Characteristics of Women Internists

Erica Frank, MD, MPH; Tricia Kunovich-Frieze, MD; Giselle Corbie-Smith, MD

In This Article

Results

Women general internists were younger than other women primary care physicians. They were also more likely to have children, to be the primary caretaker of those children, to have less educated husbands, and to be politically conservative than were women subspecialized internists (Table 1). Women subspecialized internists were younger, more likely to be politically liberal, more likely to be part of an unmarried couple, and less likely to be separated or divorced than were other women subspecialists.

Women subspecialized internists exercised fewer minutes per week and were less likely to consume vitamin supplements than were other women subspecialists(Table 2). No other health behaviors (cigarette smoking, alcohol, fruit and vegetable, or fat intake, or compliance with examined US Preventive Services Task Force recommendations[9]) or perceived health status differed significantly for any specialty comparisons.

Older women general internists were less likely to be board certified than were older women subspecialized internists; they were also more likely to be board eligible than were other women primary care physicians (Table 3). Women subspecialized internists were more likely to practice in solo or group sites and less likely to practice in hospitals or medical schools than were other women subspecialists; subspecialized internists also spent more hours on CME (especially more time reading journals) than did other internists or other women subspecialists and were more likely to work in a urban setting than other women physicians.

Women internists expressed more dissatisfaction with their careers than did other women physicians (Table 4), although there were no significant differences in reported desire to again be a physician (not shown). Subspecialized internists were more likely than other women specialists to feel they worked too much. Internists were more likely than other women physicians to feel they worked too much and to have less career satisfaction. General internists were also more likely than other women primary care physicians to report severe work stress and were more likely than other women internists and other women primary care physicians to change their specialty if they were to relive their careers. Subspecialized internists had lower personal incomes than those of other women subspecialists, but higher household incomes than those of women general internists (notably, they also had more educated husbands than did other women internists and other women physicians). They also had more hours of nonclinical work than did other women internists or other women specialists. Internists' number of nights on call and their perceived work control were similar to those of other women physicians, and general internists' incomes were identical to those of other primary care women physicians.

The authors questioned whether the 5 noninternist primary care specialties (family practice, general practice, obstetrics/gynecology, pediatrics, and public health) were sufficiently homogeneous with respect to work satisfaction parameters to combine them into a single "primary care" category. These 5 primary care specialties were indistinguishable with regard to work stress, work control, and general career satisfaction. The only significant differences were that general practitioners reported having a more comfortable work load, yet 46% of them reported strong dissatisfaction with their specialty as compared with 17% to 25% of other women physicians (not shown).

To determine correlates of internists' career satisfaction, the authors modeled (Table 5) variables that had been shown in prior analyses[6] to be correlated with women physicians' career satisfaction. Among generalists, career satisfaction was significantly correlated with work control and work stress, number of call nights, and mental health status. Among subspecialists, career satisfaction was significantly correlated with work control, call nights, and harassment.

The authors examined 14 counseling practices and 4 outcomes for each practice: (1) the amount of counseling physicians reported performing, (2) the clinical relevance they ascribed to that counseling, (3) their self-confidence in performing the counseling, and (4) the amount of training they have received (Table 6). In virtually all cases, and usually by substantial margins, subspecialized internists were more interested and confident and believed they were better trained in counseling than were other women subspecialists. Exceptions to this were their training in skin cancer prevention and their training, self-confidence, and perceived relevance in counseling regarding alcohol use. General internists counseled much more frequently on flu vaccine than did other women primary care practitioners but reported less counseling than other women primary care physicians on HIV counseling, mammography, and hormone replacement therapy (HRT). When women obstetricians/gynecologists were excluded from the primary care practitioner group (not shown), internists performed less well (P < .05) than other women primary care physicians regarding breast examination and HRT. Women general internists tended to be more interested in and confident about counseling than were subspecialized women internists, though they consistently claimed similar amounts of training.

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