Intended for healthcare professionals

Research Christmas 2018: Equal to the Task

Physician mothers’ experience of workplace discrimination: a qualitative analysis

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4926 (Published 12 December 2018) Cite this as: BMJ 2018;363:k4926

Linked editorial

Unto them a child is born

  1. Meghan C Halley, research scientist1 2 *,
  2. Alison S Rustagi, physician3 *,
  3. Jeanette S Torres, strategic director1,
  4. Elizabeth Linos, assistant professor of public policy4,
  5. Victoria Plaut, professor of law and social science5,
  6. Christina Mangurian, professor of psychiatry6,
  7. Esther Choo, associate professor of emergency medicine7,
  8. Eleni Linos, associate professor of dermatology1
  1. 1Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
  2. 2Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
  3. *Contributed equally
  4. 3Santa Clara Valley Medical Center, San Jose, California, USA
  5. 4Goldman School of Public Policy, University of California, Berkeley, California, USA
  6. 5University of California, Berkeley School of Law, Berkeley, California, USA
  7. 6Department of Psychiatry, University of California, San Francisco, California, USA
  8. 7Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
  1. Correspondence to: Eleni Linos eleni.linos{at}ucsf.edu
  • Accepted 20 November 2018

Abstract

Objectives To report woman physicians’ experiences, in their own words, of discrimination based on their role as a mother.

Design Qualitative analysis of physician mothers’ free-text responses to the open question: “We want to hear your story and experience. Please share” included in questions about workplace discrimination. Three analysts iteratively formulated a structured codebook, then applied codes after inter-coder reliability scores indicated high concordance. The relationships among themes and sub-themes were organized into a conceptual model illustrated by exemplary quotes.

Participants Respondents to an anonymous, voluntary online survey about the health and wellbeing of physician mothers posted on a Facebook group, the Physician Moms Group, an online community of US physicians who identify as mothers.

Results We analyzed 947 free-text responses. Participants provide diverse and vivid descriptions of experiences of maternal discrimination. Gendered job expectations, financial inequalities (including lower pay than equally qualified colleagues and more unpaid work), limited opportunities for advancement, lack of support during the pregnancy and postpartum period, and challenging work-life balance are some of the key themes identified. In addition, participants’ quotes show several potential structural drivers of maternal discrimination and describe the downstream consequences of maternal discrimination on the physician herself, her career, family, and the healthcare system.

Conclusions These findings provide a view of maternal discrimination directly from the perspective of those who experience it. Women physicians report a range of previously uncharacterized ways in which they experience maternal discrimination. While certain aspects of these experiences are consistent with those reported by women across other professions, there are unique aspects of medical training and the medical profession that perpetuate maternal discrimination.

Footnotes

  • Contributors: MCH and Eleni L conceived of the study and analysis plan. MCH, JST, and ASR analyzed the data. MCH drafted the conceptual model. MCH and ASR wrote the first draft of the manuscript. All authors contributed to interpretation of the data, edited the manuscript, and approved of the final manuscript. Eleni L had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Funding: Eleni L is supported by the National Cancer Institute (grant No R21CA212201, the National Institute of Aging (grant K76AGO54631), and the National Institute of Health (grant DP2CA225433); VP is supported by NSF #1535435; and CM is supported by grants K23MH093689, R01MH112420, and R03DK101857.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work.

  • Ethical approval: Obtained from University of California, San Francisco’s institutional review board.

  • Data sharing: No additional data are available.

  • The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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