"That is when I understood everything": Ideological trajectories of pro-choice female doctors in Mexico.

OBJECTIVES: There is little evidence about how physicians become abortion clinicians or advocates. We describe the ideological trajectories of pro-choice female Mexican doctors and the factors that made them pro-choice. STUDY DESIGN: In this qualitative study, we conducted semistructured interviews with members of the Mexican Network of Female Pro-choice Physicians. Participants came from eight diverse states. We used a feminist epistemology approach and analyzed data using inductive coding as well as a priori categories (becoming pro-choice, trajectories, and training). RESULTS: We included 24 female pro-choice physicians. We identified five intersecting factors that influenced becoming pro-choice: feminism, personal experiences, confrontation with the inequalities and violence that women experience, role models, and routine exposure to abortion care. Participants described three ideological trajectories: being pro-choice before studying medicine, not having a specific opinion, and changing from "pro-life" to "pro-choice." Participants described the absence of abortion training in medical schools, stigmatizing training, and the use of alternative training sources. CONCLUSIONS: In the absence of training on abortion during medical education, a combination of intersecting personal as well as work-related experience may turn doctors into pro-choice abortion clinicians and/or advocates. The findings of this study may be used to develop comprehensive medical curricula as well as strategies directed at doctors who have never received training on abortion care, such as promoting interactions with nonmedical abortion providers, education on inequalities and violence against women, moving beyond public health to a human rights and gender perspective, and exposure to routine safe abortion care. IMPLICATIONS: Mexican female doctors become pro-choice clinicians who provide abortion care and/or advocates in spite of their medical education.

Satisfacción personal y percepción de éxito en mujeres en traumatología: factores determinantes en la elección de la especialidad y desarrollo profesional / Personal satisfaction and perception of success among female orntthopedic surgeons: key factors in the choice of specialty and professional development

Históricamente, las médicas han sido asociadas a especialidades determinadas. En los últimos años, estos estereotipos han sido lentamente revertidos con mayor participación de la mujer en especialidades quirúrgicas. En el proceso de aprendizaje se sabe la importancia que tienen los modelos y mentores. Buscamos evaluar el grado de satisfacción y el éxito profesional de las mujeres en Traumatología, y qué factores cumplieron un rol positivo en la decisión de optar por ella.Se encuestó a 108 mujeres dedicadas a la Traumatología, y se evaluaron las influencias positivas y los mentores como modelo en la toma de decisión por la especialidad y los grados de satisfacción personal y profesional.Pese a una mayor percepción de dificultades en lograr el objetivo, destacan los altos grados de satisfacción profesional y personal de las mujeres en Traumatología: 95% refirió haber elegido la especialidad correcta, 100% afirmó que las dificultades se compensan con los resultados obtenidos, y 96% volvería a elegir la misma especialidad. En relación con la percepción de éxito, 73% se considera exitosa en su vida profesional, y en la vida personal, 85%.Muy relevante en la toma de decisión por la especialidad es el rol que cumplen docentes, mentores, y el gusto por la cirugía y los deportes. Un 84% recibió alguna influencia positiva, 61% tuvo como modelo en su formación una traumatóloga, y un 98% recomendaría a otras mujeres en período de formación que se dedicaran a la Traumatología.Las estrategias de incremento de la participación femenina en la especialidad pudiesen orientarse a fomentar modelos femeninos durante el aprendizaje.

Historically, female doctors have been associated with certain specialties. In recent years, these stereotypes have been slowly reversed with an increased participation of women in surgical specialties. The importance of models and mentors in the learning process is known. We seek to evaluate the level of professional satisfaction and success of women in Traumatology, as well as the factors that may have played a positive role in the decision to pursue this specialty. We surveyed 108 women working in Traumatology and evaluated the positive influences and mentors as models in the decision-making regarding the specialty and the degrees of personal and professional satisfaction. Despite a greater perception of difficulties in achieving the purpose, the high degrees of professional and personal satisfaction of women in Traumatology stands out: 95% reported having chosen the correct specialty, 100% stated that the difficulties are offset by the results obtained, and 96% would choose the same specialty again. Regarding the perception of success, 73% consider themselves successful in their occupation, and 85% consider themselves successful in their personal lives. The role played by teachers, mentors, as well as an interest in surgery and sports are very relevant in choosing the specialty. In total, 84% of the sample received some positive influence 61% had a female traumatologist as a model during their training, and 98% would recommend other women in training to dedicate themselves to Traumatology. The strategies to increase female participation in the specialty could be aimed at promoting female role models during learning.

Women Physicians: Burnout during the COVID-19 Pandemic in Brazil. / Mulheres Médicas: Burnout durante a Pandemia de COVID-19 no Brasil.

BACKGROUND: COVID-19 has placed a tremendous burden on physicians worldwide, especially women physicians, affected by increased workload and loss of quality of life. OBJECTIVE: To assess the effects of the COVID-19 pandemic on the quality of life, burnout and spirituality of Brazilian women physicians directly or indirectly providing care to COVID-19 patients. METHODS: Prospective, observational study performed from July 28 to September 27, 2020, in Brazil, with women physicians from 47 specialities, the most frequent being cardiology (22.8%), with no age restriction. They voluntarily answered an online survey with questions on demographic and socioeconomic characteristics, quality of life (WHOQOL-brief), spirituality (WHOQOL-SRPB), and statements from the Oldenburg Burnout Inventory. Statistical analysis used the R software, beta regression, classification trees, and polychoric correlation matrix, with a 5% of significance level. RESULTS: Of the 769 respondents, 61.6% reported signs of burnout. About 64% reported wage loss of up to 50% during the pandemic. Some reported lack of energy for daily tasks, frequent negative feelings, dissatisfaction with capability for work, and caring for others not adding meaning to their lives. Negative feelings correlated negatively with satisfaction with sexual life and personal relations, and energy for daily tasks. The inability to remain optimistic in times of uncertainty correlated positively with feeling unsafe daily and not acknowledging that caring for others brings meaning to life. CONCLUSION: This study showed a high frequency of burnout among Brazilian women physicians who answered the survey during the COVID-19 pandemic. Nevertheless, they presented with a relatively good quality of life and believed that spirituality comforted and reassured them in hard times.

FUNDAMENTO: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. OBJETIVO: Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. MÉTODO: Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOL-brief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. RESULTADOS: Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. CONCLUSÃO: O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis.

Global Prevalence and Impact of Hostility, Discrimination, and Harassment in the Cardiology Workplace.

BACKGROUND: Discrimination and emotional and sexual harassment create a hostile work environment (HWE). The global prevalence of HWE in cardiology is unknown, as is its impact. OBJECTIVES: This study sought to evaluate emotional harassment, discrimination, and sexual harassment experienced by cardiologists and its impact on professional satisfaction and patient interactions worldwide. METHODS: The American College of Cardiology surveyed cardiologists from Africa, Asia, the Caribbean, Eastern Europe, the European Union, the Middle East, Oceana, and North, Central, and South America. Demographics, practice information, and HWE were tabulated and compared, and their impact was assessed. The p values were calculated using the chi-square, Fisher exact, and Mann-Whitney U tests. Univariate and multivariate logistic regression analysis determined the association of characteristics with HWE and its subtypes. RESULTS: Of 5,931 cardiologists (77% men; 23% women), 44% reported HWE. Higher rates were found among women (68% vs. 37%; odds ratio [OR]: 3.58 vs. men), Blacks (53% vs. 43%; OR: 1.46 vs. Whites), and North Americans (54% vs. 38%; OR: 1.90 vs. South Americans). Components of HWE included emotional harassment (29%; n = 1,743), discrimination (30%; n = 1,750), and sexual harassment (4%; n = 221), and they were more prevalent among women: emotional harassment (43% vs. 26%), discrimination (56% vs. 22%), and sexual harassment (12% vs. 1%). Gender was the most frequent cause of discrimination (44%), followed by age (37%), race (24%), religion (15%), and sexual orientation (5%). HWE adversely affected professional activities with colleagues (75%) and patients (53%). Multivariate analysis showed that women (OR: 3.39; 95% confidence interval: 2.97 to 3.86; p < 0.001) and cardiologists early in their career (OR: 1.27; 95% confidence interval: 1.14 to 1.43; p < 0.001) had the highest odds of experiencing HWE. CONCLUSIONS: There is a high global prevalence of HWE in cardiology, including discrimination, emotional harassment, and sexual harassment. HWE has an adverse effect on professional and patient interactions, thus confirming concerns about well-being and optimizing patient care. Institutions and practices should prioritize combating HWE.

Work addiction and quality of life: a study with physicians.

OBJECTIVE: To evaluate the quality of life of physicians and investigate to what extent it is affected by work addiction. METHODS: This is an exploratory, descriptive and cross-sectional study, conducted with 1,110 physicians. For data collection, we used a questionnaire with sociodemographic information, the World Health Organization Quality of Life BREF, and the Work Addiction Scale. RESULTS: Most physicians presented high quality of life. Female participants presented lower quality of life in the domains psychologic, environment and general (p<0.05). Quality of life was negatively correlated with the number of shifts (p<0.005). The higher the addiction to work, the lower the quality of life. CONCLUSION: The research allowed understanding the implications of work addiction in the quality of life. Further studies are required to support the development of strategies that improve health conditions and quality of life of medical professionals. OBJETIVO: Avaliar a qualidade de vida de médicos e investigar em que medida a adição ao trabalho a afeta. MÉTODOS: Trata-se de um estudo exploratório, descritivo e transversal, realizado com 1.110 médicos. Para coleta de dados, optou-se por utilizar um questionário contendo informações sociodemográficas, bem como aplicar o instrumento World Health Organization Quality of Life-BREF e a Escala de Adição ao Trabalho. RESULTADOS: Os médicos, em sua maioria, apresentaram alta qualidade de vida. Os participantes do sexo feminino tiveram menor qualidade de vida em relação aos homens nos domínios psicológico, meio ambiente e geral (p<0,05). A qualidade de vida correlacionou-se negativamente com o número de plantões (p<0,005), e quanto maior a adição ao trabalho, menor a qualidade de vida. CONCLUSÃO: A pesquisa permitiu o conhecimento das implicações da adição ao trabalho sobre a qualidade de vida. Novos estudos são necessários para subsidiar a elaboração de estratégias que melhorem a saúde e a qualidade de vida do profissional médico.

Work addiction and quality of life: a study with physicians / Adição ao trabalho e qualidade de vida: um estudo com médicos

ABSTRACT Objective To evaluate the quality of life of physicians and investigate to what extent it is affected by work addiction. Methods This is an exploratory, descriptive and cross-sectional study, conducted with 1,110 physicians. For data collection, we used a questionnaire with sociodemographic information, the World Health Organization Quality of Life BREF, and the Work Addiction Scale. Results Most physicians presented high quality of life. Female participants presented lower quality of life in the domains psychologic, environment and general (p<0.05). Quality of life was negatively correlated with the number of shifts (p<0.005). The higher the addiction to work, the lower the quality of life. Conclusion The research allowed understanding the implications of work addiction in the quality of life. Further studies are required to support the development of strategies that improve health conditions and quality of life of medical professionals.

RESUMO Objetivo Avaliar a qualidade de vida de médicos e investigar em que medida a adição ao trabalho a afeta. Métodos Trata-se de um estudo exploratório, descritivo e transversal, realizado com 1.110 médicos. Para coleta de dados, optou-se por utilizar um questionário contendo informações sociodemográficas, bem como aplicar o instrumento World Health Organization Quality of Life-BREF e a Escala de Adição ao Trabalho. Resultados Os médicos, em sua maioria, apresentaram alta qualidade de vida. Os participantes do sexo feminino tiveram menor qualidade de vida em relação aos homens nos domínios psicológico, meio ambiente e geral (p<0,05). A qualidade de vida correlacionou-se negativamente com o número de plantões (p<0,005), e quanto maior a adição ao trabalho, menor a qualidade de vida. Conclusão A pesquisa permitiu o conhecimento das implicações da adição ao trabalho sobre a qualidade de vida. Novos estudos são necessários para subsidiar a elaboração de estratégias que melhorem a saúde e a qualidade de vida do profissional médico.

[Gender and career paths of female primary care physicians in Andalusia, Spain, at the beginning of 21st century]. / Género y trayectorias profesionales de las médicas de familia en Andalucía, España, a comienzos del siglo XXI.

The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in the study. The discourse analysis revealed that most of the female physicians did not plan for professional goals and, when they did plan for them, the goals were intertwined with family needs. Consequently, their career paths were discontinuous. In contrast, career paths oriented towards professional development and the conscious planning of goals were more common among the female doctors acting as directors of health care centers.

["The fact that there are more women doesn't guarantee anything": the feminization of obstetrics and gynecology and the experiences of female medical professionals in Mexico]. / "El hecho de que sean más mujeres, no garantiza nada": feminización y experiencias de las mujeres en la ginecobstetricia en México.

In the framework of an increasing feminization of the medical profession in Mexico, this article explores the characteristics of this process in the obstetrics and gynecology specialty. Understanding feminization as a process of change to be analyzed both quantitatively and qualitatively, the article focuses special attention on the experiences of female obstetrician-gynecologists within a medical specialty that has since its origins functioned as a mechanism of control over women's bodies. Based on ethnographic research, the article combines statistical and archival sources and field observation. The interviews reveal the experiences and tensions women obstetrician-gynecologists encounter in this context.

[Gender norms and the development of the medical habitus: in the years of medical schooling and residency]. / Pautas de género en el desarrollo del habitus médico: los años de formación en la escuela de medicina y la residencia médica.

This article documents the gender abuse that Mexican medical students face. The concept of medical socialization is analyzed, with emphasis on the problem of the mistreatment of medical students. The theoretical framework articulates ideas from Foucault and Goffman with the nodal points of Bourdieu using a gender focus. Numerous examples are employed to show that the formal program of study also contains a hidden curriculum which serves to reproduce gender hierarchies. Women face numerous types of socially induced discouragement in choosing and completing their course of study, particularly in certain specialties. Discrimination is present in affectivized as well as in authoritarian interactions. They face sexual harassment in the classroom and in their years of specialization, and are constantly constructed as subordinated subjects. The importance of these findings in the constitution of a medical habitus is discussed.

Personal, professional and financial satisfaction among American women urologists.

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5% of female medical students enter the surgical subspecialties compared to nearly 20% of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69%) who responded, 86.8% (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81% (198) said that they would remain in medicine and 91.4% (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Personal, professional and financial satisfaction among American women urologists

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5 percent of female medical students enter the surgical subspecialties compared to nearly 20 percent of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69 percent) who responded, 86.8 percent (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81 percent (198) said that they would remain in medicine and 91.4 percent (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

[Male physicians and female physicians, different medical styles: different users' satisfaction?]. / Médicos y médicas, estilos asistenciales distintos: satisfacción diferente de los usuarios?

OBJECTIVE: To analyse differences in the satisfaction of health service users associated with the sex of the attending doctor. MATERIAL AND METHODS: Data obtained from the Primary Care Services User Survey (2005), part of a project regarding user satisfaction with the Andalusian Public Health Services. A bivariate analysis was conducted, the two variables being doctors sex and user satisfaction, as was an ANOVA, taking as a dependent variable the indicator of general satisfaction and as independent variables the characteristics of the individual and that of the system, including physician sex. RESULTS: In the bivariate analysis a relation was confirmed between doctors sex and satisfaction with the components of the health service received. Nevertheless, this influence disappears in the analysis of dependence, which includes sociodemographic and system variables. CONCLUSION: Differences between practices by male and female doctors are confirmed, but not the differences in general satisfaction with the service received.

Médicos y médicas, estilos asistenciales distintos: ¿satisfacción diferente de los usuarios? / Male physicians and female physicians, different medical styles: different users' satisfaction?

OBJETIVO: Verificar la existencia de diferencias en la satisfacción de los usuarios de los servicios sanitarios, según sea que la atención se reciba de un médico hombre o mujer. MATERIAL Y MÉTODOS: Se utilizó la encuesta realizada a usuarios de atención primaria en 2005 que llevó a cabo el Instituto de Estudios Sociales Avanzados, del Consejo Superior de Investigaciones Científicas (IESA/CSIC). Se efectuó un análisis bivariado entre el sexo del médico y las variables de satisfacción, y un análisis de varianza (ANOVA); se tomó como variable dependiente el indicador de satisfacción general y como variables independientes las características del individuo y del sistema, entre estas últimas el sexo del médico. RESULTADOS: En el análisis bivariado se constató la relación entre sexo del médico y la satisfacción con algunos de los elementos del servicio, si bien en el análisis de dependencia, que incluye variables sociodemográficas y del sistema, esta influencia desaparece. CONCLUSIÓN: Se confirmaron las diferencias en la práctica asistencial de hombres y mujeres médicos, pero no así las diferencias en la satisfacción general con el servicio recibido.

OBJECTIVE: To analyse differences in the satisfaction of health service users associated with the sex of the attending doctor. MATERIAL AND METHODS: Data obtained from the Primary Care Services User Survey (2005), part of a project regarding user satisfaction with the Andalusian Public Health Services. A bivariate analysis was conducted, the two variables being doctors´ sex and user satisfaction, as was an ANOVA, taking as a dependent variable the indicator of general satisfaction and as independent variables the characteristics of the individual and that of the system, including physician sex. RESULTS: In the bivariate analysis a relation was confirmed between doctors´ sex and satisfaction with the components of the health service received. Nevertheless, this influence disappears in the analysis of dependence, which includes sociodemographic and system variables. CONCLUSION: Differences between practices by male and female doctors are confirmed, but not the differences in general satisfaction with the service received.

Attitudes toward physician-nurse collaboration: a cross-cultural study of male and female physicians and nurses in the United States and Mexico.

BACKGROUND: Inter-professional collaboration between physicians and nurses, within and between cultures, can help contain cost and insure better patient outcomes. Attitude toward such collaboration is a function of the roles prescribed in the culture that guide professional behavior. OBJECTIVES: The purpose of the study was to test three research hypotheses concerning attitudes toward physician-nurse collaboration across genders, disciplines, and cultures. METHOD: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was administered to 639 physicians and nurses in the United States (n = 267) and Mexico (n = 372). Attitude scores were compared by gender (men, women), discipline (physicians, nurses), and culture (United States, Mexico) by using a three-way factorial analysis of variance design. RESULTS: Findings confirmed the first research hypothesis by demonstrating that both physicians and nurses in the United States would express more positive attitudes toward physician-nurse collaboration than their counterparts in Mexico. The second research hypothesis, positing that nurses as compared to physicians in both countries would express more positive attitudes toward physician-nurse collaboration, was also supported. The third research hypothesis that female physicians would express more positive attitudes toward physician-nurse collaboration than their male counterparts was not confirmed. CONCLUSIONS: Collaborative education for medical and nursing students, particularly in cultures with a hierarchical model of inter-professional relationship, is needed to promote positive attitudes toward complementary roles of physicians and nurses. Faculty preparation for collaboration is necessary in such cultures before implementing collaborative education.

Identity and experience: a study of selected female physicians in five provincial states of Mexico.

The aim of this paper is to analyse the identity(ies) and experiences of a selected group of female physicians in five provincial states of Mexico. In the last 30 years the number of female physicians in Mexico has grown considerably and yet little is known about these women. Data for this work were drawn from two in-depth interviews with 99 female physicians during 1995-1996. In addition, physicians were asked to complete a personal diary to illustrate the nature of their daily experiences over a three-month period; the gap between the two interviews. Analysis reveals female physician identity is shaped by Mexican health care service structures, personal characteristics and goals, and career development choices and opportunities. Association with particular spaces and places influences female physician career development and identity. The multiple identities of these professional women and their lived experiences can result in various pressures and tensions in family and career life. As a result these women make choices about career development; some reassess their career goals given their family and household circumstances and thus their career development may appear to be constrained. The paper concludes by suggesting that changes in Mexican health institutions and the science of medicine may lead to changes in female physician identity.