437 General Anesthesia Gender patterns amongst Canadian anesthesiologists [La proportion hommes-femmes chez les anesthésiologistes canadiens] Mark Otto Baerlocher MD,* Rumana Hussain BSc, John Bradley MD FRCPC Purpose: The specialty of anesthesiology in Canada has traditionally had a larger proportion of male practitioners. More recently, however, the proportion of female medical students has increased. We sought to determine if the gender ratio within the specialty of anesthesiology in Canada has followed the female:male distribution patterns within medical schools. Methods: Gender-specific data were obtained from the Royal College of Physicians and Surgeons of Canada, the Canadian Institute for Health Information, the Canadian Residency Matching Service (CaRMS), and the Program Director from each of the 16 Canadian Anesthesiology Residency Training Programs. Results: The ratio of practicing female:male anesthesiologists increased from 0.29:1 in 1998 to 0.34:1 in 2005. The ratio was greatest in the youngest age grouping (< 45 yr), at 0.49:1, and lowest in the > 64 age group, at 0.16:1. As of the 2004-2005 academic year, there were 201 women in a Canadian anesthesiology residency program vs 316 males, a female:male ratio of 0.64:1. Female medical students were less likely to rank anesthesiology residency as their first choice in the annual CaRMS match as compared to their male counterparts; a mean of 21 female medical students ranked an English anesthesiology residency program as their first choice in the CaRMS match, vs a mean of 35 males, from 1993-2005 (inclusive). Conclusions: The number (and female:male ratio) of women in anesthesiology in Canada is increasing gradually. However, more males continue to enter the field than women. This may be explained by a lower number of women who rank anesthesiology as their first choice in the annual CaRMS match. Objectif : La spécialité de l anesthésiologie au Canada a traditionnellement compté une plus grande proportion d hommes. Plus récemment, toutefois, la proportion d étudiantes en médecine a augmenté. Nous voulions déterminer si la proportion hommesfemmes dans la spécialité a suivi les mêmes modèles de distribution que ceux des écoles de médecine. Méthode : Les données spécifiques au sexe ont été obtenues du Collège royal des médecins et chirurgiens du Canada, de l Institut canadien d information sur la santé, du Service canadien de jumelage des résidents (SCJR) et des patrons de chacun des 16 Programmes canadiens de résidence en anesthésiologie. Résultats : La proportion femmes:hommes chez les anesthésiologistes praticiens est passée de 0,29:1 en 1998 à 0,34:1 en 2005. Le ratio était plus élevé chez les médecins de < 45 ans, à 0,49:1 et plus faible dans le groupe d âge > 64 ans, à 0,16:1. Pour l année académique 2004-2005, il y avait 201 femmes dans un Programme canadien de résidence en anesthésiologie vs 316 hommes, un ratio femmes:hommes de 0,64:1. Les étudiantes en médecine sélectionnaient moins souvent l anesthésiologie comme premier choix de résidence selon le SCJR comparativement à leurs homologues masculins ; une moyenne de 21étudiantes en médecine a choisi un programme anglais de résidence en anesthésiologie comme prioritaire selon le SCJR, vs une moyenne de 35 hommes, de 1993 à 2005, inclusivement. Conclusion : Le nombre de femmes, et le ratio femmes:hommes, en anesthésiologie au Canada augmentent peu à peu. Cependant, plus d hommes que de femmes continuent de s y inscrire. Cette situation pourrait s expliquer par le plus faible nombre de femmes qui classent l anesthésiologie comme premier choix dans le jumelage du SCJR. From the Radiology Residency Training Program,* University of Toronto, Toronto; Ontario, Canada; King s College London, School of Medicine, University of London, London, UK; and the Department of Anesthesia, the University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Address correspondence to: Dr. Mark Baerlocher, 13 Marshview Drive, Sackville, New Brunswick E4L 3B2, Canada. Phone: 416-508-0159; E-mail: mark.baerlocher@utoronto.ca The project was not funded by any Departmental or external funding sources. Accepted for publication October 26, 2005. Revision accepted November 30, 2005. Competing interests: None declared This article is accompanied by an editorial. Please see Can J Anesth 2006; 53: 427 31. CAN J ANESTH 2006 / 53: 5 / pp 437 441
438 CANADIAN JOURNAL OF ANESTHESIA MEDICINE, and in particular, the medical specialties, have traditionally had a higher proportion of male compared to female practitioners. In the latter 20 th century, however, great progress has been made towards gender equalization in medicine. Within Canada, there are currently as many women enrolled in Canadian medical schools as men. 1 The so-called feminization of medicine will likely have important implications in a number of domains, including the patient-physician relationship, local and societal delivery of care, and the medical profession itself. 2 Certainly, the issue is a topic of much debate, on all sides. 3 With equalization of the numbers of men and women within medical school, one might expect the number of women entering anesthesiology to increase concomitantly. However, it is also possible that more women are instead entering other specialties: it is clear, for example, that family medicine is the most popular career choice for female medical students. 4 In this descriptive study, we explore the issue of feminization of anesthesiology in Canada. Specifically, we sought to determine whether or not the gender distribution of anesthesiologists in Canada has changed during the past decade. As a related issue, we also sought to determine the prioritization pattern of medical students, by gender, who ranked anesthesiology as their first choice in the Canadian Residency Matching Service (CaRMS). Methods Data were obtained from several organizations. The Canadian Institute for Health Information provided gender-specific data on anesthesiologists currently in Canadian practice from the years 1998 to 2005 (inclusive). The Royal College of Physicians and Surgeons of Canada (RCPSC) provided gender- and age-specific data on the number of Canadian anesthesiologists registered as RCPSC Fellows as of January 2005. The CaRMS provided gender-specific data regarding the number of applicants to the Canadian anesthesiology programs which participate in the annual CaRMS match. Specifically, CaRMS provided the numbers of male and female medical students who ranked anesthesiology residency (RCPSC certification track) as their first choice in the matching process, and the proportion of the total number of women and men in the CaRMS match which this represents, for each year from 1993 to 2005 (inclusive). As the medical schools in Québec do not participate in the CaRMs match, this component of the data base included data for the schools which participate in the matching program. Finally, with the cooperation of the Association of TABLE I Total number of practicing anesthesiologists in Canada from 1998-2005, by gender (data from the CIHI)* Year # Females # Males Female:male ratio 1998 503 1729 0.29:1 1999 512 1754 0.29:1 2000 526 1761 0.30:1 2001 540 1773 0.30:1 2002 570 1798 0.32:1 2003 591 1819 0.32:1 2004 614 1839 0.33:1 2005 631 1857 0.34:1 *Excludes residents and physicians over the age of 80. Canadian University Departments of Anesthesiology (ACUDA), each of the Programs Directors from the 16 Canadian anesthesiology training programs (13 English, three French) were e-mailed and asked to provide the number of male and female residents within their respective anesthesiology residency training programs as of January, 2005. The database included both part-time and full-time anesthesiologists (i.e., RCPSC-certified) practicing in academic and community hospital settings in Canada. Data relating to family-practice anesthetists were not included in this study. Summary data are presented as ratios. Results The ratio of female:male anesthesiologists increased from 0.29:1 in 1998 to 0.34:1 in 2005 (Table I). This ratio was greatest in the younger age categories of practicing anesthesiologists, from 0.49:1 amongst anesthesiologists under the age of 45 to 0.16:1 amongst anesthesiologists over the 64 yr of age (Table II). Males currently outnumber females in Canadian anesthesiology residency training programs (Table III). The female:male ratio amongst anesthesiology residents is greatest at l Université de Sherbrooke (2.7:1), and least at the University of Western Ontario (0.30:1; Table III). The number of male and female medical students ranking an anesthesiology residency program as their top choice in the annual CaRMS match has increased (Figure 1). A greater percentage of the potential male applicant pool ranked an anesthesiology program as their first choice in comparison with the female applicant pool (Figure 2). Grouping data from the years 1993-2005 (inclusive), a mean of 21 women ranked an anesthesiology program as their top choice, compared to a mean of 35 men. This represents 3.6% of potential female medical student applicants, and 5.4% of potential male
Baerlocher et al.: GENDER ISSUES IN ANESTHESIA 439 TABLE II Total number of anesthesiologists registered as fellows in good standing of the Royal College of Physicians and Surgeons of Canada, by age and gender, as of January 2005* Age (yr) # Females # Males Female:male ratio < 45 291 600 0.49:1 45 54 223 667 0.33:1 55 64 98 356 0.28:1 > 64 75 472 0.16:1 *Includes retired Fellows. TABLE III Total number of residents enrolled in the thirteen English anesthesia residency training programs in the academic year ending 2005, by gender FIGURE 1 Number of medical students ranking an anesthesiology residency program as top choice in Canadian residency match, by gender, 1993-2005. # Females # Males Female:male ratio Memorial University 5 10 0.5:1 of Newfoundland Dalhousie University 6 18 0.33:1 McGill University 9 19 0.47:1 University of Ottawa 19 25 0.76:1 Queen s University 10 9 1.1:1 University of Toronto 24 50 0.48:1 McMaster University 15 18 0.83:1 University of Western Ontario 9 30 0.30:1 University of Manitoba 7 22 0.32:1 University of Saskatchewan 7 13 0.54:1 University of Alberta 8 14 0.57:1 University of Calgary 9 11 0.82:1 University of British Columbia 17 35 0.49:1 Université Laval 14 19 0.74:1 Université de Montréal 23 16 1.44:1 Université de Sherbrooke 19 7 2.7:1 Total 201 316 0.64:1 medical student applicants respectively, reflecting a female:male ratio of 0.67:1. As of the 2004-2005 academic year, men outnumbered women within anesthesiology residency training programs, with 201 women vs 316 men, a ratio of 0.64:1 (Table III). Two of the three French programs (l Université de Montréal, and l Université de Sherbrooke), and the program at Queen s University have more women than men (female:male ratios of 1.44:1, 2.7:1, and 1.1:1 respectively). The lowest female:male ratio was observed in the program at the University of Western Ontario (0.30:1). Discussion Aside from a transient decrease in the late 1990 s, the number of female medical students within Canadian medical schools has increased steadily over the past four decades, while the number of males has decreased FIGURE 2 Percentage of total male and female medical student applicant pool ranking an anesthesiology residency program as top choice in Canadian residency match, by gender, 1993-2005. since a peak in the mid-1970 s. 5 Indeed, graduating female medical students currently outnumber graduating male medical students. This increased female:male ratio amongst medical students has been accompanied by an increased female:male ratio amongst physicians in Canadian practice. 5 Within the practice of anesthesiology in Canada, the current female:male ratio is approximately 0.34:1. This represents a modest increase from a female:male ratio of 0.29:1 observed in 1998. Categorized by age, the ratio of female:male anesthesiologists practicing in Canada is greatest within the youngest age groupings: one in three anesthesiologists under the age of 45 is female (a female:male ratio of 0.49:1), vs one in six over the age of 64 (a female:male ratio of 0.16:1; Table II). A discrepancy regarding the number of certified anesthesiologists presented in Tables I and II is due to the fact that retired anesthesiologists were included in the data base of Figure II. The lower number of female anesthesiology residents reflects a proportionately lower application rate by women. This is seen in both the absolute number
440 CANADIAN JOURNAL OF ANESTHESIA of women ranking anesthesiology programs as their first choice, as well as the percentage of the total female applicant pool, compared to males. The pattern of female:male ratios of applicants over the past 13 years has not been consistent. However, we project that the female:male ratio of anesthesiologists in clinical practice will continue to increase, possibly approaching an equilibrium value near 0.67:1. This projection may not apply to the three French programs, as data from these centres are not available through the CaRMS match. A previous study has shown an absence of gender discrimination at the level of Canadian residency selection committees. 4 This matter was not evaluated in the current study. However, potential factors possibly dissuading female medical students from selecting a career in anesthesiology must be considered. For example, lifestyle factors such as pressure to start a family may play a role, particularly during residency training. There is no question, for example, that proportionately more female medical students rank family medicine as their top choice in the CaRMS matching program, 4 and the shorter training period is an important determinant. Strategies to attract more female applicants to anesthesiology are complex, and issues related to family planning, and the prolonged specialty training program are important considerations. 6 In a survey of 946 members of the Canadian Anesthesiologists Society conducted in 1998, Jenkins and Wong reported that women were as satisfied with their professional careers as their male counterparts. 7 In a South African study, Gardner et al. 8 reported that female anesthesiologists have high career satisfaction; however they also reported that women are more likely to report gender discrimination and harassment. It may be possible, to increase attraction to the specialty by examining such factors such as work-related stress, and ability to influence the work environment. 9 Providing the option of practicing on a part-time basis is another factor which departments must also consider. Finally, increasing numbers of women entering anesthesiology will create additional issues: the recent Ryten report 10 found that female anesthesiologists work fewer hours than their male counterparts until the age of 55, particularly in the youngest age groups. Female anesthesiologists between the ages of 30 and 39 work, on average, 70% less than male anesthesiologists. As the changing gender balance leads to an increasing female:male ratio amongst anesthesiologists, there may be additional human resource implications for the specialty of anesthesia. There are several limitations to this study. First, the data in Table III provide only a snapshot of the gender ratios amongst anesthesiology residents for the year 2005. Essentially, the ratios shown represent an average of the gender ratio over 5 years, Post-Graduate Years 1-5. Second, the data shown in Figures 1 and 2 refer only to males and females who ranked an anesthesia program as their top choice, and does not take into account those who ranked an anesthesia program as their second or lower choices. In conclusion, there is an increase in the number (and an increase in the female:male ratio) of practicing female anesthesiologists in Canada. Although the number of female specialists continues to rise, the application rate to anesthesiology residency training programs continues to be lower amongst graduating female medical students compared to that of their male counterparts. Steps to equalize the gender distribution of anesthesiologists in Canada should examine measures to ensure the specialty is able to recruit effectively from the cohort of graduating medical students. Acknowledgements The authors sincerely thank representatives from the Canadian Institute for Health Information, the Royal College of Physicians and Surgeons of Canada, the Canadian Residency Matching Service, and the Program Directors of the Anesthesiology Residency Training Programs of each of the 16 Canadian Medical Schools, for providing the data presented in this study. References 1 Burton KR, Wong IK. A force to contend with: the gender gap closes in Canadian medical schools. CMAJ 2004; 170: 1385 6. 2 Levinson W, Lurie N. When most doctors are women: what lies ahead? Ann Intern Med 2004; 141: 471 4. 3 Sibbald B. Feminization of medicine - people say it like it s a bad thing. CMAJ 2002; 167: 914. 4 Baerlocher MO, Detsky AS. Are applicants to Canadian residency programs rejected because of their sex? CMAJ 2005; 173: 1439 40. 5 Baerlocher MO, Walker M. Does gender impact upon success rate amongst Canadian radiology residency applicants? CARJ 2005; 56: 232-37. 6 Strange Khursandi DC. Unpacking the burden: gender issues in anaesthesia. Anaesth Intensive Care 1998; 26: 78 85. 7 Jenkins K, Wong D. A survey of professional satisfaction among Canadian anesthesiologists. Can J Anesth 2001; 48: 637 45. 8 Gardner SV, James MF, Evans NR. Gender issues among South African anaesthetists. S Afr Med J 2002; 92: 732 6.
Baerlocher et al.: GENDER ISSUES IN ANESTHESIA 441 9 Frank E, McMurray JE, Linzer M, Elon L. Career satisfaction of US women physicians: results from the Women Physicians Health Study. Society of General Internal Medicine Career Satisfaction Study Group. Arch Intern Med 1999; 159: 1417 26. 10 Ryten E. A physician workforce planning model for the specialty of anesthesia: theoretical and practical considerations. Available from URL; http://www.anesthesia. org/acuda/en/ryten.html.