The Changing Personal and Professional Characteristics of Women in Oral and Maxillofacial Surgery

Transcription

1 J Oral Maxillofac Surg 68: , 2010 The Changing Personal and Professional Characteristics of Women in Oral and Maxillofacial Surgery Farzaneh Rostami, BS,* Anwar E. Ahmed, MS, Al M. Best, PhD, and Daniel M. Laskin, DDS, MS Purpose: In 1994, Risser and Laskin surveyed practicing female oral and maxillofacial surgeons and those in oral and maxillofacial surgery (OMFS) residency programs to determine the factors that attract women to the field, their attitudes toward the various aspects of the specialty, their current practice patterns, and any biases that they may have encountered. The purpose of this study was to determine whether there have been any changes since that report was published. Materials and Methods: Invitations to participate in an online survey were ed to all practicing female oral and maxillofacial surgeons and female OMFS residents in the United States. Results: One hundred fifty-six of the 281 practicing surgeons (56%) and 60 of 111 residents (54%) responded. Fifty-eight percent of residents were single, whereas 63% of practitioners were married. Most residents were childless (88%), but only 46% of practitioners had no children. Residents were more racially diverse only 58% Caucasian versus 75% for practitioners. Both residents and practitioners agreed that they were satisfied with the selection of OMFS as a career choice, 91% and 87%, respectively. The major attractions to the field in both groups included liking surgery in general, the combination of dentistry and medicine, and the challenges offered in the specialty. Both practitioners (61%) and residents (60%) still reported a bias against women in their residency. Twenty-nine percent of residents and 38% of practitioners also reported experiencing sexual harassment. Conclusions: Since 1994, there has been a definite increase of women in both residency programs and practice. There is also greater diversity in both groups. The factors attracting women to the field continue to be relatively unchanged. However, there continues to be bias against women in the field, sexual harassment is not uncommon, and there is no evidence this has improved since Time commitment and social compromises remain the largest deterrents for women entering the specialty of OMFS American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68: , 2010 Over the past 3 decades, the number of women dental students has gradually increased. In , of the 16,533 students enrolled in US dental schools, 231 were women (1.4%). 1 Overall, first-year enrollment peaked in 1978, declined through 1989, and began a slight but steady increase from 1989 to the present. In 2002, the total predoctoral enrollment of women in US dental schools reached more than 40%. 2 This trend continues and is likely to reach 50% within the next decade. In addition, this trend is reflected in postdoctoral dental enrollment and the number of professionally active dentists. 2 Although there has been an increase in the number of women enrolled in dental school, there has not been a significant increase in the number of females applying to oral and maxillofacial surgery (OMFS) programs. The number of females entering OMFS residency has increased by only 2% since Moreover, an overview *Senior Dental Student, School of Dentistry, Virginia Commonwealth University, Richmond, VA. Graduate Student, Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA. Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA. Professor and Chairman Emeritus, Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, Richmond, VA. Address correspondence and reprint requests to Dr Laskin: Department of Oral and Maxillofacial Surgery, School of Dentistry, Virginia Commonwealth University, PO Box , Richmond, VA ; dmlaskin@vcu.edu 2010 American Association of Oral and Maxillofacial Surgeons /10/ $36.00/0 doi: /j.joms

2 382 WOMEN IN ORAL AND MAXILLOFACIAL SURGERY of the active American Association of Oral and Maxillofacial Surgeons (AAOMS) membership statistics in 2003 indicates that of 5,318 active fellows and members, only 154 are women (2.9%). 3 Dental specialization has rewards, and specialists earn substantially higher income than general dentists. 4 However, much like in the general profession, practitioners in dental specialty fields are still overwhelmingly male. According to a study performed by Scarbecz and Ross, 5 even at an early stage of a dental student s career, gender plays a significant role in the level of interest in dental specialty areas. Female firstyear dental students were less interested in some dental specialties than their male counterparts, especially oral surgery and endodontics, and more interested in pediatric dentistry than their male counterparts. However, this trend disappears by the time these students reach their fourth year, and the major determining factors for postgraduate education include encouraging mentors, family members, and dental school faculty. 5 The literature regarding factors that influence postgraduate program selection in dentistry is sparse and limited to certain specialties. 6-8 In 1994, Risser and Laskin 9 conducted a survey of females practicing OMFS or participating in an OMFS residency program, the results of which were published in The aim of the study was to determine the factors influencing women to enter the specialty and to analyze what they perceived to be the advantages and disadvantages of such a career. The present study was initiated to determine whether there have been any changes in the personal and professional characteristics of female residents and practitioners since the previous report was published. Such information can be useful in determining factors that may make this field more welcoming to women. Materials and Methods A current list of addresses of all female members of the American Association of Oral and Maxillofacial Surgeons and its residency organization (ROAAOMS) was obtained in February Separate questionnaires, similar to those used in 1994 but with minor clarifying wording added, were prepared for each participating group. All potential participants were sent an invitation with a letter of introduction requesting their participation. Responses were collected using Inquisite survey software (version 7; Inquisite, Austin, TX) on a secure university Web site. The questionnaires requested personal data including age, race, marital status, and whether participants had children. It also requested information regarding factors that influenced their entering the specialty. There were also questions for the practitioners regarding practice patterns, teaching interest, hours of work, and reasons for choosing their current practice location. They were asked whether they had ever encountered bias or sexual harassment during residency or practice, whether they were completely satisfied with their selection of the specialty, and if they would recommend this specialty to other women. An opportunity was provided for comments. The resident survey also asked for type of residency program (4-year or combined with an MD degree), and if participants would be interested in a fellowship program. The invitations were sent once, and the survey was closed after 1 month. Groups were compared using SAS software (SAS Institute, Cary, NC). The answers from the practitioner and resident surveys were analyzed, and, where possible, these results were compared with those reported from the survey conducted in Because respondents did not always answer all questions, some percentage answers do not add up to 100%. Results In 1994, there were only 107 female practitioners who were members of AAOMS compared with 281 currently. One hundred fifty-six of the 281 practicing surgeons (56%) and 60 of the 111 residents (54%) returned the surveys. The demographic characteristics of the resident and practitioner groups are summarized in Table 1. The practitioners were older, more often married, and more likely to have children Table 1. DEMOGRAPHIC CHARACTERISTICS Resident Practitioner Total Race/ethnicity African American 4 (7%) 5 (3%) 9 Caucasian 35 (58%) 117 (75%) 152 Hispanic 0 (0%) 10 (6%) 10 Other 21 (35%) 24 (15%) 45 Marital status Divorced/widowed 4 (7%) 20 (13%) 24 Married 21 (35%) 99 (63%) 120 Single 35 (58%) 37 (24%) 72 No. of children None 53 (88%) 72 (46%) (10%) 32 (21%) (2%) 42 (27%) (0%) 7 (4%) (0%) 3 (2%) 3 Age n Mean SD Minimum Maximum Rostami et al. Women in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2010.

3 ROSTAMI ET AL 383 than the residents. A smaller percentage of residents than practitioners were Caucasian (58% vs. 75%), and a larger percentage were African American or of other race/ethnicities (42% vs. 18%). PRACTICING SURGEON SURVEY Most of the practicing oral and maxillofacial surgeons worked full time, with an average of 5 workdays per week. Five percent had no hospital appointments, 39% had 1, 31% had 2, 14% had 3, and 10% had more than 3 hospital appointments. Seventy-two percent were board certified in OMFS, an increase from the 59% reported in 1996 (P.0006). Licensure in both dentistry and medicine was rare (29%). Of those respondents who answered questions concerning practice arrangement, 36% owned their practice and 35% worked solo. The remainder held a variety of positions such as working with a partner (25%), being an associate (12%), employed by an OMFS (6%), or other type of practice arrangement (22%). Of those in group practices, 64% had no other female colleagues, 24% had 1 other female in their practice, and 12% had 2, 3, or 4 other females in their practice. Forty-seven percent devoted at least some of their time to teaching, with 66% teaching part time and 44% teaching full time. Location of practice was chosen for a variety of reasons, with family concerns accounting for 25% of the choices. Other major factors were geographic location (37%), job availability (16%), state of licensure (3%), and other major factors (20%). Ninety percent of respondents would recommend the specialty of OMFS to other women, and this was a significant increase from the 75% reported in 1996 (P.001). In terms of satisfaction with their career selection, 68% strongly agreed, 19% agreed, 2% disagreed, 6% strongly disagreed, and 5% remained neutral. Of those who would not recommend the specialty to other women, their reasons differed, summarized as follows: Health care in general is a very challenging field. I wish I did not have to work so many hours to cover the overhead because costs continue to rise and reimbursement declines. I wish I could spend more time with my daughter. OMFS continues to be an old boys club even in If interested in surgery in general, I would recommend medical school and then [moving] on to a surgical specialty. If already a dentist, I would think twice about a career in OMFS. Females, like it or not, are the primary caregivers in a family. This job, unlike general dentistry, cannot be done part time. Arrangements for child care will be unusual, meaning no children; father is a stayat-home, or using nannies. The results regarding the question about what was the motivation to select OMFS are shown in Table 2. The most important determinant was like surgery in general, followed by combines dentistry and medicine, challenging specialty, female role model/ mentor, didn t like general dentistry, encouraging practicing oral and maxillofacial surgeons, financial security, lifestyle, prestige, and other family members in OMFS, in decreasing order. Sixty-one percent of the respondents (n 94/155) stated that there was some bias against women in their residency. Some commented that they were not respected or taken seriously by fellow residents and, to a lesser extent, by the attending faculty. Although the level of bias was lower than in the 1994 survey (64.5%), it was not a significant difference (P.22). In the present survey, 48% also reported encountering bias against females in their practice. Thirty-eight percent also claimed that they had encountered sexual harassment in their residency, whereas 11% had similar situations in their practice. The earlier survey did not report the percentage who encountered sexual harassment, reporting only that There were multiple claims of sexual harassment during residency (p 754). The comments in this survey are summed as follows: Part-time attendings asked me to tense my biceps muscle to see if I was strong enough to take out a tooth. I was also told I would need to use a drill on most of the extractions because I didn t have the strength. I was not prepared for the discrimination; could probably have won a suit, but I m not that type. Good old boys club, left out of the loop, lack of mentoring, and morale issues horrible, but worth it in the end. RESIDENT SURVEY Twenty-seven percent of the residents classified themselves as first year, 22% as second year, 20% as third year, 20% as fourth year, and 11% as fifth year. Forty percent were in a combined OMFS and MD degree program, compared with the 60% who were enrolled in a 4-year program. Twenty percent of the participants had a plan to pursue a fellowship after completion of their residency. The majority were interested in a facial cosmetics fellowship, and some showed interest in craniofacial surgery, head and neck oncology, medical school after residency, and academics. Only a small portion were undetermined and indicated that they would wait a few years before making a decision. Ninety-three percent of the residents planned on practicing full time after completion of their training. Seventy-five percent preferred working in a group

4 384 WOMEN IN ORAL AND MAXILLOFACIAL SURGERY Table 2. PERCENTAGE RANKING OF MOTIVATIONS FOR CHOOSING THE SPECIALTY What was your motivation in selecting oral and maxillofacial surgery as your specialty? Importance Mean Prestige Resident Practitioner Financial security Resident Practitioner Like surgery in general Resident Practitioner Combines dentistry and medicine Resident Practitioner Challenging specialty Resident Practitioner Lifestyle Resident Practitioner Female role model/mentor in dental school Resident Practitioner An encouraging practicing OMFS surgeon Resident Practitioner Did not like general dentistry Resident Practitioner Family member in OMFS Resident Practitioner Abbreviation: OMFS, oral and maxillofacial surgery. Rostami et al. Women in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg practice, 18% would like to have an academic career, and 7% preferred solo practice. The number one reason for selecting OMFS as a career was a liking for surgery in general, followed by a combination of medicine and dentistry, challenging specialty, presence of a family member in OMFS, lifestyle, dislike for general dentistry, presence of an encouraging oral and maxillofacial surgeon, financial security, prestige, and female role model/mentor in dental school, in decreasing order (Table 2). There was a significant difference between residents and practitioners in these rank orderings (multiple analysis of variance, P.0072). Residents placed higher value on liking surgery in general and on lifestyle. Sixty-eight percent of the respondents strongly agreed with their selection of OMFS as a career, 23% agreed, 5% were neutral, and 3% strongly disagreed. The reasons for disagreement can be found in some of the following comments made by the residents: Female residents must outperform their male counterparts to get the same respect. It is still a very male-dominated field, perhaps due to a lack of female mentors. However, I do believe the gender trend in OMFS is changing. I feel that faculty and fellow residents think female residents are not mentally strong enough to cope with the hardships of residency or physically strong enough for certain procedures. Most also assume a female will only end up working part time after residency. Ninety-three percent of residents would recommend the specialty of OMFS to other women. One of the residents not willing to recommend the specialty to other females mentioned that The residency requires long hours, there is no respect from male counterparts, and you are past the child-bearing age once finished. Male residents hate females being pregnant or having any thought of having any children during a 6-year residency program. Another respondent said The program is not fulfilling and I would not recommend it to either sex. I am undecided about a fellowship and it depends upon final adequacy of

5 ROSTAMI ET AL 385 training. Some also mentioned that there are still some people who do not think women are as capable as men to be oral and maxillofacial surgeons. There is incredible discrimination from attendings and some residents. I am the only female in my residency, and the chauvinism encountered is unbelievable! I sometimes wonder why they even ranked females if they truly dislike them in the program! In this survey, 29% claimed sexual harassment during residency, and 60% claimed bias against females. Caucasians (80%) were more likely to claim sexual harassment than African Americans (0%), Hispanics (4%), and other races (16%); also, Caucasians (75%) were more likely to claim bias against females during residency than African Americans (4%), Hispanics (3%), and other races (19%). Surprisingly, 89% of those who claimed bias against females during residency would still recommend the specialty to other females. Discussion Although many of the responses by residents and practitioners have not changed since the survey in 1994, there also have been some significant changes. The number of practitioners who are married has declined slightly, and the number divorced has greatly increased (5.3% vs 13%). Caucasians are still the majority in both groups of respondents. However, there has been an increase in the number of African Americans and those with other racial backgrounds (15.7%). Although the average age of the residents has not changed, there has been an increase in the average age of the practitioners. This is consistent with the greater number of women currently in this group. There have also been changes in the practice characteristics. The number of women owning their own practice has decreased from 47% to 36%, and those in a partnership have increased (18.4% vs 25%). An interesting finding has been the change in the number of hospital appointments. Whereas in 1996, the average was 3, currently only 14% indicated that they had 3 appointments, and 6% had no hospital appointments. This may be part of the unfortunate trend of many oral and maxillofacial surgeons refusing to take emergency calls and preferring to limit their practice to the office rather than to combine it with hospital-based surgery. The number of practitioners who are diplomates of the American Board of Oral and Maxillofacial Surgery has increased significantly, from 59% to 72%. There has also been a small increase in the number who devote part of their time to teaching (42% vs 47%). In 1994, only 3 practitioners reported having both a dental and medical degree. In the current survey, there were 46, a significant increase (P.0001). In 1994, only 25% of the residents were in an OMFS-MD program. This increased to 40% in the current study. Although the number of residents planning on practicing full time was similar to the 1994 study, the number who planned on working in a group practice had increased from 34% to 75%, and the number wanting to go into solo practice had decreased from 34% to 7%. Whereas in the previous study half of the residents had plans to pursue a fellowship after completion of their residency, currently only 12% were interested. Both the residents and practitioners in this study indicated experiencing some level of bias against women as well as instances of sexual harassment. Thus, this situation has not changed significantly since The bias was mainly in the form of perceived incompetence. Although the residents experienced fewer incidents of sexual harassment compared with practitioners, the majority seemed to consider inappropriate jokes shared by their male colleagues as problematic. However, despite the bias against women that still exists in this field, many still recall going through their residency as a rewarding experience. Although there has been an increase in the number of females pursuing a career in OMFS since 1994, the field is still male dominated. There is a need for more role models to help correct this gender bias. Female practitioners should consider reaching out to female dental students and young women dentists and encourage them to enter the specialty. In the near future, OMFS will likely be more challenging for some women and men to establish balance between professional life and family life. However, despite such challenges, success in the profession is not a function of gender, but a reflection of sheer determination and perseverance. References 1. Annual Report on Dental Education Trend Analysis. Chicago, American Dental Association, 1974, pp Sinkford JC, Valachovic RW, Harrison S: Advancement of women in dental education: Trends and strategies. J Dent Educ 67:79, AAOMS Today M:4, April American Dental Association: The 2000 Survey of Dental Practice: Characteristics of Dentists in Private Practice and Their Patients. Chicago, American Dental Association, Scarbecz M, Ross JA: The relationship between gender and postgraduate aspirations among first- and fourth-year students at public dental schools: A longitudinal analysis. J Dent Educ 71: 797, Saeed S, Jimenez M, Howell H, et al: Which factors influence student s selection of advanced graduate programs? One Institution s experience. J Dent Educ 72:688, Brunner MK, Hilgers KK, Silveira AM, et al: Graduate orthodontic education: The residents perspective. Am J Orthod Dentofac Orthop, 82:277, Marciani RD, Smith TA, Heaton LJ: Applicants opinions about the selection process for oral and maxillofacial surgery programs. J Oral Maxillofac Surg, 14:608, Risser MJ, Laskin DM: Women in oral and maxillofacial surgery: Factors affecting career choices, attitudes, and practice characteristics. J Oral Maxillofac Surg 54:753, 1996