Diversity & Equality in Health and Care Open Access

Abstract

The low number of female physicians in Japan is a significant diversity management issue. Policies such ‘positive action’ are needed to improve gender equality and eliminate gender barriers that form obstacles to female physicians who continue working as well as rearing children. This study investigated factors related to openness in implementing ‘positive action’ in healthcare organizations and in extending work-term appointments for child rearing among female physicians in Japan. A cross-sectional, self-administered questionnaire with 34 questions was distributed to 2,159 medical school alumni in 2011. Primary outcome measures were ῾openness in implementing ‘positive action’ in academic hospitals’ and in ῾extending work-term appointments for child rearing’. Statistically significant relationships were identified using chisquare tests. A total of 453 responses were received: 51.7% females and 23.7% males approved to implement ‘positive action’. Gender, Makiko Arima 147 Introduction Diversity management is a process intended to create and maintain a positive work environment in which the similarities and differences of individuals are valued (Patrick and Kumar, 2012). Effective diversity management is recognized in contemporary human resource management as a key to improving organizational performance, client service delivery and employee satisfaction (Victoria State Government, Australia, 2012). Many Japanese enterprises and local governments have started holding seminars on business skills and leadership such as the decision making process and how to become a motivational leader; they are implementing approaches to diversity management, such as introducing female promotion policies ‘to set targets for the employment, and promotion to managerial positions of women’, and flexible working systems, such as short work hours and work sharing. However, despite these advances, very few health organizations/hospitals in Japan have implemented any diversity management approaches; to date none has been listed among the enterprises included in the Japanese ‘Diversity Management Selection 100’ (Japanese Ministry of Economy, Trade and Industry, 2015). The low number of female physicians is a significant issue in clinical settings, including academic hospitals. In Japan, approximately 30% of students enrolled in medical schools are female but this percentage decreases by the time they finish training; female physicians account for only 19.7% (n=303268) of the medical workforce and this percentage decreases with age. Female physicians in their 30s make up approximately 30% of the medical workforce; those in their 40s, account for 20.4% and by their 50s and 60s only 13.0% and 9.7% respectively (Japanese Ministry of Health, Labour and Welfare, 2012). This situation has led to an underrepresentation of female physicians in senior positions and academic settings as well as an unbalanced gender distribution in clinical settings (Hancke et al. 2014). In many developed countries women still account for only a small percentage of those in prominent leadership positions in academia (Wietsma, 2014). An explanation given for the gender inequity in promotion is that women work fewer hours because of family obligations (Wietsma, 2014). The institutional and cultural structures of organizations/academic medicine affect gender inequity. Female physicians have reported that one of the causes of stress at work was the male-dominated society (Japan Medical Association Committee on Gender Equality, 2009). The women needed a ‘gender-equal support system at workplace’ to continue their career (Japan Medical Association Committee on Gender Equality, 2010). ‘Positive action’ is a term referring to the elimination of all forms of discrimination against women. It is defined as ῾positive provision of the opportunities stipulated in the preceding item to either women or men within the necessary limits in order to redress gender disparities in terms of such opportunities.’ (Cabinet Office, Government of Japan, 2011). Balancing family life and clinical practice is still challenging for Japanese female physicians. In a survey by the Japanese Medical Association Committee on Gender Equality (2009) 70% (n=2931) of female and male respondents reported that they had to forgo promising careers because of difficulties in raising children, balancing family life and a career. The proportion of Japanese physicians of both genders taking leave following childbirth is relatively low at 27.6% (n=2,978) (Japan Medical Association Committee on Gender Equality, 2010), and only 2.6% (n=4,286) of male physicians request paternity leave (Japan Medical Association Committee on Gender Equality, 2014). These findings indicate that, in clinical settings, the working environment does not support the physicians’ need for a family life and leads to loss of expertise. In the Japanese clinical work system and in academic medicine, a work-term appointment is given to each physician at the beginning of their employment. This term is not usually extended, even for pregnancy, child rearing or care-giving for the elderly, although this is at the discretion of each health organization. Consequently, many Japanese female physicians have to either abandon their career development or give up on having children. If more organizations approved extensions of work-term appointments for family life it would help women to continue their careers as physicians and maintain work-life balance (WLB). Male physicians with children should be able to do the same. Research design Diversity management is a process intended to create and maintain a positive work environment, where similarities and differences between individuals are valued. Thus we assumed that maintaining job and WLB satisfaction may lead to creating awareness of workplace diversity. In clinical practice, where long working hours are common, improving WLB is a challenge. Previous studies have indicated that WLB has an impact on various workplace and personal outcomes in many having children, average weekly work hours, and satisfaction with work-life balance (WLB) were factors related to openness in implementing ‘positive action’. Not having a specialist licence, specialty, dissatisfaction with their current position and satisfaction with their WLB were related to openness in extending work-term appointments for child rearing. Logistic regression analysis indicated that among female physicians with children, working 41–60 h/week and satisfied with their WLB, showed greater openness to implementing ‘positive action’ . Physicians with no specialist licence, those specialized in internal medicine and those unsatisfied with their current position showed greater openness to extending work-term appointments for child rearing. Female physicians urgently require reduced working hours and a WLB-friendly working environment. Flexible working hours with part-time options and work sharing could help to achieve a gender-equal workplace for female physicians with children. Improving awareness of gender-equality and extension of work-term appointments to accommodate family life will enhance female physicians’ career development and improve work environments, gender equality and equal opportunity in the workplace.