Introduction
The number of women who graduate from medical school is increasing. Also in Poland, we observe feminisation in the profession of physician. In 2023, there were 156,290 practicing physicians, of whom 92,421 were women (59.13%) [1]. However, there are specialties in which women are underrepresented.
Various factors can influence the choice of specialisation and the difficulty in its implementation. Females who choose gastroenterology as their specialisation encounter diverse challenges throughout their education. The prevailing belief in gender-based prejudice can hinder the realisation of women’s untapped potential and may even discourage them from pursuing specialty training. A significant aspect of practical skills in gastroenterology involves performing endoscopic procedures. The standardised size of endoscope heads presents a challenge for individuals with smaller hands in handling and manoeuvring them [2]. Endoscopy is perceived as physically and manually demanding, which can hinder access to education and the performance of more sophisticated procedures by women, restricting the professional development of women in this field.
Women continually face discrimination and encounter stereotypical perceptions on many levels. According to the data, female physicians are affected by concerns of unequal pay – they earn less than men in equivalent positions [3, 4]. Additionally, they are still underrepresented as reviewers and editors in gastroenterology journals. The conducted study, which included 6 major gastroenterology journals, showed that the proportion of women on editorial boards increased from 2.9% in 1985 to 19.8% in 2020 [5]. Women encounter difficulties in conducting original research; they rarely assume the role of senior author, which not only hampers personal growth but also impedes global medical progress. The same study showed that, in significant gastroenterology journals, women constitute 19% of first authors and 14.4% of senior authors [5]. Female gastroenterologists are promoted less frequently than their male counterparts [6] and are underrepresented in global organisations [7]. As the data show, women still constitute a minority of team leaders in academic gastroenterology [8]. Disproportions in taking executive positions are also noticed by the American Society for Gastrointestinal Endoscopy (ASGE), which suggests solutions to promote gender equality [9].
All over the world, there are networks and associations that consociate female gastroenterologists. They mainly aim to take care of gender equality and the support of women in professional development. Also in Poland, there is a foundation called “Women of science – Polish network of women science”, which assists women in their careers, promotes the research results of Polish female scholars, and propagates an attitude of equality [10]. Making up the network of contacts is crucial for establishing women gastroenterologists’ cooperation, the exchange of experience, and peer support.
Aim
The study aimed to characterise both women practicing gastroenterology and those undergoing specialty training in gastroenterology, as well as point out potential problems and difficulties in their daily work in Poland.
Material and methods
A web-based, voluntary, anonymous questionnaire was sent out to Polish Society of Gastroenterology female members and Polish Society of Gastroenterology Congress female participants. We obtained responses from 144 women, who were included in the study. All responses preclude personal identification, and participants could waive the survey any time. The survey was distributed in August 2023 through email, using Google Forms.
The questionnaire was specially created for this study. The questions were set based on reviewed literature about gender inequality in gastroenterology. The survey comprised 16 questions about demographic data, work character, and encountering difficulties in medical practice concerning gender. The characteristics of a female gastroenterologist were determined on the basis of age, age of graduated specialty training (or projected age), habitation (province), and having children. We sourced information about place of work (province, city size, type of health care facility), sort of performed endoscopic procedures, and taking up a management post. We also asked about the satisfaction of specialty choice, difficulties and constraints in practicing associated with the female sex, and the sense of gender discrimination.
Results
According to the survey results, the highest number of women working in gastroenterology were within the age range of 30–40 years, constituting 30.6% of the respondents. However, this was only slightly higher than the group of women aged 40–50 years, who made up 29.2%.
Considering the place of residence and workplace, the highest proportion of female gastroenterologists indicated the Masovian Voivodeship, accounting for a total of 16.7% of the surveyed group. The second most frequently indicated was the Lesser Poland Voivodeship. These two aforementioned questions about the workplace and residence also showed that the majority of women worked in their place of residence. Those who responded differently were most often from the province of Lodz.
25% of the surveyed women stated that they did not have children. 38% of those asked were raising 2 children, 27.8% had 1 child, and the rest, 8.3%, had 3 children. None of the surveyed women had more than 3 children.
The women were asked about the age of completing specialisation or the expected age of completing specialisation, and they predominantly indicated the age range of 30–40 years (76.4%), while 22.9% indicated the range of 41–50 years.
The majority of those surveyed, 37.5%, when asked about the number of inhabitants of the workplace city, indicated that the city had more than 500,000 inhabitants, while the second most frequently chosen answer, at 31.9%, was up to 500,000 inhabitants but more than 250,000.
Female gastroenterologist asked, when about their primary workplace, most frequently indicated the gastroenterological ward – as much as 66.7%. The second most frequently indicated place was an endoscopic unit within a hospital – 16.7%. When asked about additional workplaces, the women most frequently indicated the gastroenterological outpatient clinic (54.9%) and private practice (54.2%). As for additional work in endoscopy units, 32.6% of those asked worked additionally in such a unit within a hospital, while 23.6% worked in an outpatient setting. It should be noted that the question described above allowed multiple choices. Answers to these questions indicated that 144 women worked in 280 additional workplaces. The respondents’ answers showed that there were about three jobs for each female doctor. Less than one-third (25.7%) of the surveyed women held management positions.
Women answering the multiple-choice question about performed procedures most frequently indicated diagnostic gastroscopy (91%), diagnostic colonoscopy (77.1%), and polypectomy (63.2%). The majority (97.9%) of surveyed women stated that they were satisfied with their choice of specialisation.
Nearly half of the surveyed women (47.2%) stated that gender caused or had caused limitations in their professional work, and 18.8% felt discriminated against. The majority (72.9%) of the women found it particularly difficult to balance their work schedule with their private life, and for exactly half, the necessity of being on duty was particularly difficult.
Discussion
The study allowed us to draw many valuable conclusions. Most women working in gastroenterology live in large cities. The fact that most responses were received from the Mazovia Province may reflect both the total number of doctors in these voivodeships and the leadership role of women in this area. The study showed that more than half of the surveyed women worked in a gastroenterology department. The second most frequently mentioned place of work was an endoscopy unit. Almost half of the women indicated that gender caused professional limitations, and almost one-fifth felt discriminated against. These results indicate that gender-related difficulties are still a serious problem.
Gender discrimination in the workplace often takes the form of unconscious behaviour. There is no rule that it always comes from the opposite sex. The interpretation of the concept of discrimination is wide; it can be an indirect or direct phenomenon. Due to motherhood and established stereotypes, women are more exposed to inappropriate questions at job interviews, which can be a hindrance in salary negotiations. In addition, they may be asked to choose between a professional career and a family. On the one hand, there are legally established rules specifying working hours or the length of maternity leave; on the other hand, working in a hospital is always teamwork, and each member of the team would like to be treated with respect and on an equal footing. As many as 25% of the surveyed women held managerial positions, which confirms the positive trend. However, until now, many people subconsciously considered leadership traits to be exclusively male, which is a starting point for prejudice and a difficult challenge, especially for women in managerial positions. Everyone, regardless of gender, should focus on developing their individual aptitudes, without being judged by whether these traits are traditionally associated with men or women. This approach would positively impact both the quality of work and social relationships among colleagues. Gender-related difficulties in medicine are a fact, as evidenced by emerging initiatives supporting the professional development of women in healthcare. In Poland, the first such initiative was “Polish Women in Medicine”, whose creators intensively address the topic of discrimination against women and what can be done to improve the situation of female doctors in healthcare. Below, we review and summarise how the available literature addresses the topic of gender inequality in medicine.
The WEL project is an excellent effort to increase the advancement of women in medicine through the use of mentoring. It also emphasises the need for organisational and social interventions to equalise the working conditions of all physicians. Compensation and career advancement conditions need to be standardised. The initiative aims not only to help women achieve leadership positions, but it can also reduce the gender imbalance that exists in medicine [11]. Other authors who have studied this issue point to the need to eliminate gender inequality in medicine, in access to mentoring, but also in special funding and flexible work arrangements for women. The data presented above show that women achieve good clinical outcomes. The achievement of good outcomes by women was influenced by personality traits, conditions, and predispositions that affect the way they practice their profession. According to research, women are more likely to show empathy and have well-developed communication skills, which has a positive impact on relationships with patients and, consequently, on the entire treatment process. The authors point out that there is a need to take action to eliminate gender inequality and use the positive attributes of women in medicine and natural sciences [12]. It is also important to note that various studies have shown that female physicians are more likely to follow clinical guidelines, provide preventive care and psychosocial counselling, and spend more time with their patients than their male colleagues. Therefore, it is incumbent upon healthcare systems to promote diversity in the medical workforce and support female physicians in their professional development [13].
The concept of the “glass ceiling” has been revived in scholarly articles about the lack of advancement of women into leadership positions in academic medicine. The authors argue that deeply ingrained gender biases and assumptions contribute to stifling women’s progress in both areas [14]. Women have been catching up with men in medical school enrolment for more than a decade, yet significant gaps in pay, academic rank, and leadership positions remain. Progress has been too slow to meet suggested gender equity goals. There are still many barriers to true gender equity in academic medicine. Examples include pay gaps and poor workplace culture [15]. Performing endoscopic procedures can be considered particularly challenging for women. This is due, in part, to the standard size of the equipment, which causes significant discomfort for women with smaller hands, potentially making the procedure more difficult to perform. This is supported by research conducted by Arlow et al., who found that women were less trained in advanced endoscopy [16].
The gender disparity is especially noticeable in the authorship of scientific studies [17]. The smaller number of female authorities in academic medicine can be discouraging for women who wish to actively pursue a scientific career. Arlow et al. noted that female trainees are more likely than their male counterparts to choose a specialty based on family needs [16].
The study group should not be treated as representative, as it only reflects the situation of the respondents. Additionally, it is not possible to specify what restrictions make women feel discriminated against because there was no such question in the survey.
Conclusions
Gender-related difficulties remain a serious issue in various aspects of medicine. Nearly one-half of female gastroenterologists have a sense of limitation related to gender in work performance. Nevertheless, a significant number of women work in endoscopic units and assume management positions. Despite significant progress, there is a need to raise awareness of the scale of gender-related difficulties and take further action to support the potential of women in gastroenterology.
