Women are progressively outnumbering men in many medical schools. In anaesthesia, the percentage of women entering the workforce has modestly increased by 7% in the United Kingdom and 8% in Norway but has decreased in several other countries such as Germany, France and the Czech Republic.1,2 Professional perspectives, expected revenue and personal satisfaction are recognised drivers in the choice of the speciality of anaesthesia by women.3 There is a paucity of data available on gender differences in the level of professional satisfaction and promotion of anaesthetists, particularly in high-income countries. We therefore performed a cross-sectional study in all French and Italian speaking cantons of Switzerland to assess anaesthetists’ professional characteristics, job satisfaction and expectations and compared men with women.
Following ethical committee waiver of the Geneva University Hospitals Ethics committee (Chairperson Professor O. Irion) on 27 February 2009, study coordinators in each public or private hospital provided a 103-item questionnaire to anaesthetists (in training or certified) practicing anaesthesia as a main activity. Data collected included personal information (i.e. sex, age, family status and professional training) and information on professional activity (i.e. type of institution, professional career and life plan, activity ratio and characteristics). Participant's satisfaction was measured with a 17-item validated measurement tool developed for the Johns Hopkins precursor study and that addressed five dimensions of satisfaction: income prestige, work-related burden, patient care, personal rewards and professional relations with colleagues.4 We added to the questionnaire a generic scale (Likert scale with 1 = extremely dissatisfied and 7 = extremely satisfied) for the rating of overall job satisfaction.
Anonymity was guaranteed by a strict separation between study participation Identity number numbers (only available to study managers)-Guy Haller/Chantal Mamie) and the detailed list of participants’ names (only in possession of local study coordinators). Up to a maximum of three reminders were sent to all participants.
For descriptive analyses, we used frequency tables and proportions, stratified by gender. For satisfaction measurement each crude score of the 17-item questionnaire was summarised as means and SD and a standardised aggregated score on a 1 to 100 scale created. Comparisons were adjusted for age, type of compensation, type of position, working hours and family status using linear regression. χ2 and Fisher's exact test or binary logistic regression were used for other comparisons. The statistical Package for Social Sciences, version 21.0 was used.
Overall, 413 (82%) of the 506 invited anaesthetists completed the questionnaire. We found that the majority of women (80.1%) were younger than 50 years compared with 59.1% of men and more often had training positions. One of the reasons to explain this phenomenon could be Switzerland's high dependence on foreign trainees. As the proportion of women among trainees from foreign origin was higher than men, this may explain this imbalance.
More women (40.2%) than men (11.3%) worked part-time and were paid with a fixed salary (59.2 vs.46.6%). High-income compensations (fee for service) were provided more often to men (36.9%) than women (22.9%). There were no women chairing a department as a full professor and only 5.2% of women had a leadership position as co-chair or head of a division in a public or private hospital. The latter may be because of a generation gap between women and men. Women have only recently entered this male-dominated specialty and may therefore not yet have reached the level of seniority and age required for leadership positions. Another possible explanation could be the ‘glass-ceiling phenomenon’. This refers to a concealed barrier that hinders women from rising above a certain level in corporations.5 It is built on both traditional perspectives over gender roles and lack of effective same-sex mentors because of the scarcity of women in senior positions. In addition, women are still traditionally in charge of child care, even in dual-career couples.6 As a result, time spent at work and opportunities to develop a network of potential sponsors are lower for women. This is confirmed in our study with 36.2% of women working more than 50 h/week compared with 63.3% of men (Table 1).
The majority of women (85.5%) and men (79.8%) were somewhat satisfied to very satisfied. There were no significant gender differences for any of the dimensions of professional satisfaction even after adjustment for differences in age, type of compensation, professional position, working hours and family status (Fig. 1). These results are surprising since in our study, women received lower compensation and had lower leadership positions compared with men. This may be because of the fact that professional satisfaction of anaesthetists may relate more to professional autonomy, the practical nature of work and relations with patients and colleagues.7 Income or professional prestige may have less impact on the overall level of satisfaction than previously thought.3
This study has a number of limitations. First, the cross-sectional design of the study does not allow causal inferences to be made but only hypotheses to be generated. Secondly, we did not include anaesthetists working in ICU care and lacked information on this category of professionals. Finally, we mainly assessed gender differences in job satisfaction related to income-prestige, work-related burden, patient care, personal rewards and professional relations with colleagues. Many other aspects that may also influence professional satisfaction such as personal health status, stress at work, personality types and cultural bias, were not measured.
Despite these limitations, this study identified in a high-income country, Switzerland, a number of differences between men and women anaesthetists: a lower income and an underrepresentation of women in leadership positions. Thus, to enhance female presence and engagement into prolonged career development in anaesthesia, these issues should be addressed.
Acknowledgements relating to this article
Assistance with the study: the authors would like to thank all the members of the Commission for Anaesthesia Training of Latin Switzerland (COMASUL) as well as all the local study coordinators. The authors are also grateful to Mrs Anne-Gabrielle de Haller who coordinated the data collection process and contributed to the organization of the whole study.
Financial support and sponsorship: the study was supported by a grant from the Department of Anaesthesiology, Clinical Pharmacology and Intensive Care Medicine, Geneva University Hospitals.
Conflicts of interest: none.
1. Egger Halbeis CB, Cvachovec K, Scherpereel P, et al. Anaesthesia workforce in Europe. Eur J Anaesthesiol
2. Fauvet L. Les affectations des étudiants en médecine à l’issue des épreuves classantes nationales en 2010. Études et Résultats- Direction de la recherche, des études, de l’évaluation et des statistiques (DREES)
3. Augustin ID, Long TR, Rose SH, Wass CT. Recruitment of house staff into anesthesiology: a longitudinal evaluation of factors responsible for selecting a career in anesthesiology and an individual training program. J Clin Anesth
4. McMurray JE, Williams E, Schwartz MD, et al. Physician job satisfaction: developing a model using qualitative data. J Gen Intern Med
5. Carnes M, Morrissey C, Geller SE. Women's health and women's leadership in academic medicine: hitting the same glass ceiling? J Womens Health (Larchmt)
6. Hofoss D, Gjerberg E. Physicians’ working hours. Tidsskrift for den Norske laegeforening
7. Kluger MT, Townend K, Laidlaw T. Job satisfaction, stress and burnout in Australian specialist anaesthetists. Anaesthesia