which in turn reduces women’s likelihood to invest insf...

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...h was in place from 1957 andsencouraged ‘equal remuneration for equal work’ in the six European member states;sand the US Civil Rights Act (1964) addressed various forms of discrimination insAmerica (=-=Connolly and Gregory 2007-=-).sDuring the 1970s and 1980s there were also general changes to the labour market thatsencouraged greater female participation in the workplace. A reduction in heavy industrysled to a fall in men’s e...

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...f occupations (Giddens 2006).sAt this time there were also growing numbers of women studying medicine in Britain insorder to meet the needs of the country, as men became enlisted in the armed forcess(=-=Elston 1993-=-). However, there were still restrictions on where women could studysmedicine, with only a small number of medical schools allowing women. From 1915ssome hospitals in London that had previously only a...

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...ariables, such as participants’ age or years since completion ofsspecialist training as research suggests that female doctors may delay parenthood untilsthey have progressed further in their careers (=-=Elston 2009-=-, Goldacre, Davidson et al.s2012).sIn addition to these suggested changes to questions about child’s age, future surveyssshould consider including a childcare category that enables participants to ind...

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...lt as human beings havesevolved to be active during daylight hours and sleep at night, creating an internal ‘bodysclock’ which controls circadian rhythms that are linked to physiological performances(=-=Folkard and Hill 2002-=-). High levels of workload and sleep deprivation can have as“widespread detrimental effect on performance – both speed and accuracy, as well assselective attention and most aspects of memory” (Hockey ...

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... that peopleswould become less reliant on prayer, God and the Church. The Church was thereforesheavily involved in discrediting the role of such women, and encouraged witch huntingsthroughout Europe (=-=Achterberg 1991-=-). Practicing “conjour[ing], and witchcraft andssourcery and enchantments” were crimes punishable by death (Bourdillon 1988, p19).sA significant text written by two monks in 1487, the Malleus Malefica...

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... Specific opening questions were also used and were carefully chosen tosaddress any potentially sensitive issues in a neutral, non-threatening manner and tosavoid creating discomfort in participants (=-=Arthur and Nazroo 2003-=-). Yin discusses thesissue of raising difficult questions and suggests that researchers should be carefulsabout how they phrase things that could be viewed as sensitive: “the verbal line ofsinquiry [s...

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...rious authors have described gender differences in earnings across a range ofsoccupations and countries; reporting that women earn less than men even aftersaccounting for differences in hours worked (=-=Bell and Ritchie 1998-=-, Robinson 1998,sConnolly and Gregory 2007, Office for National Statistics 2010a). This is often referredsto as the ‘pay gap’ and in the UK this gender pay gap has been gradually reducingssince the fe...

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... to view role conflict associated with greater domestic responsibilities to be asbarrier and women typically considering organisational culture, career structure andsworking practices to be barriers (=-=Dumelow and Griffiths 1995-=-).sFindings from this thesis suggest that all of these factors may be important to femalesdoctors’ working lives and career progression, as in addition to the organisationalsbarriers described above, ...

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...fromsvariations in the perceptions held about male and female consultants. Perceptions aresa type of heuristic, which simplify and speed up the process by which individuals makessense of their world (=-=Balu 2009-=-). The field of psychology suggests that individualssmake subjective judgements about other people and situations based on their existingsbeliefs and past experiences, and that these perceptions may i...

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...profiles over time, suggests that wider sociological and psychological factorssmay influence behaviours in the home. In most developed countries there are nowsmore university-educated women than men (=-=Beck 2011-=-), and yet women continue tosdo more non-market work. In medicine, for example, women in dual doctor householdsscontinue to take on the majority of care-giving responsibilities in the home, despite th...

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...niversities Central Council on Admissions (UCCA) first measuredsthe proportion of male and female medical applicants in 1963, women comprised fewersthan 34% of applicants and only 29% of acceptances (=-=BMA 2009-=-). Female medicalsstudents rose to approximately 40% in 1980, increasing by approximately 10% in eachssubsequent decade (McManus 2002).sWhile the proportion of women studying medicine has increased su...

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...y,sdoctors in the SAS grade included associate specialists; clinical assistants; clinicalsmedical officers; hospital practitioners; locums; specialist doctors; staff grade doctors;sand trust doctors (=-=BMA 2011-=-). These terms have now been dissolved and replaced bysthe term ‘specialty doctor.’ Some of these previous terms are used in the routinelyscollected data by the NHS Information Centre on workforce num...

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...y,sdoctors in the SAS grade included associate specialists; clinical assistants; clinicalsmedical officers; hospital practitioners; locums; specialist doctors; staff grade doctors;sand trust doctors (=-=BMA 2011-=-). These terms have now been dissolved and replaced bysthe term ‘specialty doctor.’ Some of these previous terms are used in the routinelyscollected data by the NHS Information Centre on workforce num...

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...ding has implications for working teams in hospital settings, theseffectiveness of which is necessary for good collaboration between healthsprofessionals in order to ensure high quality patient care (=-=Boaden and Leaviss 2000-=-).sFurthermore, well-functioning teams may affect the productivity of the workforce andsresearch suggests that problems with teamwork can predict long spells of sicknesssabsence amongst hospital physi...

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...n in the samesdecile (Office for National Statistics 2010a). The presence of a gender pay gapsregardless of professional status is seen in professions such as law, where womensearn 27% less than men (=-=Connolly and Holdcroft 2009-=-). This may, however, be asfunction of lawyers being paid on a fee-for-service basis, where women working fewershours would result in lower incomes.sEven when men and women have the same levels of ski...

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...he workplace, historicalspatriarchal forces may still inhibit women’s progress. Several authors have commentedson the patronage that exists in medicine and how it discriminates against womensdoctors (=-=Currie 1993-=-, Hafferty 1998, Davies 2003, Abbott 2005). These discriminatorysforces have been linked to the historically low numbers of women in the profession:s“medicine has been held up as a particularly extrem...

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...aresarrangements (Royal College of Surgeons 2012). Recommendations, such as the needsfor improved access to childcare, have also been made in a report from BaronesssDeech to the Department of Health (=-=Deech 2009-=-). Future research measuring theseffectiveness of strategies designed to improve childcare support are considered latersin this chapter.sDifficulties arising from personal commitments may be relevant ...

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...oundation year two (FY2) doctors. This training stagesprovides junior doctors with experience in a variety of specialties and helps them tosmake decisions about which area they plan to specialise in (=-=Eccles and Sanders 2009-=-).sIn other countries the timeline and process for early medical training varies slightly,salthough there are still the same elements of undergraduate study, followed by on-thejob training to attain g...

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...ere in opposition to the Church and weresthought to represent a threat to the religious messages preached and the formalsmedical licences that were issued by the Church to university-trained doctorss(=-=Ehrenreich and English 1973-=-, Bourdillon 1988).sDuring centuries of witch-hunting, which started in the 14th century and lasted until thes18th century (Bourdillon 1988), the Church distinguished between peasant (female)shealers,...

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...or example, a recent analysis of data from the Millennium Cohort Studyssuggests that, even amongst children as young as 7 years of age, gender-typicalscareer aspirations and motivations are apparent (=-=Flouri and Moulton 2012-=-). Inssocialisation theory it is stressed that it is not the sex of the individual per se thatsshapes behaviours, but the social roles that are built up over time according to differentsforces within ...