Women Psychiatrists: Personal and Professional Choices—A Survey
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《精神病学术期刊》
ABSTRACT
OBJECTIVE: A survey of female psychiatrists' personal and professional choices, their stress levels related to these choices, and their overall personal and professional satisfaction was conducted. METHOD: Members of the Association of Women Psychiatrists residing in the U.S. and Canada were anonymously surveyed. RESULTS: Respondents with children spent significantly less time in career related activities, more time in family related activities, were more satisfied with their careers and with intimate relationships, and had less personal time than respondents without children. Respondents with academic affiliation reported significantly more satisfaction with their careers as a source of economic and personal reward, devoted more time to career related activities, less time to family, and were more stressed by current professional situation than women without academic appointment. Respondents without children and with academic affiliations reported the most stress in their current professional setting. CONC
LUSIONS: Female psychiatrists who were able to combine children, intimate relationships, and academic involvement were the most satisfied of all groups.
Women in psychiatry have long carried the burden of balancing multiple roles in their personal and professional choices. The impact of this burden on their physical and mental health continues to be a source of inquiry and concern in the field (1–6). To study the effect of multiple roles on the quality of life for female psychiatrists, members of the Association of Women Psychiatrists, a professional association formed in 1983 were surveyed. The results of the survey are discussed in this article.
METHOD
All members of the Association of Women Psychiatrists residing in the United States and Canada were surveyed via a single mailing of an anonymous questionnaire developed by the author of this study. Prior to this mass mailing, the survey was tested in a pilot group of women psychiatrists known to the author (i.e., a convenience sample).
The questionnaire gathered information on respondents’ demographics, their parents’ level of education, their parents’ employment history and child care arrangements, their career choices, their time spent in career related activities, their time spent in personal/leisure activities, and their childcare arrangements during their working years. Most questions required a forced-choice response (yes/no) or asked for numerical specification (7-point Likert scale).
Frequency distributions and means with standard deviations (SD) were used to describe the sample. Children and academic affiliation variables were used to dichotomize and divide the sample four ways. Two sample t test procedure and analysis of variance (ANOVA) procedures with post hoc analysis were conducted.
RESULTS
The 483 (55% response rate) completed questionnaires were tabulated. The cohort’s median age was 48 years old (SD=0.11 years). Ninety-one percent of respondents were white (N=435); 1.03% were African American (N=5); 4.34% were Asian/Pacific (N=21); 2.1% were Hispanic (N=10); 1.4% were other (N=7) and 1.03% were unspecified (N=5). Sixty-seven percent (N=324) were married or in a committed relationship, and 75% (N=362) had children. Seventy-seven percent (N=374) were board certified. Sixty-two percent (N=299) had an academic affiliation distributed as follows: 26.3% (N=127) assistant professor, 11.4% (N=55) associate professor, 10.4% (N=50) adjunct professor, 7.9% (N=38) instructor, and 4.5% (N=22) professor; and 1.4% (N=7) with affiliation but unspecified. Ninety-seven percent (N=466) were working and had spent a mean of 9.4 (SD=0.88) years at their current job. Sixty-four percent (N=308) were in private practice, while the rest were working in an institutional setting (hospital, clinic, with or without academic affiliation) or were splitting their time between an institutional setting and private practice.
Of the 466 respondents working at the time of the survey, 387 stated their choice of employment (private practice, institutional setting or a combination of the two) as follows: personal (54%, N=260), economic (18%, N=85), and family (9%, N=42). Using a 7-point Likert scale (1=low, 7=high), respondents rated their career as economically satisfying (mean=5.4, SD=1.41). They reported satisfaction with their current work choice (mean=5, SD=1.52), rated the stress level of their work choice (mean=4.7, SD=1.47), expressed an interest in spending more time with family and mates (mean=4.4, SD=1.63), and voiced a desire to increase their personal time (mean=3.2, SD=1.58).
Of the cohort, 60% (N=289) had participated in some form of research prior to this survey; 20% (N=96) had participated in grants, 51% (N=247) had written peer reviewed articles, and 31%(N=148) had written book chapters. Of those who had not participated in research, their two main reasons for not having pursued this interest were lack of training opportunity (29%, N=105) and lack of mentoring (13%, N=46).
In surveying the family history of respondents, it was found that the majority of respondents listed their mothers as their primary caregivers (84%, N=399). Seventy-five percent (N=360) of respondents’ mothers were not employed outside the home during preschool years. This number decreased during grade school (61%, N=296) and high school (46%, N=220). The educational level of respondents’ mothers was 14.3 years (SD=3.2) and respondents’ fathers was 15.6 years (SD=3.9).
Seventy-five percent (N=350) of respondents working at the time of the survey were mothers with children living at home. Fifty-six percent of these children (N=272) were cared for by an employee in the home during their preschool years, 57% (N=273) during grade school years, and 51% (N=246) during high school years. Outside day care, the second choice for those surveyed, was used for 17% (N=84) of these children during preschool years, 18% (N=86) during grade school years, and 3% (N=14) during high school years.
Forty-two percent of respondents (N=205) were devoting 51%–75% of their time to their careers, allocating most of the remainder of their time to their families and leaving less than 25% of their time for personal pursuits. When asked which portion of allocated time they would like to increase, 62% (N=299) responded that they would like to increase personal time.
Table 1 summarizes significant findings when the sample was dichotomized by whether or not respondents had children. Table 2 summarizes significant findings when the sample was dichotomized by whether or not respondents had academic affiliation. For the analysis, academic affiliation was defined as anyone who, at the time, held an academic position such as adjunct professor, instructor, assistant professor, associate professor, professor, or professor emeritus. The sample was divided into four groups, utilizing children and academic affiliation as variables.
The groups differed significantly in the percentage of time spent in career-related activities (F= 16.722, df=3, 455, p<0.0001). Respondents with children and no academic affiliation differed statistically from all other groups and devoted the least time to career-related activities (mean=46.28, SD=20.81).
The groups differed significantly in the degree of satisfaction in their intimate relationships (F=6.071, df=3, 456, p<0.001). Respondents with children and an academic affiliation reported to be the most satisfied (mean=4.68, SD=1.49), while respondents with no children and an academic affiliation reported slightly lower degrees of satisfaction (mean=3.96, SD=2.05), and respondents with no children and no academic affiliation reported the lowest level of satisfaction (mean=3.80, SD=2.05).
The groups differed significantly in time devoted to family activities (F=47.328, df=3, 455, p<0.0001). Respondents with children and no academic affiliation spent the most time involved in family activities (mean=37.90, SD=18.08), while respondents with children and an academic affiliation differed from both other groups without children (mean=31.56, SD=16.20).
The groups differed significantly in time spent doing personal/leisure-related activities (F=5.127, df=3, 459, p=0.002). Respondents with no children and no academic affiliation reported the highest percentage of time devoted to personal/leisure activities (mean=18.64, SD=11.26), while respondents with no children and an academic affiliation reported slightly less time devoted to personal time (mean=17.76, SD=13.20), and respondents with children and an academic affiliation reported the least amount of time spent in personal/leisure activities (mean=12.22, SD=11.74).
DISCUSSION
This study helps to characterize self-reported attitudes of female psychiatrists concerning personal and professional choices. This particular cohort of female psychiatrists chose to work mainly for personal satisfaction, differing from their own mothers in that they allowed others, often an employee in the house, to help with child rearing responsibilities. Similar to other professional women, this group of women psychiatrists tried to negotiate their multiple roles (6). They elected to compromise on professional choices available to them, hire help for some traditional domestic chores, and minimize their personal time. The majority of respondents were satisfied with their current professional situation in spite of the limitations on their personal time and their lack of academic advancement. They favored private practice because of its flexibility, allowing for more control over their time. Most women surveyed found their multiple roles stressful. When asked about feelings of regret regarding their personal and professional choices, 72% did not express regret regarding the manner in which their lives had unfolded. Female psychiatrists with children allocated significantly less time to their careers, devoted more time to their family, allocated less time to personal activities, were more satisfied with their intimate relationships, and were more satisfied with their current employment.
Sixty-two percent of respondents reported academic affiliations. Most were at the assistant professor level, in agreement with studies that suggest a distribution of women primarily among the lower faculty ranks (7, 8). In this study, female psychiatrists with academic affiliations (versus those without) expressed a significantly higher degree of economic satisfaction, reported their career as a source of personal satisfaction, expressed a higher level of stress with their current professional situation, spent more of their time in career-related activities, and allocated less time for family-related activities. Female psychiatrists without academic affiliations and with children devoted the least time to career-related activities and differed from all other groups. Respondents with children and academic affiliations experienced the most satisfaction with intimate relationships, reported the least amount of personal time, and spent more time with family than respondents without children (with or without an academic affiliation). Respondents with children and with no academic affiliation spent the most time with family.
Limitations of this study include: those surveyed were part of a preselected group of female psychiatrists who were members of one professional association; the majority of respondents were in a committed relationship and had children; and the sample was comprised primarily of white professional women who went to medical school at a time when female medical students were in the minority and were not racially diverse. It is also important to note that this study did not address issues of shared parenting or the sharing of home responsibility (9).
The steady increase in the number of women applying to medical schools and completing psychiatry training is changing the composition of our field. This pattern highlights the need to further study the effect of multiple roles on the career paths of female psychiatrists, their interpersonal relationships, their support systems, and their physical and mental health.
ACKNOWLEDGMENTS
The author would like to thank Dr. Vivian Mougios for her assistance with the statistical analysis.
This article was presented in part at the 149th annual meeting of the American Psychiatric Association, New York, May 4–9, 1996; the 41st winter meeting of the American Academy of Psychoanalysis, New York, January 8–11, 1998; and the 50th Institute of Psychiatric Services, Los Angeles, October 1998.
REFERENCES
Facione NC: Role overload and health: the married mother in the waged labor force. Health Care Women Int 1994; 15:157–167
Spurlock J: Multiple roles of women and role strains. Health Care Women Int 1995; 16:501–508
Luecken LJ, Suarez EC, Kuhn CM, et al: Stress in employed women: impact of marital status and children at home on neurohormone output and home strain. Psychosom Med 1997; 59:352–359
Barnett RC, Marshall NL: Worker and mother roles, spillover effects and psychological distress. Women Health 1992; 18:9–40
Barnett RC, Marshall NL, Singer JD: Job experiences over time, multiple roles, and women’s mental health: a longitudinal study. J Pers Soc Psychol 1992; 62:634–644
Gray JD: The married professional woman: an examination of her role conflicts and coping strategies. Psychol Women Q 1983; 7:235–243
Whiting BE, Bickel J: Women on faculties of U.S. Medical Schools, 1978–1989. Acad Med 1990; 65:277–278
Nonnemaker L: Women physicians in academic medicine. N Engl J Med 2000; 342:399–405
Fish LS, New RS, Van Cleave NJ: Shared parenting in dual-income families. Amer J Orthopsychiatry 1992; 62:83–92(Silvia W. Olarte, M.D.)
OBJECTIVE: A survey of female psychiatrists' personal and professional choices, their stress levels related to these choices, and their overall personal and professional satisfaction was conducted. METHOD: Members of the Association of Women Psychiatrists residing in the U.S. and Canada were anonymously surveyed. RESULTS: Respondents with children spent significantly less time in career related activities, more time in family related activities, were more satisfied with their careers and with intimate relationships, and had less personal time than respondents without children. Respondents with academic affiliation reported significantly more satisfaction with their careers as a source of economic and personal reward, devoted more time to career related activities, less time to family, and were more stressed by current professional situation than women without academic appointment. Respondents without children and with academic affiliations reported the most stress in their current professional setting. CONC
LUSIONS: Female psychiatrists who were able to combine children, intimate relationships, and academic involvement were the most satisfied of all groups.
Women in psychiatry have long carried the burden of balancing multiple roles in their personal and professional choices. The impact of this burden on their physical and mental health continues to be a source of inquiry and concern in the field (1–6). To study the effect of multiple roles on the quality of life for female psychiatrists, members of the Association of Women Psychiatrists, a professional association formed in 1983 were surveyed. The results of the survey are discussed in this article.
METHOD
All members of the Association of Women Psychiatrists residing in the United States and Canada were surveyed via a single mailing of an anonymous questionnaire developed by the author of this study. Prior to this mass mailing, the survey was tested in a pilot group of women psychiatrists known to the author (i.e., a convenience sample).
The questionnaire gathered information on respondents’ demographics, their parents’ level of education, their parents’ employment history and child care arrangements, their career choices, their time spent in career related activities, their time spent in personal/leisure activities, and their childcare arrangements during their working years. Most questions required a forced-choice response (yes/no) or asked for numerical specification (7-point Likert scale).
Frequency distributions and means with standard deviations (SD) were used to describe the sample. Children and academic affiliation variables were used to dichotomize and divide the sample four ways. Two sample t test procedure and analysis of variance (ANOVA) procedures with post hoc analysis were conducted.
RESULTS
The 483 (55% response rate) completed questionnaires were tabulated. The cohort’s median age was 48 years old (SD=0.11 years). Ninety-one percent of respondents were white (N=435); 1.03% were African American (N=5); 4.34% were Asian/Pacific (N=21); 2.1% were Hispanic (N=10); 1.4% were other (N=7) and 1.03% were unspecified (N=5). Sixty-seven percent (N=324) were married or in a committed relationship, and 75% (N=362) had children. Seventy-seven percent (N=374) were board certified. Sixty-two percent (N=299) had an academic affiliation distributed as follows: 26.3% (N=127) assistant professor, 11.4% (N=55) associate professor, 10.4% (N=50) adjunct professor, 7.9% (N=38) instructor, and 4.5% (N=22) professor; and 1.4% (N=7) with affiliation but unspecified. Ninety-seven percent (N=466) were working and had spent a mean of 9.4 (SD=0.88) years at their current job. Sixty-four percent (N=308) were in private practice, while the rest were working in an institutional setting (hospital, clinic, with or without academic affiliation) or were splitting their time between an institutional setting and private practice.
Of the 466 respondents working at the time of the survey, 387 stated their choice of employment (private practice, institutional setting or a combination of the two) as follows: personal (54%, N=260), economic (18%, N=85), and family (9%, N=42). Using a 7-point Likert scale (1=low, 7=high), respondents rated their career as economically satisfying (mean=5.4, SD=1.41). They reported satisfaction with their current work choice (mean=5, SD=1.52), rated the stress level of their work choice (mean=4.7, SD=1.47), expressed an interest in spending more time with family and mates (mean=4.4, SD=1.63), and voiced a desire to increase their personal time (mean=3.2, SD=1.58).
Of the cohort, 60% (N=289) had participated in some form of research prior to this survey; 20% (N=96) had participated in grants, 51% (N=247) had written peer reviewed articles, and 31%(N=148) had written book chapters. Of those who had not participated in research, their two main reasons for not having pursued this interest were lack of training opportunity (29%, N=105) and lack of mentoring (13%, N=46).
In surveying the family history of respondents, it was found that the majority of respondents listed their mothers as their primary caregivers (84%, N=399). Seventy-five percent (N=360) of respondents’ mothers were not employed outside the home during preschool years. This number decreased during grade school (61%, N=296) and high school (46%, N=220). The educational level of respondents’ mothers was 14.3 years (SD=3.2) and respondents’ fathers was 15.6 years (SD=3.9).
Seventy-five percent (N=350) of respondents working at the time of the survey were mothers with children living at home. Fifty-six percent of these children (N=272) were cared for by an employee in the home during their preschool years, 57% (N=273) during grade school years, and 51% (N=246) during high school years. Outside day care, the second choice for those surveyed, was used for 17% (N=84) of these children during preschool years, 18% (N=86) during grade school years, and 3% (N=14) during high school years.
Forty-two percent of respondents (N=205) were devoting 51%–75% of their time to their careers, allocating most of the remainder of their time to their families and leaving less than 25% of their time for personal pursuits. When asked which portion of allocated time they would like to increase, 62% (N=299) responded that they would like to increase personal time.
Table 1 summarizes significant findings when the sample was dichotomized by whether or not respondents had children. Table 2 summarizes significant findings when the sample was dichotomized by whether or not respondents had academic affiliation. For the analysis, academic affiliation was defined as anyone who, at the time, held an academic position such as adjunct professor, instructor, assistant professor, associate professor, professor, or professor emeritus. The sample was divided into four groups, utilizing children and academic affiliation as variables.
The groups differed significantly in the percentage of time spent in career-related activities (F= 16.722, df=3, 455, p<0.0001). Respondents with children and no academic affiliation differed statistically from all other groups and devoted the least time to career-related activities (mean=46.28, SD=20.81).
The groups differed significantly in the degree of satisfaction in their intimate relationships (F=6.071, df=3, 456, p<0.001). Respondents with children and an academic affiliation reported to be the most satisfied (mean=4.68, SD=1.49), while respondents with no children and an academic affiliation reported slightly lower degrees of satisfaction (mean=3.96, SD=2.05), and respondents with no children and no academic affiliation reported the lowest level of satisfaction (mean=3.80, SD=2.05).
The groups differed significantly in time devoted to family activities (F=47.328, df=3, 455, p<0.0001). Respondents with children and no academic affiliation spent the most time involved in family activities (mean=37.90, SD=18.08), while respondents with children and an academic affiliation differed from both other groups without children (mean=31.56, SD=16.20).
The groups differed significantly in time spent doing personal/leisure-related activities (F=5.127, df=3, 459, p=0.002). Respondents with no children and no academic affiliation reported the highest percentage of time devoted to personal/leisure activities (mean=18.64, SD=11.26), while respondents with no children and an academic affiliation reported slightly less time devoted to personal time (mean=17.76, SD=13.20), and respondents with children and an academic affiliation reported the least amount of time spent in personal/leisure activities (mean=12.22, SD=11.74).
DISCUSSION
This study helps to characterize self-reported attitudes of female psychiatrists concerning personal and professional choices. This particular cohort of female psychiatrists chose to work mainly for personal satisfaction, differing from their own mothers in that they allowed others, often an employee in the house, to help with child rearing responsibilities. Similar to other professional women, this group of women psychiatrists tried to negotiate their multiple roles (6). They elected to compromise on professional choices available to them, hire help for some traditional domestic chores, and minimize their personal time. The majority of respondents were satisfied with their current professional situation in spite of the limitations on their personal time and their lack of academic advancement. They favored private practice because of its flexibility, allowing for more control over their time. Most women surveyed found their multiple roles stressful. When asked about feelings of regret regarding their personal and professional choices, 72% did not express regret regarding the manner in which their lives had unfolded. Female psychiatrists with children allocated significantly less time to their careers, devoted more time to their family, allocated less time to personal activities, were more satisfied with their intimate relationships, and were more satisfied with their current employment.
Sixty-two percent of respondents reported academic affiliations. Most were at the assistant professor level, in agreement with studies that suggest a distribution of women primarily among the lower faculty ranks (7, 8). In this study, female psychiatrists with academic affiliations (versus those without) expressed a significantly higher degree of economic satisfaction, reported their career as a source of personal satisfaction, expressed a higher level of stress with their current professional situation, spent more of their time in career-related activities, and allocated less time for family-related activities. Female psychiatrists without academic affiliations and with children devoted the least time to career-related activities and differed from all other groups. Respondents with children and academic affiliations experienced the most satisfaction with intimate relationships, reported the least amount of personal time, and spent more time with family than respondents without children (with or without an academic affiliation). Respondents with children and with no academic affiliation spent the most time with family.
Limitations of this study include: those surveyed were part of a preselected group of female psychiatrists who were members of one professional association; the majority of respondents were in a committed relationship and had children; and the sample was comprised primarily of white professional women who went to medical school at a time when female medical students were in the minority and were not racially diverse. It is also important to note that this study did not address issues of shared parenting or the sharing of home responsibility (9).
The steady increase in the number of women applying to medical schools and completing psychiatry training is changing the composition of our field. This pattern highlights the need to further study the effect of multiple roles on the career paths of female psychiatrists, their interpersonal relationships, their support systems, and their physical and mental health.
ACKNOWLEDGMENTS
The author would like to thank Dr. Vivian Mougios for her assistance with the statistical analysis.
This article was presented in part at the 149th annual meeting of the American Psychiatric Association, New York, May 4–9, 1996; the 41st winter meeting of the American Academy of Psychoanalysis, New York, January 8–11, 1998; and the 50th Institute of Psychiatric Services, Los Angeles, October 1998.
REFERENCES
Facione NC: Role overload and health: the married mother in the waged labor force. Health Care Women Int 1994; 15:157–167
Spurlock J: Multiple roles of women and role strains. Health Care Women Int 1995; 16:501–508
Luecken LJ, Suarez EC, Kuhn CM, et al: Stress in employed women: impact of marital status and children at home on neurohormone output and home strain. Psychosom Med 1997; 59:352–359
Barnett RC, Marshall NL: Worker and mother roles, spillover effects and psychological distress. Women Health 1992; 18:9–40
Barnett RC, Marshall NL, Singer JD: Job experiences over time, multiple roles, and women’s mental health: a longitudinal study. J Pers Soc Psychol 1992; 62:634–644
Gray JD: The married professional woman: an examination of her role conflicts and coping strategies. Psychol Women Q 1983; 7:235–243
Whiting BE, Bickel J: Women on faculties of U.S. Medical Schools, 1978–1989. Acad Med 1990; 65:277–278
Nonnemaker L: Women physicians in academic medicine. N Engl J Med 2000; 342:399–405
Fish LS, New RS, Van Cleave NJ: Shared parenting in dual-income families. Amer J Orthopsychiatry 1992; 62:83–92(Silvia W. Olarte, M.D.)