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Minority physicians provide care in a manner that promotes patient satisfaction and meets the needs of an increasingly diverse U.S. population. In addition, minority medical school faculty bring diverse perspectives to research and teach cross-cultural care. However, men and women of color remain underrepresented among medical school faculty, particularly in the higher ranks. National data show that although the numbers of women in medicine have increased, minority representation remains essentially static. Studying minority women faculty as a group may help to improve our understanding of barriers to diversification. Six National Centers of Excellence in Women's Health used a variety of approaches in addressing the needs of this group. Recommendations for other academic institutions include development of key diversity indicators with national benchmarks, creation of guidelines for mentoring and faculty development programs, and support for career development opportunities.

The health system in Lithuania before independence was the same centralized system, the Semashko model that was prevalent throughout the former Soviet Union. The Soviet system focused more on quantity than quality, which resulted in a greater number of physicians per 100,000 than found in Western Europe. As in other Central and Eastern European countries, the health system in Lithuania has undergone substantial change since 1990. A major part of the reform of physician workforce in the former communist countries has been development of primary health care as a centerpiece of the health systems. This move in Lithuania has been hindered to some degree by the shortage of general or family practitioners. The focus on specialists in the old Soviet system led to a severe shortage of physicians in general practice. Only about 10% of physicians were general practitioners (GPs) in 1993 compared to a European Union average of 35%. That percentage had increased to 16% by 1998. Programs have been established to both train new GPs and to retrain specialists to become GPs, although a shortage of teachers and finances are problems facing these programs. Although the physician workforce in Lithuania has undergone substantial reform since 1990, real change has been slow. The physician to population ratio in Lithuania has failed to decline, moving from 387 per 100,000 population in 1991 to 398 in 1997, before dropping to 395 in 1998. The ratio remains substantially higher than current EU averages, reflecting a difficulty in reducing the number of physicians. Here we review what has happened to the physician workforce in Lithuania since independence and evaluate policies implemented. Efforts to reduce the number of physicians are also assessed. The results in Lithuania are compared to those in other CEE countries and to EU averages.

Background: Several studies have shown that the percentage of women represented in senior academic positions at US medical schools is lower than the percentage of men in senior positions. Similarly, the percentage of minority faculty members represented in senior academic positions is lower than that of their majority counterparts. This study assessed whether these findings were also present in departments of family medicine and identified any factors related to the institution or department that favored academic success for women and minorities., Methods: Data regarding faculty workforce composition, including faculty rank and rank for women and underrepresented minorities, were extracted from a comprehensive survey of departments of family medicine at US allopathic medical schools. The data are based on faculty workforce in 1997 and include responses from 58 (51%) of all schools with a department of family medicine., Results: Faculty in departments of family medicine were more likely to be female (41% versus 25%) and an underrepresented minority (9% versus 4%), compared with all academic medicine disciplines. However, women in full-time positions were less likely than men, and minorities were less likely than nonminorities, to be either an associate or full professor. We could find no institutional or departmental characteristics that were associated with academic success for women or minority faculty members., Conclusions: While women and underrepresented minorities are more common to the faculty workforce in family medicine, members of both of these groups are not well represented in senior faculty ranks.

As increasing numbers of female physicians enter the specialty of obstetrics and gynecology, their productivity (defined as producing goods and services) as compared with male physicians becomes important. Data from the American Medical Association socioeconomic survey and from a survey of ACOG Fellows indicate that, as a group, female physicians in the specialty are approximately 85% as productive as male physicians in the specialty. ACOG data for physician net income validate the productivity calculations (P <.03). The increasing numbers of female physicians in the specialty will lead to a decreasing aggregate productivity. At the same time, the increasing numbers of women of all ages in the United States will lead to a decline in the available obstetrician-gynecologist work force beginning in the year 2010.

Background: Of 5,812 persons boarded by the American Board of Thoracic Surgery (ABTS), 99 (< 2%) are women. This study was designed to collect and report the contributions made by these women in the specialty of cardiothoracic surgery., Methods: Identification of ABTS board-certified women was obtained from the ABTS. Compilation of data was accomplished through membership databases, medical licensing boards, thoracic surgery residency programs, and residency program attending surgeons. Data were substantiated through hospital medical staff offices, local practitioners, and personal telephone calls. Curricula vitae were requested; practice types (adult, pediatric, cardiac, general thoracic, or transplantation) were established. Data were collated, extrapolated, and tallied. Trends over time were analyzed by logistic regression analyses., Results: Currently, 84 women are actively practicing: 44 have academic appointments and 40 are in private practice. Of the remaining 15 women, 4 are deceased; 4 are retired; 5 are in other professional fields; and 2 are in an unknown practice setting. Accumulated data confirmed that women surgeons are practicing in every type and subgroup of cardiothoracic surgery (adult, pediatric, cardiac, general thoracic, transplantation, and combinations of these). Collectively, they have published 2,292 articles and book chapters. Manuscripts directly related to cardiac topics number 1,220. Women in cardiothoracic surgical research have been awarded $31.9 million in grant funds. Two trends over time were identified. First, the distribution of practice setting (academic or private) was stable compared with year of board certification. Secondly, a statistically significant rise in the annual percentage of board-certified persons who are women (p < 0.0001) has been established., Conclusions: The percent of ABTS board-certified women surgeons has increased; more than 50% have academic appointments; and a stable trend for women to choose academic cardiothoracic surgery exists.

Background and Objective: In Germany leadership positions in medicine are characterized by an almost complete lack of women. The goal of this study was to determine the representation of women among different career ranks during medical school, residency and academic advancement during the past 20 years., Methods: The annual reports of the German Federal Statistic Office in Wiesbaden were checked for the numbers of medical students, dissertations, physicians, internists, fellows and trainees at universities, habilitations and professorships., Results: Among medical students, final examination, dissertation, physicians, internists and trainees at universities a proportion of women can be found nowadays which is at a 15% higher percentage level than 20 years ago. Among assistant professors and habilitations at universities there is a very low proportion of women, which did increase only slightly from 5 to 10% during the past 20 years. Within the same period of time the total number of professors and the proportion of female professors were nearly unchanged. Reunification of East and West Germany led to an increase of the representation of women among all levels of qualification which is due to the much higher proportion of female physicians in the former GDR., Conclusions: The lack of women in leadership positions in medicine in Germany is not due to a general lack of women in medicine. Among all other career ranks the proportion of women increased by 15%. The completely unchanged number and composition of the professors during the past 20 years suggests that the lack of women among this professional group has to do with conservatism which is an inherent trait of university professors in Germany.

This article looks at the nation's community and migrant health centers, where substantial numbers of female physicians are medical directors, the second highest executive position, in search of insights for managed care organizations for recruiting and retaining women medical directors. This paper provides the first comparative national profile of women and men community and migrant health center (C/MHC) medical directors in terms of their personal and work characteristics, as well as job satisfaction. The study findings indicate that, for the most part, female medical directors do not differ much from their male colleagues in issues of work characteristics or job satisfaction.

The increasing numbers of women in medicine in western societies has raised the issue about their impact on medical practice. As a way of addressing the issue, this paper explores women's position in medicine in the Nordic countries, where the medical profession will soon be gender-balanced. Support for both a ghettoization and a vanguard argument for women physicians can be documented. The final section offers three sociological perspectives--the socialization theory, the neo-Weberian, and the social constructionist--as theoretical explanations for the gender segregation of medicine and as diagnostic paradigms and potential heuristic devices to aid women's empowerment as medical providers.

While the number of women entering U.S. medical schools has risen substantially in the past 25 years, the number of women in leadership positions in academic medicine is disproportionately small. The traditional pathway to academic leadership is through research. Women's health research is an ideal venue to fill the pipeline with talented women physicians and scientists who may become academic leaders in positions where they can promote positive change in women's health as well as mentor other women. The Office on Women's Health (OWH) in the U.S. Department of Health and Human Services has contracted with 18 academic medical centers to develop National Centers of Excellence in Women's Health. Emphasizing the integral link between women's health and women leaders, each of the Centers of Excellence must develop a leadership plan for women in academic medicine as part of the contract requirements. This paper describes the training programs in women's health research that have developed at five of the academic medical centers: the University of Wisconsin, Magee Women's Hospital, the University of Maryland, Medical College of Pennsylvania Hahnemann University, and the University of Illinois at Chicago. We discuss some of the challenges faced for both initiation and future viability of these programs as well as criteria by which these programs will be evaluated for success.

Women now constitute 43% of US medical students, 37% of residents, and 27% of full-time medical school faculty. Less than 11% of women faculty are full professors, however, compared to 31% of men, and these proportions haven't changed in more than 15 years. Since the proportion of women reaching the top ranks remains relatively low, the pool of women available for leadership positions in academic medicine is still small. This review article first summarizes recent data on women's representation in academic medicine and then discusses why they are not succeeding at the same pace as men. Reasons include a complex combination of women's choices, sexism, cultural stereotypes, constraints in combining family responsibilities with professional opportunities, and lack of effective mentoring. Multiple approaches are required to overcome these "cumulative disadvantages," among them improving the gender climate at academic medical centers; the mentoring of women faculty, residents, and students; and skill-building opportunities for women.

Objective: To characterize the distribution of male and female ophthalmologists with regard to practice type, subspecialty training, rural-urban distribution, and regional distribution., Methods: Ophthalmology Matching Program files containing the records of residents who began their second year at accredited programs between 1986 and 1990 (inclusive), were compared to membership files of the American Academy of Ophthalmology. Practice locations for each individual were classified according to region, stage, and Rural-Urban Continuum County Code, as defined by the US Department of Agriculture., Results: This cohort comprised 2,494 individuals, 77.1% (1922) of whom were male and 22.9% (572) of whom were female. Group practice was most common (55.9% for women and 61.3% for men). More women were in salaried positions associated with health maintenance organizations (p = 0.006) and academic settings (p < 0.001) than were men. Notable differences in subspecialty choice were restricted to pediatric ophthalmology, chosen three times more frequently by women, and vitreoretinal diseases/surgery, chosen twice as often by men. Only 5.6% of women selected nonmetropolitan practice locales compared to approximately twice that percentage of men. The Middle Atlantic and New England regions attracted more women, while the South Atlantic attracted more men.

The gender composition of the medical profession is changing rapidly in many parts of the world, including Mexico. We analyze cross-sectional and longitudinal data on sex differences in physician employment from household employment surveys. The results suggest that Mexico is a particularly interesting example of the feminization of physician employment. Female enrollment in medical school increased from 11% in 1970 to about 50% in 1998. The increased participation of women in medicine seems to be accompanied by differences in employment patterns that could generate significant reductions in the total supply of physician hours of service. Women physicians are unemployed at a much higher rate than men and hence account for half of underused physician human capital. The results suggest that improved educational opportunities do not translate automatically into equal employment opportunities.

In order to gain further insight into the system factors responsible for changes in the health workforce, this study undertook an empirical examination of the determinants of the size of the health workforce and overall health expenditures across fifteen OECD countries. Specifically, using the latest release of OECD data, the analysis estimated and evaluated the effects of variables such as the proportion of female physicians and the elderly, expenditures on ambulatory care, enrollment levels in training programs, level of public financing, and per capita income on the size of the health workforce and level of health spending between 1970-1991. The findings of this study help to place the problem of the changing health workforce within the context of the complexity of health systems. It confirms any understanding of what accounts for changes in the size of the health labor force and expenditures require disentangling the effects of variables which needs to be taken into account when considering health system reforms.

Background: The number of women entering general practice is rising in many countries. Thus, gender differences in work situation preferences and practice activities are important for future planning., Objectives: This article describes the differences between male and female general practitioners (GPs) in 32 European countries. It examines gender differences in curative and preventive services and relates these to features of the health care system and the practice., Methods: The data were collected in 1993 and 1994 in the European Study of Task Profiles of General Practitioners. In 32 countries, 8,183 GPs answered standardized questionnaires written in their own languages on their self-reported involvement in curative and preventive services, as well as how their practice was organized and managed. Because the independent variables in this study were on both the national 1 and individual practice levels, the data were subjected to multilevel analysis., Results: Regardless of the type of health care system, the female GPs were younger than the male GPs and more often worked part time in groups or partnerships and in cities, although not in deprived areas. They made fewer house calls and did less work outside office hours. Differences between men and women regarding workload diminished considerably after controlling for part-time work. When other characteristics of the person and the practice were taken into account, female GPs proved to be less involved in several curative services, except as the first contact for gynecological problems, but more involved in health education. Some differences were found in only certain types of health care systems., Conclusions: The results may have important implications for working arrangements, training, education, and planning of resources for general practice in the future.

Consultant post prospects for Specialist Registrars (SpRs) in all the medical specialties have been analysed using the databases of the Royal College of Physicians and the Joint Committee on Higher Medical Training (JCHMT). A 'bulge' in the numbers of SpRs obtaining Certificates of Completion of Specialist Training (CCSTs) is anticipated over the next 2-3 years, but this effect will be alleviated by the increasing trend to spend extra years in research or flexible training. There are profound differences between the specialties in the ratios of SpRs holding National Training Numbers (NTNs) to consultants, and in the proportions of female SpRs, and these factors will markedly influence consultant post prospects. The outlook within most specialties is favourable, but this is critically dependent on the rate of consultant expansion over the next few years.

Female physicians are underrepresented in rural areas. What impact might the increasing proportion of women in medicine have on the rural physician shortage? To begin addressing this question, we present data describing the geographic distribution of female physicians in the United States. We examine the geographic distribution of all active U.S. allopathic physicians recorded in the October 1996 update of the American Medical Association Physician Masterfile. Percentages and numbers of female physicians by professional activity, specialty type, and geographic location are reported. Findings reveal there were fewer than 7,000 female allopathic physicians practicing in rural America in 1996. The proportion of generalist female physicians who practice in rural settings was significantly lower than the proportion who practice in urban locations. Although members of the most recent 10-year medical school graduation cohort of female generalist physicians were slightly more likely to practice in rural areas than members of earlier cohorts, female physicians remained significantly underrepresented in rural areas. States varied dramatically in rural female generalist underrepresentation. Should female generalists continue to be underrepresented in rural locations, the rural physician shortage will not be resolved quickly. Effective strategies to improve rural female physician placement and retention need to be identified and implemented to improve rural access to physician care.

The quality of care received by a patient or consumer critically depends on the knowledge, skills and attitudes of the health workforce; the structure and functioning of the health workforce is critical to the structure and functioning of the health system overall. To a very large extent, diagnosis and treatment decisions call on the training and experience of the health professional. The quality of the interaction between a patient or consumer depends on the interpersonal and technical skills of health professionals. In a sense, health workers are important to defining the very nature of health care services. The importance of the health workforce is further highlighted by the fact that, as is typical of most service industries, labour accounts for a large proportion of health costs (around 80%). This paper provides an overview of the size and composition of the health workforce in Australia. It then reviews three segments of the workforce in more detail (medical, nursing and other health professionals) and reviews contemporary policy issues affecting those groups.

The winds of change world-wide have swept medical education in the last fifteen years. Today, Australia's medical students are older and drawn from more diverse socio-economic, ethnic and geographic backgrounds than twenty years ago, and there is now an equal mix of men and women in medical school. Admission policies have been rewritten to broaden access with a range of entry options now available including direct entry from high school and graduate entry following a first degree. Curricula have been revised and modes of learning transformed. This paper describes these changes and discusses the implications for medical schools and for planning the future workforce.

Men and women doctors participate differently in the workforce. As the proportion of women in the workforce increases, gender-based differences in workforce participation are raising important planning questions. For example, how will differences in hours worked per week impact on the number of trainee doctors required to meet future demand, why do some disciplines attract more women, what will be the impact on the practice of medicine if these trends continue and how does the training environment impact on variation in career decision. In this paper we summarise and discuss the findings of recent research undertaken by the Australian Medical Workforce Advisory Committee and outline some public policy responses.

Belgium is experiencing a strong medical workforce oversupply. At the end of 1998, there were 345 active physicians per 100,000 population and the ratio is even higher in the francophone area of the country (433 active physicians per 100,000 population). Health expenditures are steadily raising. A numerous clauses system was established in the medical schools in 1996 but its will not affect the annual number of graduates before 2004. During the next two decades, for various reasons, population aging will have only a slight effect on the growth of health care expenditures. However, most probably, more doctors will be needed. Given the current manpower oversupply, such forecasts are not easily accepted.

Objectives: This study examined the extreme medical unemployment and underemployment in the urban areas of Mexico. The conceptual and methodological approach may be relevant to many countries that have experienced substantial increases in the supply of physicians during the last decades., Methods: On the basis of 2 surveys carried out in 1986 and 1993, the study analyzed the performance of physicians in the labor market as a function of ascription variables (social origin and gender), achievement variables (quality of medical education and specialty studies), and contextual variables (educational generation)., Results: The study reveals, despite some improvement, persistently high levels of open unemployment, qualitative underemployment (i.e., work in activities completely outside of medicine), and quantitative underemployment (i.e., work in medical activities but with very low levels of productivity and remuneration). The growing proportion of female doctors presents new challenges, because they are more likely than men to be unemployed and underemployed., Conclusions: While corrective policies can have a positive impact, it is clear that decisions regarding physician supply must be carefully considered, because they have long-lasting effects. An area deserving special attention is the improvement of professional opportunities for female doctors.

Although we can observe a real change in the participation of women in the medical profession, we must ask ourselves what feminisation means. Does it refer to the number of women, or to an eventual change in the content of the profession due to the fact that women are more oriented toward caring, empathy, relationships. The figures for Belgium show a real improvement in the presence of the women but not in the more prestigious specialisations like surgery or internal medicine.

Objective: To increase gender diversity among the physician consulting staff (PCS) at a major medical center., Design: Because the proportion of female PCS at academic medical centers in the United States has not increased commensurately with increases in the proportion of female graduates from American medical schools, a modeling and graphing technique was developed to analyze this problem and recommend solutions for one large academic medical center., Material and Methods: Personnel data, by gender and year from 1980 through 1994, were collected for all PCS at Mayo Clinic Rochester (MCR). These data were compared with similar data from other US academic medical centers and were used to develop models to predict the proportion of female PCS at MCR yearly until 2005, assuming various hiring and resignation patterns. Novel techniques were developed to illustrate and compare the models. Model-based predictions were compared with national projections, and a realistic target proportion of female PCS was defined on the basis of assumptions about the proportion of female graduates from medical school and internship programs during the next 10 years as well as probable hiring, retention, and resignation rates at MCR. To identify issues critical to recruitment, retention, and professional growth of female PCS at MCR, we used factor analysis to assess responses to a confidential questionnaire sent to all female faculty members., Results: In 1994 and 1995, the proportion of female PCS was 25% at US academic medical centers but only 15% at MCR, and the rate at which this proportion increased from 1980 through 1994 at MCR was also lower than the national rate. Model-based predictions demonstrated that gradually (1.5% per year) increasing the female percentage of new recruits from 26% in 1995 to 40% in 2005 would achieve the targeted 25% female PCS in 13 years. Questionnaire responses from 119 (68%) of the 175 female PCS at MCR identified 6 important recommendations for recruitment and retention of female PCS: survey resignees and candidates who decline positions; appoint more qualified women to policy-making committees; require sensitivity and diversity training for all staff (especially leaders); develop explicit, gender-sensitive criteria for selecting department and division chairs; compare Mayo gender and diversity data with national data at the department or division level; and develop mechanisms for mentoring junior female staff members., Conclusion: We developed useful methods for analyzing the PCS gender distribution, defined feasible hiring strategies, and identified specific recommendations to enhance the professional experience of female PCS. These methods can provide a model for other institutions seeking to optimize gender diversity among their staff.

More than half the LIZ funding has been spent on improving GP premises and practice staffing. But many premises are still below standard. The programme has had no effect on reducing the number of GPs over 65 working in London. In some areas of London the proportion has increased. Almost half (46 per cent) of practices in London still consist of a doctor working alone. Nationally, the figure is 30 per cent. London GPs' lists are significantly higher than in the rest of the country. Further improvements in London's primary care are vital.

To date there have been few studies of professional women in health care in the developing world. With the increased feminization of the Mexican health work force, an estimated 30 per cent of all physicians are female, there is an urgent need to study this group of workers in terms of their impact on the health service. In particular, the potential for female physicians to migrate could have a dramatic impact on the health service. Indeed, it has long been recognised by the Mexican health authorities that there is an uneven spatial distribution of physicians and yet little is known about the distribution and mobility of female physicians. To this end this paper will analyse the migration and mobility of female physicians through the lifecourse in provincial Mexico. The paper examines the factors that control and structure female physician migration in childhood, during their training and career development. Data for this study were obtained during a period of ten months fieldwork in Mexico. Primary data were obtained from interviews with a sample of physicians in five study states. The interviewees also completed a diary for three months to outline their daily, weekly and monthly routine activities. Secondary data sources were various health employment records, medical school output statistics and the Atlas of Professionals produced by the Mexican census service. Material presented in this paper demonstrates that female physicians in provincial Mexico are not highly mobile. A lack of mobility is due to the constraining factors of education, gender, institutional structures and family and household imperatives.

This paper provides an exploration of the gendered nature of the working experience of women within a high status and predominantly male dominated medical specialty, that of general practice or primary care physician. Women currently represent just over a third of all general practitioners in the U.K. and their numbers have been increasing. Women now account for 60% of new recruits into general practice. Despite this increase, consideration of the experience and role of women within medicine has largely focused on hospital medicine. The findings presented are derived from a three year project, that aimed to develop an understanding of the role women health workers play in the U.K. in the construction and provision of primary health care services for women. The methods employed consisted of a series of postal surveys and qualitative interviews conducted with GPs, female nurses and women service users. The first section of the discussion provides an exploration of the nature and impact of the sexual division of labour within general practice and the resulting occupational marginalisation of women GPs. Attention is given to identifying the key processes whereby the sexual division of labour is maintained and reproduced, particularly through the normative expectations of colleagues, patients and women GPs themselves. The final section presents a typology of the differing strategies the sampled women GPs adopted for managing their working roles in response to the existence of a sexual division of labour. The conclusion highlights the possible impact of the differing strategies upon the functioning of women within general practice and their relationship with women users of the service.

Concerns have been voiced about an impending oversupply of physicians in the United States. Do these concerns also apply to California, a state with many unique demographic characteristics? We examined trends in physician supply and medical education in California and the United States between 1980 and 1995 to better inform the formulation of workforce policies appropriate to the state's requirements for physicians. We found that similar to the United States, California has more than an ample supply of physicians in the aggregate, but too many specialists, too few underrepresented racial/ethnic minority physicians, and poor distribution of physicians across the state. However, recent growth in the supply of practicing physicians and resident physicians per capita in California has been much less dramatic than in the country overall. The state's unusually high rate of population growth has enabled California, unlike the United States as a whole, to absorb large increases in the number of practicing physicians and residents during 1980 to 1995 without substantially increasing the physician-to-population ratio. Due to a projected slowing of the state's rate of population growth, the supply of physicians per capita in the state will begin to rise steeply in coming years unless the state implements prompt reductions in the production of specialists. An immediate 25% reduction in specialist residency positions would be necessary to bring the state's supply of practicing specialists in line with projected physician requirements for the state by 2020. We conclude that major changes will be required if the state's residency programs and medical schools are to produce the number and mix of physicians the state requires. California's medical schools and residency programs will need to act in concert with federal and state government to develop effective policies to address the imbalance between physician supply and state requirements.