ORIGINAL ARTICLE
Comparison of lifestyle and practice patterns between male and female Canadian ophthalmologists Chryssa McAlister, MD, FRCSC,* Ya-Ping Jin, MD, PhD,*,† Rosa Braga-Mele, MD, FRCSC,* Beatrice F. DesMarchais, MD, FRCSC,‡ Yvonne M. Buys, MD, FRCSC§ ABSTRACT ● RÉSUMÉ Objective: To identify sex differences in lifestyle and practice patterns of Canadian ophthalmologists. Design: Web-based national survey. Participants: Members of the Canadian Ophthalmological Society. Methods: A 48-item questionnaire was sent electronically. Analysis of results was completed using χ2 and Fisher’s exact tests where appropriate. Results: Of 385 respondents (30%), 102 were female and 283 male. Several statistically significant differences exist in lifestyle and practice patterns. Fifty-one percent of females operate less than 2 days per month as compared with 36% of males (p ¼ 0.01) despite similar clinical hours. No statistically significant differences were found in other practice pattern parameters including laser refractive surgery, hospital affiliation, university appointment/rank, and number of peer-review publications. Ninety percent of males and 81% of females report having Z1 children, but males report greater number of children (p o 0.001). Females are commonly the primary caregiver, whereas males report their partner as primary caregiver (p o 0.001). Fifty-two percent of females are unhappy with the amount of parental leave (p o 0.001). Fifty-one percent of females believe that childbearing slowed or markedly slowed career progress, as compared with 15% of males (p o 0.001). Both female (83%) and male (87%) ophthalmologists report high career satisfaction (p ¼ 0.43). Conclusions: Differences in practice patterns between males and females in our analysis surround surgical time, with no difference seen in other practice patterns or academic achievements. Differences in family patterns surround household and childrearing duties. Despite differences, both males and females report high satisfaction across several professional and personal parameters. Compared with previous studies, this suggests a change in practice patterns over time. Objet : Identifier les différences associées au sexe dans le genre de vie et les modes de pratique des ophtalmologistes canadiens. Nature : Sondage national par Internet. Participants : Membres de la Société canadienne d’ophtalmologie. Méthodes : Questionnaire électronique en 48 points. L’analyse des résultats a été complétée par chi-carré et un test d’exactitude Fisher au besoin. Résultats : Parmi les 385 répondants (30 %), 102 étaient des femmes et 283 des hommes. Il y avait plusieurs différences statistiquement significatives concernant le style de vie et les modes de pratique. 51 % des femmes opèrent o2 jour par mois comparativement à 36 % des hommes (p=0,01), malgré la similitude des heures de clinique. Aucune différence statistiquement significative n’a été trouvée dans les paramètres des autres modes de pratique, y compris la chirurgie réfractive au laser, l’affiliation hospitalière, les postes ou échelons universitaires et le nombre de publications révisées par les pairs. 90 % des hommes et 81 % des femmes ont dit avoir un ou plusieurs enfants, mais les hommes ont indiqué un plus grand nombre d’enfants (po0,001). Les femmes sont généralement les principales dispensatrices de soins, alors que les hommes indiquent leurs partenaires comme principaux dispensateurs de soins (po0,001). 52 % des femmes ne sont pas contentes de la somme des allocations de congé parental (po0,001). 51 % des femmes pensent que la maternité a ralenti ou diminué remarquablement l’évolution des carrières, comparativement à 15 % des hommes (po0,001). Dans les deux sexes, 83 % des femmes et 87 % des hommes, les ophtalmologistes ont fait état d’une grande satisfaction de leur carrière. (p=0,43). Conclusions : Les différences des modes de pratique entre les hommes et les femmes dans notre analyse marquent le temps chirurgical et aucune différence n’a été observée dans les autres modes de pratique ou les réalisations académiques. Les différences de vie familiale soulignent les responsabilités domestiques et le devoir d’éducation des enfants. Malgré les différences, les hommes et les femmes ont tous deux fait état d’une grande satisfaction sous plusieurs paramètres professionnels et personnels. Comparativement aux études précédentes, cela suggère un changement des modes de pratique avec le temps.
Despite the increasing proportion of females in medicine in Canada,1 those pursuing surgical specialties still face barriers. Data from surveys of Canadian female surgeons in 19912 and male and female Ontario ophthalmologists
in 2003 demonstrate specific academic and social challenges.3 These challenges include achieving top academic positions, obtaining surgical time, balancing work and household responsibilities, and childbearing during
From the *Department of Ophthalmology and Vision Sciences; †Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; ‡ Médecine-Département d’Ophtalmologie et d’Oto-Rhino-LaryngologieChirurgie Cervico-Faciale, Université Laval, Quebec City, Que.; and § Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ont.
Can J Ophthalmol 2014;49:287–290 0008-4182/14/$-see front matter & 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2014.02.007
Originally received Aug. 30, 2013. Final revision Feb. 7, 2014. Accepted Feb. 10, 2014 Correspondence to Yvonne M. Buys, MD, Toronto Western Hospital, 399 Bathurst Street, EW 6-405, Toronto ON M5T 2S8; [email protected] CAN J OPHTHALMOL — VOL. 49, NO. 3, JUNE 2014
287
Gender differences in lifestyle and practice patterns—McAlister et al. Table 1—Comparison of practice patterns and training between male and female ophthalmologists in Canada in 2012 Practice pattern parameter Full-time work hours (31þ/week) Perform surgery Perform laser refractive surgery Z2 operating room days/month Top university rank (full professor) Fellowship training Advanced degrees (doctorate/ master’s)
Males, n (%) Females, n (%) (N ¼ 283) (N ¼ 102) 238 226 45 181 23 164 42
(84) (80) (16) (64) (8) (58) (15)
81 71 10 50 6 54 19
(79) (70) (10) (49) (6) (53) (19)
p 0.071 0.087 0.268 0.01* 0.12 0.18 0.56
*A significant value.
training. Similar findings have been described in a 2005 survey of New Zealand male and female ophthalmologists,4 and of other female physicians in Canada.5 The number of females in ophthalmology and medicine continues to increase.6 In 2000, 28.4% of all practicing physicians in Canada were females and that percentage increased to 36.9% in 2013. Although the proportion of females in surgical specialties is lower than the national average, this number is also increasing from 13.8% in 2000 to 23.1% in 2013. The corresponding figures for ophthalmology are 16.3% in 2000 and 21.6% in 2013.7 Given the increasing proportion of females in ophthalmology, we undertook this study to provide an update comparison of lifestyle and practice patterns between male and female ophthalmologists in Canada.
METHODS A 48-item questionnaire in both official languages was sent by electronic mail in 2012 to all male and female ophthalmologist members of the Canadian Ophthalmological Society using Survey Monkey, an online survey tool. A reminder email was sent to nonresponders at 2 weeks, and the survey was closed after 2 months. Confidentiality was achieved through enhanced server side inclusion encryption. Anonymity was maintained with a unique numerical identifier for data analysis. Research Ethics Board approval was obtained through the University Health Network. Univariate differences between male and female respondents were compared using the χ2 test for continuous variables or Fisher’s exact test for categorical variables as appropriate. SAS version 9.3 (SAS Institute, Cary, N.C.) was used for the analysis. Statistically significant level was set at p ¼ 0.05.
RESULTS Of the 1278 ophthalmologists across Canada who were invited to participate in the survey, 385 (30%) responded; 102 respondents were female (26%) and 283 were male (74%). The female response rate of 21.1% was slightly greater than the proportion of females in ophthalmology in Canada in 2012 (data from Canadian Medical Association Masterfile).
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Practice patterns and training
Table 1 compares male and female ophthalmologists self-reported practice patterns and training. No differences were found between males and females in working Z31 hours per week (males 84%, females 79%; p ¼ 0.071), performing surgery (males 80%, females 70%; p ¼ 0.087), or performing laser refractive surgery (males 16%, females 10%; p ¼ 0.268). However, males were more likely to have Z2 operating days per month than females (64% vs 49%, respectively; p ¼ 0.01). No differences were reported in academic ranking, with 8% of males and 6% of females achieving full professor (p ¼ 0.12). Both males (58%) and females (53%) commonly had fellowship training (p ¼ 0.18), and no difference was seen in advanced degrees (doctorate/master’s) between the 2 cohorts (p ¼ 0.56). No difference was found in numbers of peer-review publications (p ¼ 0.08), university appointments (p ¼ 0.026), or hospital affiliation (geographic full time vs teaching hospital affiliation vs community based, p ¼ 0.12). Lifestyle patterns
Table 2 compares lifestyle patterns between male and female ophthalmologists. Although the majority of males (90%) and females (82%) reported being married or common-law, the proportion was statistically significantly greater for males (p ¼ 0.01). There was a significant difference in the profession and employment status of partners for males and females: males frequently have partners who are not working outside the house (17%) or working part time (41%) and in allied health professions (36%) or not in medicine (34%) (p o 0.001). Females more commonly have full-time working partners (72%) who are physicians (33%) or not in medicine (46%, p o 0.001). Females and males also report different household responsibilities, with females more likely to have higher Table 2—Comparison of lifestyle patterns between male and female ophthalmologists in Canada in 2012
Demographic/Family pattern parameter Hours as primary caregiver 0 hours 1–20 hours 21–40 hours 41þ hours No response Employment status of partner Working full time Working part time Not working outside the house No response/no partner Spouse’s profession Physician Allied health care Not in health care No response/no partner Number of children 0 1 2 3þ
Males, n (%) (N ¼ 283)
Females, n (%) (N ¼ 102)
p o0.001
76 129 18 16 44
(27) (45) (6) (6) (16)
7 33 20 20 22
(7) (32) (20) (20) (22)
85 116 48 34
(30) (41) (17) (12)
73 9 5 15
(72) (9) (5) (15)
51 102 96 34
(18) (36) (34) (12)
34 6 47 15
(33) (6) (46) (15)
29 24 89 141
(10) (9) (31) (50)
19 10 48 25
(19) (10) (47) (24)
o0.001
o0.001
o0.001
Gender differences in lifestyle and practice patterns—McAlister et al. numbers of hours as primary caregiver than males (p ¼ 0.001). Both males (90%) and females (81%) frequently report having children, but males report greater number of children (p o 0.001), as shown in Table 2. Both males (47%) and females (48%) report low comfort with taking parental leave (p ¼ 0.52), and 52% of females report parental leave taken with their first child as inadequate (p o 0.001). Figure 1 demonstrates the perceived impact of children on career progress, with 51% of females responding that it slowed or significantly slowed their career as compared with 15% of males (p o 0.001). Career satisfaction
Despite differences reported in surgical practice patterns and family patterns between males and females, no difference was found in satisfaction parameters rated on a 5-point Likert scale including number of hours worked (p ¼ 0.67), number of operating room hours (0.52), time management between career and personal responsibilities (p ¼ 0.08), flexibility of work schedule (p ¼ 0.56), relationships with work colleagues (p ¼ 0.12), and relationships with operating room staff (p ¼ 0.26). Both males (87%) and females (83%) report high satisfaction in their decision to pursue ophthalmology as a career (p ¼ 0.43).
DISCUSSION Practice patterns and training
Older studies suggest female physicians work significantly fewer hours than male physicians.8,9 This, however, does not hold true for Canadian female surgeons. Both 19912 and 20033 surveys demonstrate the majority of female surgeons and female ophthalmologists in Canada work full time. Our survey also found no difference between male and female ophthalmologists in the number of hours worked per week, corroborating this shift in practice patterns over time for females to work full time. The only difference between male and female practice patterns found in our study relates to surgical time per
Fig. 1 — Childbearing effect on career progress of male and female ophthalmologists in Canada in 2012. Differences are highly significant, p o 0.001.
month, where females more commonly operate o2 days per month compared with their male counterparts (p ¼ 0.01). Despite this difference, females and males have similar satisfaction ratings when asked about number of operating room hours worked (p ¼ 0.52). All other parameters of practice patterns and academic achievement had similar results for male and female ophthalmologists in Canada, including performing surgery, performing laser refractive surgery, and achieving top academic ranking. These parameters in earlier studies from 19912 and 20033 reported lower rates for females than males, suggesting an evolution of practice patterns over time for female ophthalmologists in Canada. In our survey, females and males also reported the same frequency of fellowship training and advanced degrees. Demographics and family patterns
In 1991, Canadian female surgeons remained primarily responsible for running their household, on top of often working 40 to 60 hours per week.10 More than 57% of female ophthalmologists reported being the primary caregivers, with 0% reporting that a spouse held primary responsibility for the household.2,10 In 2003, Jinapriya et al.3 reported similar findings in a survey of female and male Ontario ophthalmologists, but females still reported good satisfaction with personal life balance. Training in surgical specialties coincides with optimal timing for childbearing. In 1991, female surgeons practicing in Canada were much more likely than comparative employed females not to have children (43.5% vs 26%).10 Those who did have children were at a significantly older mean age at the birth of their first child (31 vs 24 years). Seventy-five percent of practicing female surgeons in 1991 did not have any formal maternity leave policy during their training, and the overwhelming majority, 89%, did not interrupt their training for family.10 Although practice patterns between males and females are becoming more similar, significant differences still exist in family patterns and responsibilities. In 2012, females report significantly higher numbers of hours as primary caregivers than their male counterparts (p o 0.001). Females are more likely to have partners who work full time, and males are more likely to have partners who work part time or are not working outside the house (p o 0.001). Females are more commonly married to physicians, and males are more commonly married to allied health care workers (p o 0.001). Jinapriya et al.3 reported similar trends among Ontario ophthalmologists in 2003, suggesting that trends in spousal employment influences the division of child care responsibilities. Career satisfaction
Despite these differences in family responsibilities, previous surveys of female ophthalmologists in Canada CAN J OPHTHALMOL — VOL. 49, NO. 3, JUNE 2014
289
Gender differences in lifestyle and practice patterns—McAlister et al. suggest an adequate ability to balance a surgical career with family life. In 1991, 57% (n ¼ 42) of female ophthalmologists reported satisfaction with time management between career and personal responsibilities, the highest of any female surgeon group in Canada.2 In 2003, Jinapriya et al.3 reported a mean of 3.08 on a 5point rating scale for female satisfaction in balancing career and personal life, with no difference found between males and females. In 2012, 36% of females were satisfied or extremely satisfied with their time management between career and personal responsibilities, with 23% reporting dissatisfaction. No difference was found between males and females in these ratings (p ¼ 0.08). We found male and female ophthalmologists across Canada to be equally satisfied with a selection of professional and personal parameters, despite significant differences seen in practice and family patterns. However, females report more frequently than males dissatisfaction with parental leave, with 52% reporting leave taken as inadequate (p o 0.001). The frequency of dissatisfaction with parental leave may decrease over time as Canadian residents are now protected under provincial union groups to ensure fair standards, and all provinces have maternity or parental benefits for nonsalaried physicians. In 1991, 58% of female surgeons believed that childbearing slowed their career progress.10 Similarly, in 2012, 51% of female ophthalmologists said childbearing slowed or significantly slowed their career (p o 0.001). This study has inherent limitations as a survey dependent on voluntary participation and self-reporting. Several survey questions are retrospective and may be influenced by recall bias. The overall response rate of 30% was good; however, the proportion of female respondents (26%) was slightly greater than the proportion of licensed female ophthalmologists in 2012 (21.2%), and may influence our results. To help encourage participation from both male and female Canadian ophthalmologists, the survey title specifically did not mention that the primary goal of the study was to compare sex responses.
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CONCLUSION The results of our survey found that female and male ophthalmologists have more similar practice patterns and academic achievements than previously reported, with the exception of monthly surgical time. Females report higher dissatisfaction than males regarding parental leave and the effect of childbearing on career progress, and significant differences exist in family patterns and household responsibilities. Despite these, both male and female ophthalmologists in Canada report similar career and personal satisfaction.
Disclosure: The authors have no proprietary or commercial interest in any materials discussed in this article. REFERENCES 1. Canadian Medical Association Bulletin. Medicine growing fast, changing fast. CMAJ. 2013;185:732. 2. Mackinnon SE, Mizgala CL, McNeill IY, Walters BC, Ferris LE. Women surgeons: career and lifestyle comparisons among surgical subspecialties. Plast Reconstr Surg. 1995;95:321-9. 3. Jinapriya D, Cockerill R, Trope GE. Career satisfaction and surgical practice patterns among female ophthalmologists. Can J Ophthalmol. 2003;38:373-8. 4. Danesh-Meyer HV, Deva NC, Ku JY, Carroll SC, Tan YW, Gamble G. Differences in practice and personal profiles between male and female ophthalmologists. Clin Experiment Ophthalmol. 2007;35:318-23. 5. Woodward Ca, Williams AP, Ferrier B, Cohen M. Time spent on professional activities and unwaged domestic work. Is it different for male and female primary physicians who have children at home? Can Fam Physician. 1996;42:1928-35. 6. Buys YM. Aging and feminization of the physician workforce in Canada—comparing ophthalmologists to all other physicians. Can J Ophthalmol. In press. 7. Canadian Medical Association’s Canadian Collaborative Centre for Physician Resources. Count and percent by specialty and sex, Canada, 2013. www.cma.ca/multimedia/CMA/Content_Images/ Inside_cma/Statistics/06SpecSex.pdf. Accessed August 28, 2013. 8. Uhlenberg P, Cooney TM. Male and female physicians: family and career comparisons. Soc Sci Med. 1990;30:373-8. 9. Williams AP, Domnick-Pierre K, Vayda E, Stevenson HM, Burke M. Women in medicine: practice patterns and attitudes. CMAJ. 1990;143:194-201. 10. Mizgala CL, Mackinnon SE, Walters BC, Ferris LE, McNeill IY, Knighton T. Women surgeons results of the Canadian population study. Ann Surg. 1993;218:37-46.
Comparison of lifestyle and practice patterns between male and female Canadian ophthalmologists Chryssa McAlister, MD, FRCSC,* Ya-Ping Jin, MD, PhD,*,† Rosa Braga-Mele, MD, FRCSC,* Beatrice F. DesMarchais, MD, FRCSC,‡ Yvonne M. Buys, MD, FRCSC§ ABSTRACT ● RÉSUMÉ Objective: To identify sex differences in lifestyle and practice patterns of Canadian ophthalmologists. Design: Web-based national survey. Participants: Members of the Canadian Ophthalmological Society. Methods: A 48-item questionnaire was sent electronically. Analysis of results was completed using χ2 and Fisher’s exact tests where appropriate. Results: Of 385 respondents (30%), 102 were female and 283 male. Several statistically significant differences exist in lifestyle and practice patterns. Fifty-one percent of females operate less than 2 days per month as compared with 36% of males (p ¼ 0.01) despite similar clinical hours. No statistically significant differences were found in other practice pattern parameters including laser refractive surgery, hospital affiliation, university appointment/rank, and number of peer-review publications. Ninety percent of males and 81% of females report having Z1 children, but males report greater number of children (p o 0.001). Females are commonly the primary caregiver, whereas males report their partner as primary caregiver (p o 0.001). Fifty-two percent of females are unhappy with the amount of parental leave (p o 0.001). Fifty-one percent of females believe that childbearing slowed or markedly slowed career progress, as compared with 15% of males (p o 0.001). Both female (83%) and male (87%) ophthalmologists report high career satisfaction (p ¼ 0.43). Conclusions: Differences in practice patterns between males and females in our analysis surround surgical time, with no difference seen in other practice patterns or academic achievements. Differences in family patterns surround household and childrearing duties. Despite differences, both males and females report high satisfaction across several professional and personal parameters. Compared with previous studies, this suggests a change in practice patterns over time. Objet : Identifier les différences associées au sexe dans le genre de vie et les modes de pratique des ophtalmologistes canadiens. Nature : Sondage national par Internet. Participants : Membres de la Société canadienne d’ophtalmologie. Méthodes : Questionnaire électronique en 48 points. L’analyse des résultats a été complétée par chi-carré et un test d’exactitude Fisher au besoin. Résultats : Parmi les 385 répondants (30 %), 102 étaient des femmes et 283 des hommes. Il y avait plusieurs différences statistiquement significatives concernant le style de vie et les modes de pratique. 51 % des femmes opèrent o2 jour par mois comparativement à 36 % des hommes (p=0,01), malgré la similitude des heures de clinique. Aucune différence statistiquement significative n’a été trouvée dans les paramètres des autres modes de pratique, y compris la chirurgie réfractive au laser, l’affiliation hospitalière, les postes ou échelons universitaires et le nombre de publications révisées par les pairs. 90 % des hommes et 81 % des femmes ont dit avoir un ou plusieurs enfants, mais les hommes ont indiqué un plus grand nombre d’enfants (po0,001). Les femmes sont généralement les principales dispensatrices de soins, alors que les hommes indiquent leurs partenaires comme principaux dispensateurs de soins (po0,001). 52 % des femmes ne sont pas contentes de la somme des allocations de congé parental (po0,001). 51 % des femmes pensent que la maternité a ralenti ou diminué remarquablement l’évolution des carrières, comparativement à 15 % des hommes (po0,001). Dans les deux sexes, 83 % des femmes et 87 % des hommes, les ophtalmologistes ont fait état d’une grande satisfaction de leur carrière. (p=0,43). Conclusions : Les différences des modes de pratique entre les hommes et les femmes dans notre analyse marquent le temps chirurgical et aucune différence n’a été observée dans les autres modes de pratique ou les réalisations académiques. Les différences de vie familiale soulignent les responsabilités domestiques et le devoir d’éducation des enfants. Malgré les différences, les hommes et les femmes ont tous deux fait état d’une grande satisfaction sous plusieurs paramètres professionnels et personnels. Comparativement aux études précédentes, cela suggère un changement des modes de pratique avec le temps.
Despite the increasing proportion of females in medicine in Canada,1 those pursuing surgical specialties still face barriers. Data from surveys of Canadian female surgeons in 19912 and male and female Ontario ophthalmologists
in 2003 demonstrate specific academic and social challenges.3 These challenges include achieving top academic positions, obtaining surgical time, balancing work and household responsibilities, and childbearing during
From the *Department of Ophthalmology and Vision Sciences; †Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; ‡ Médecine-Département d’Ophtalmologie et d’Oto-Rhino-LaryngologieChirurgie Cervico-Faciale, Université Laval, Quebec City, Que.; and § Department of Ophthalmology and Vision Sciences, Toronto Western Hospital, Toronto, Ont.
Can J Ophthalmol 2014;49:287–290 0008-4182/14/$-see front matter & 2014 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjo.2014.02.007
Originally received Aug. 30, 2013. Final revision Feb. 7, 2014. Accepted Feb. 10, 2014 Correspondence to Yvonne M. Buys, MD, Toronto Western Hospital, 399 Bathurst Street, EW 6-405, Toronto ON M5T 2S8; [email protected] CAN J OPHTHALMOL — VOL. 49, NO. 3, JUNE 2014
287
Gender differences in lifestyle and practice patterns—McAlister et al. Table 1—Comparison of practice patterns and training between male and female ophthalmologists in Canada in 2012 Practice pattern parameter Full-time work hours (31þ/week) Perform surgery Perform laser refractive surgery Z2 operating room days/month Top university rank (full professor) Fellowship training Advanced degrees (doctorate/ master’s)
Males, n (%) Females, n (%) (N ¼ 283) (N ¼ 102) 238 226 45 181 23 164 42
(84) (80) (16) (64) (8) (58) (15)
81 71 10 50 6 54 19
(79) (70) (10) (49) (6) (53) (19)
p 0.071 0.087 0.268 0.01* 0.12 0.18 0.56
*A significant value.
training. Similar findings have been described in a 2005 survey of New Zealand male and female ophthalmologists,4 and of other female physicians in Canada.5 The number of females in ophthalmology and medicine continues to increase.6 In 2000, 28.4% of all practicing physicians in Canada were females and that percentage increased to 36.9% in 2013. Although the proportion of females in surgical specialties is lower than the national average, this number is also increasing from 13.8% in 2000 to 23.1% in 2013. The corresponding figures for ophthalmology are 16.3% in 2000 and 21.6% in 2013.7 Given the increasing proportion of females in ophthalmology, we undertook this study to provide an update comparison of lifestyle and practice patterns between male and female ophthalmologists in Canada.
METHODS A 48-item questionnaire in both official languages was sent by electronic mail in 2012 to all male and female ophthalmologist members of the Canadian Ophthalmological Society using Survey Monkey, an online survey tool. A reminder email was sent to nonresponders at 2 weeks, and the survey was closed after 2 months. Confidentiality was achieved through enhanced server side inclusion encryption. Anonymity was maintained with a unique numerical identifier for data analysis. Research Ethics Board approval was obtained through the University Health Network. Univariate differences between male and female respondents were compared using the χ2 test for continuous variables or Fisher’s exact test for categorical variables as appropriate. SAS version 9.3 (SAS Institute, Cary, N.C.) was used for the analysis. Statistically significant level was set at p ¼ 0.05.
RESULTS Of the 1278 ophthalmologists across Canada who were invited to participate in the survey, 385 (30%) responded; 102 respondents were female (26%) and 283 were male (74%). The female response rate of 21.1% was slightly greater than the proportion of females in ophthalmology in Canada in 2012 (data from Canadian Medical Association Masterfile).
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CAN J OPHTHALMOL — VOL. 49, NO. 3, JUNE 2014
Practice patterns and training
Table 1 compares male and female ophthalmologists self-reported practice patterns and training. No differences were found between males and females in working Z31 hours per week (males 84%, females 79%; p ¼ 0.071), performing surgery (males 80%, females 70%; p ¼ 0.087), or performing laser refractive surgery (males 16%, females 10%; p ¼ 0.268). However, males were more likely to have Z2 operating days per month than females (64% vs 49%, respectively; p ¼ 0.01). No differences were reported in academic ranking, with 8% of males and 6% of females achieving full professor (p ¼ 0.12). Both males (58%) and females (53%) commonly had fellowship training (p ¼ 0.18), and no difference was seen in advanced degrees (doctorate/master’s) between the 2 cohorts (p ¼ 0.56). No difference was found in numbers of peer-review publications (p ¼ 0.08), university appointments (p ¼ 0.026), or hospital affiliation (geographic full time vs teaching hospital affiliation vs community based, p ¼ 0.12). Lifestyle patterns
Table 2 compares lifestyle patterns between male and female ophthalmologists. Although the majority of males (90%) and females (82%) reported being married or common-law, the proportion was statistically significantly greater for males (p ¼ 0.01). There was a significant difference in the profession and employment status of partners for males and females: males frequently have partners who are not working outside the house (17%) or working part time (41%) and in allied health professions (36%) or not in medicine (34%) (p o 0.001). Females more commonly have full-time working partners (72%) who are physicians (33%) or not in medicine (46%, p o 0.001). Females and males also report different household responsibilities, with females more likely to have higher Table 2—Comparison of lifestyle patterns between male and female ophthalmologists in Canada in 2012
Demographic/Family pattern parameter Hours as primary caregiver 0 hours 1–20 hours 21–40 hours 41þ hours No response Employment status of partner Working full time Working part time Not working outside the house No response/no partner Spouse’s profession Physician Allied health care Not in health care No response/no partner Number of children 0 1 2 3þ
Males, n (%) (N ¼ 283)
Females, n (%) (N ¼ 102)
p o0.001
76 129 18 16 44
(27) (45) (6) (6) (16)
7 33 20 20 22
(7) (32) (20) (20) (22)
85 116 48 34
(30) (41) (17) (12)
73 9 5 15
(72) (9) (5) (15)
51 102 96 34
(18) (36) (34) (12)
34 6 47 15
(33) (6) (46) (15)
29 24 89 141
(10) (9) (31) (50)
19 10 48 25
(19) (10) (47) (24)
o0.001
o0.001
o0.001
Gender differences in lifestyle and practice patterns—McAlister et al. numbers of hours as primary caregiver than males (p ¼ 0.001). Both males (90%) and females (81%) frequently report having children, but males report greater number of children (p o 0.001), as shown in Table 2. Both males (47%) and females (48%) report low comfort with taking parental leave (p ¼ 0.52), and 52% of females report parental leave taken with their first child as inadequate (p o 0.001). Figure 1 demonstrates the perceived impact of children on career progress, with 51% of females responding that it slowed or significantly slowed their career as compared with 15% of males (p o 0.001). Career satisfaction
Despite differences reported in surgical practice patterns and family patterns between males and females, no difference was found in satisfaction parameters rated on a 5-point Likert scale including number of hours worked (p ¼ 0.67), number of operating room hours (0.52), time management between career and personal responsibilities (p ¼ 0.08), flexibility of work schedule (p ¼ 0.56), relationships with work colleagues (p ¼ 0.12), and relationships with operating room staff (p ¼ 0.26). Both males (87%) and females (83%) report high satisfaction in their decision to pursue ophthalmology as a career (p ¼ 0.43).
DISCUSSION Practice patterns and training
Older studies suggest female physicians work significantly fewer hours than male physicians.8,9 This, however, does not hold true for Canadian female surgeons. Both 19912 and 20033 surveys demonstrate the majority of female surgeons and female ophthalmologists in Canada work full time. Our survey also found no difference between male and female ophthalmologists in the number of hours worked per week, corroborating this shift in practice patterns over time for females to work full time. The only difference between male and female practice patterns found in our study relates to surgical time per
Fig. 1 — Childbearing effect on career progress of male and female ophthalmologists in Canada in 2012. Differences are highly significant, p o 0.001.
month, where females more commonly operate o2 days per month compared with their male counterparts (p ¼ 0.01). Despite this difference, females and males have similar satisfaction ratings when asked about number of operating room hours worked (p ¼ 0.52). All other parameters of practice patterns and academic achievement had similar results for male and female ophthalmologists in Canada, including performing surgery, performing laser refractive surgery, and achieving top academic ranking. These parameters in earlier studies from 19912 and 20033 reported lower rates for females than males, suggesting an evolution of practice patterns over time for female ophthalmologists in Canada. In our survey, females and males also reported the same frequency of fellowship training and advanced degrees. Demographics and family patterns
In 1991, Canadian female surgeons remained primarily responsible for running their household, on top of often working 40 to 60 hours per week.10 More than 57% of female ophthalmologists reported being the primary caregivers, with 0% reporting that a spouse held primary responsibility for the household.2,10 In 2003, Jinapriya et al.3 reported similar findings in a survey of female and male Ontario ophthalmologists, but females still reported good satisfaction with personal life balance. Training in surgical specialties coincides with optimal timing for childbearing. In 1991, female surgeons practicing in Canada were much more likely than comparative employed females not to have children (43.5% vs 26%).10 Those who did have children were at a significantly older mean age at the birth of their first child (31 vs 24 years). Seventy-five percent of practicing female surgeons in 1991 did not have any formal maternity leave policy during their training, and the overwhelming majority, 89%, did not interrupt their training for family.10 Although practice patterns between males and females are becoming more similar, significant differences still exist in family patterns and responsibilities. In 2012, females report significantly higher numbers of hours as primary caregivers than their male counterparts (p o 0.001). Females are more likely to have partners who work full time, and males are more likely to have partners who work part time or are not working outside the house (p o 0.001). Females are more commonly married to physicians, and males are more commonly married to allied health care workers (p o 0.001). Jinapriya et al.3 reported similar trends among Ontario ophthalmologists in 2003, suggesting that trends in spousal employment influences the division of child care responsibilities. Career satisfaction
Despite these differences in family responsibilities, previous surveys of female ophthalmologists in Canada CAN J OPHTHALMOL — VOL. 49, NO. 3, JUNE 2014
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Gender differences in lifestyle and practice patterns—McAlister et al. suggest an adequate ability to balance a surgical career with family life. In 1991, 57% (n ¼ 42) of female ophthalmologists reported satisfaction with time management between career and personal responsibilities, the highest of any female surgeon group in Canada.2 In 2003, Jinapriya et al.3 reported a mean of 3.08 on a 5point rating scale for female satisfaction in balancing career and personal life, with no difference found between males and females. In 2012, 36% of females were satisfied or extremely satisfied with their time management between career and personal responsibilities, with 23% reporting dissatisfaction. No difference was found between males and females in these ratings (p ¼ 0.08). We found male and female ophthalmologists across Canada to be equally satisfied with a selection of professional and personal parameters, despite significant differences seen in practice and family patterns. However, females report more frequently than males dissatisfaction with parental leave, with 52% reporting leave taken as inadequate (p o 0.001). The frequency of dissatisfaction with parental leave may decrease over time as Canadian residents are now protected under provincial union groups to ensure fair standards, and all provinces have maternity or parental benefits for nonsalaried physicians. In 1991, 58% of female surgeons believed that childbearing slowed their career progress.10 Similarly, in 2012, 51% of female ophthalmologists said childbearing slowed or significantly slowed their career (p o 0.001). This study has inherent limitations as a survey dependent on voluntary participation and self-reporting. Several survey questions are retrospective and may be influenced by recall bias. The overall response rate of 30% was good; however, the proportion of female respondents (26%) was slightly greater than the proportion of licensed female ophthalmologists in 2012 (21.2%), and may influence our results. To help encourage participation from both male and female Canadian ophthalmologists, the survey title specifically did not mention that the primary goal of the study was to compare sex responses.
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CONCLUSION The results of our survey found that female and male ophthalmologists have more similar practice patterns and academic achievements than previously reported, with the exception of monthly surgical time. Females report higher dissatisfaction than males regarding parental leave and the effect of childbearing on career progress, and significant differences exist in family patterns and household responsibilities. Despite these, both male and female ophthalmologists in Canada report similar career and personal satisfaction.
Disclosure: The authors have no proprietary or commercial interest in any materials discussed in this article. REFERENCES 1. Canadian Medical Association Bulletin. Medicine growing fast, changing fast. CMAJ. 2013;185:732. 2. Mackinnon SE, Mizgala CL, McNeill IY, Walters BC, Ferris LE. Women surgeons: career and lifestyle comparisons among surgical subspecialties. Plast Reconstr Surg. 1995;95:321-9. 3. Jinapriya D, Cockerill R, Trope GE. Career satisfaction and surgical practice patterns among female ophthalmologists. Can J Ophthalmol. 2003;38:373-8. 4. Danesh-Meyer HV, Deva NC, Ku JY, Carroll SC, Tan YW, Gamble G. Differences in practice and personal profiles between male and female ophthalmologists. Clin Experiment Ophthalmol. 2007;35:318-23. 5. Woodward Ca, Williams AP, Ferrier B, Cohen M. Time spent on professional activities and unwaged domestic work. Is it different for male and female primary physicians who have children at home? Can Fam Physician. 1996;42:1928-35. 6. Buys YM. Aging and feminization of the physician workforce in Canada—comparing ophthalmologists to all other physicians. Can J Ophthalmol. In press. 7. Canadian Medical Association’s Canadian Collaborative Centre for Physician Resources. Count and percent by specialty and sex, Canada, 2013. www.cma.ca/multimedia/CMA/Content_Images/ Inside_cma/Statistics/06SpecSex.pdf. Accessed August 28, 2013. 8. Uhlenberg P, Cooney TM. Male and female physicians: family and career comparisons. Soc Sci Med. 1990;30:373-8. 9. Williams AP, Domnick-Pierre K, Vayda E, Stevenson HM, Burke M. Women in medicine: practice patterns and attitudes. CMAJ. 1990;143:194-201. 10. Mizgala CL, Mackinnon SE, Walters BC, Ferris LE, McNeill IY, Knighton T. Women surgeons results of the Canadian population study. Ann Surg. 1993;218:37-46.
