The "humanisation" of medicine? : the feminisation of medicine: a qualitative study of the career experiences of female doctors and implications for human resources management in Ireland.

The féminisation of medicine is an international phenomenon referring to increasing numbers of females undertaking medical education and entering the medical workforce. This phenomenon has been a hallmark of the medical profession in Ireland since the 1990s. Associated with this phenomenon are several trends that may have implications for human resources management of the medical workforce. These trends are: distinct variation in the distribution of female doctors across the medical specialties, under-representation of female doctors in senior medical roles, and a greater likelihood of less-than-full-time working among female doctors compared to males. Suggested implications of the féminisation of medicine for human resources management are: the development of shortage and surplus specialties in terms of applicants, a decline in interest in hospital-based specialties, and an overall decrease in available WTE. However, the implications of this phenomenon for the medical workforce in Ireland are unclear. This PhD study provides an in-depth exploration of the féminisation of medicine and identifies the possible implications of this phenomenon for human resources management in Ireland. A qualitative methodological approach was employed for this PhD study as it facilitated exploration of the phenomenon and generation of in-depth knowledge to understand the associated trends. A two-phase semi-structured interview study was carried out: Phase One described and analysed the trends associated with the féminisation of medicine from the experiences of female doctors working in Ireland. Phase Two reported and analysed the perspectives of key national stakeholders in areas related to human resources management to ascertain the consequences of the féminisation of medicine for the medical workforce in Ireland and describe possible policy responses. Key findings are (i) the 'plannable' characteristics (i.e. working hours, and location and duration of training) of specialties are crucial influencing factors on specialty choice for female doctors, (ii) the existence of a gender bias against female doctors in the form of a glass ceiling, and (iii) human resources management as a discipline is in its infancy in Ireland, which has largely ignored not only the féminisation of medicine, but wider challenges facing the medical workforce. These findings support the existence of Acker's theory of gendered organisations with respect to the medical profession in Ireland, which asserts that organisations have developed with a male worker at the core. The key findings of this PhD study suggest that human resources management in Ireland must address organisational structures in the medical profession to reduce a gender bias against female doctors inherent in their foundation. However, human resources management must first address underlying medical workforce challenges, such as the working conditions of doctors, before it can prioritise issues arising due to the féminisation of medicine.</p

Predictors of career progression and obstacles and opportunities for non-EU hospital doctors to undertake postgraduate training in Ireland

Background The World Health Organization’s Global Code on the International Recruitment of Health Personnel urges Member States to observe fair recruitment practices and ensure equality of treatment of migrant and domestically-trained health personnel. However, international medical graduates (IMGs) have experienced difficulties in accessing postgraduate training and in progressing their careers in several destination countries. Ireland is highly dependent on IMGs, but also employs non-European Union (EU) doctors who qualified as doctors in Ireland. However, little is known regarding the career progression of these doctors. In this context, the present study assesses the determinants of career progression of non-EU doctors with particular focus on whether barriers to progression exist for those graduating outside Ireland compared to those who have graduated within. Methods The study utilises quantitative data from an online survey of non-EU doctors registered with the Medical Council of Ireland undertaken as part of the Doctor Migration Project (2011–2013). Non-EU doctors registered with the Medical Council of Ireland were asked to complete an online survey about their recruitment, training and career experiences in Ireland. Analysis was conducted on the responses of 231 non-EU hospital doctors whose first post in Ireland was not permanent. Career progression was analysed by means of binary logistic regression analysis. Results While some of the IMGs had succeeded in accessing specialist training, many experienced slow or stagnant career progression when compared with Irish-trained non-EU doctors. Key predictors of career progression for non-EU doctors working in Ireland showed that doctors who qualified outside of Ireland were less likely than Irish-trained non-EU doctors to experience career progression. Length of stay as a qualified doctor in Ireland was strongly associated with career progression. Those working in anaesthesia were significantly more likely to experience career progression than those in other specialities. Conclusions The present study highlights differences in terms of achieving career progression and training for Irish-trained non-EU doctors, compared to those trained elsewhere. However, the findings herein warrant further attention from a workforce planning and policy development perspective regarding Ireland’s obligations under the Global Code of hiring, promoting and remunerating migrant health personnel on the basis of equality of treatment with the domestically-trained health workforce.</p

Additional file 1: of Passing through – reasons why migrant doctors in Ireland plan to stay, return home or migrate onwards to new destination countries

Results of logistic regression analyses. Table S1. Factors associated with intention to remain in Ireland. Table S2. Factors associated with intention to return home. Table S3. Factors associated with intention to migrating onwards/elsewhere. (DOC 115 kb