Identifying Challenges Iranian Female Physicians Facing : A Case of Hospitals in Babol in Iran

Physician job satisfaction is essential for ensuring the quality of health care services. It is vital to address physicians' problems and try to redesign their working patterns as it is closely associated with patients and health care systems as a whole. However it has been reported in related studies that physician especially female physicians encounter different challenges. Hence, this study is aimed at exploring the factors relating to female physician problems and providing some solutions. The questionnaire was distributed among female physicians in hospitals of Babol in Mazandaran province, Iran. The findings show that the challenges female physicians facing mainly consisted of factors relating to family level, occupational level, and structural level. Based on the findings of this study, some strategies to solve the identified challenges are also presented.


Introduction
Hygiene and health care systems are one of the most significant systems in every society since they have salient role in the life and development of societies.Hence, health care systems are considered as one of the societies' advancement criteria.Moreover, the need for having human who are healthy mentally and physically increases the importance of hygiene and health care systems.
Physicians hold a profession that is traditionally connected to very high work commitment.Today, female physicians constitute the growing number of human resources in hygiene and health care systems.Therefore, identifying the problems female physicians facing and taking actions in an attempt to eliminating their problems can improve the quality of these systems.It is noteworthy that female physicians have special significance from the view of emotional aspects as they have principal role in family life.Female physicians as mothers in home and www.hrmars.comphysicians at clinics and hospitals are dealing with individuals who need the most attention and care, so the mental health of the society is in close relation with female physicians' wellness.Decades of research have disclosed that the main challenge physicians facing is the incompatibility between work and family.Greenhaus and Beutell defined Work-Family Conflict (WFC) as a "form of inter role conflict in which the role pressures from work and family are mutually incompatible in some respect" (Greenhaus and Beutell, 1985).Theoretically, it implies that individuals have a certain, limited amount of energy, when they have the responsibility of multiple roles; these roles tend to drain them and cause stress or inter role conflict.There is a bidirectional relationship between work and family; there is work interfering with family (WIF) and family interfering with work (FIW) (Frone et al., 1997).WIF happens when demands and obligations of the work role are detrimental to family life.FIW occurs when the conflict arising from family duties and responsibilities interrupt one's work (Frone et al., 1997(Frone et al., , 1992)).Moreover, based on gender role theory, women are more likely to see their family role as part of their social identity than men do (Grandey et al., 2005;Milkie & Peltola, 1999).As a result, central social role is threatened by WIF in particular for women.Reportedly, women's roles in the workplace have increased in recent years but their responsibilities in family roles have not diminished which leads to strains and tensions.Childcare and finding time for other activities reported to be the highest expected strains on family life.Feeling guilty has been discussed as the other challenges female physicians encounter acting as both mothers and physicians (Parsons et al 2009) and stressful life events and psychological distress have been reported higher in female physicians than male physicians (De Koninck et al, 1995).In other word, the masculine characteristics of the medical world may make it particularly difficult for women to fit in (Langballe et al, 2011).Thus, physicians' physical, mental, and emotional health and wellbeing should be addressed strongly as neglecting this negatively affects health-care systems and patient care and may cause the performance of the health-care system become suboptimum.Therefore, the main purpose of this study is identifying the challenges facing female physicians and finding solutions in order to solve or at least diminish the identified difficulties and concerns.Some related studies exploring female physician challenges are presented in table 1.

Buddeberg-Fischer et al
The impact of gender and parenthood on physicians' careersprofessional and personal situation seven years after graduation Female physicians, especially those with children, have lower rates of employment and show lower values in terms of career success and career support experiences than male physicians.Females physicians show higher levels of satisfaction and are less advanced in their specialty qualification, are less prone to choosing prestigious surgical fields, have a mentor less often, more often work at small hospitals or in private practice, aspire less often to senior hospital or academic positions and consider part time work more.

Fuß et al
Working conditions and Work-Family Conflict in German hospital physicians: High values of WIF were significantly correlated to higher rates of personal burnout, behavioral and cognitive stress symptoms, and the intention to leave the job.In contrast, low levels of www.hrmars.compsychosocial and organizational predictors and consequences WIF predicted higher job satisfaction, better self-judged general health status, better work ability, and higher satisfaction with life in general.Barnett

Methods
The participants of this study were the female physicians in the hospitals of Babol in Mazandaran province named Yahyanejad, Shahid Beheshti, Fatemeh Zahra, Rouhani and Amirkola.According to Ministry of Health and Medical Education, the number of female physicians in Babol was 84 in 2014.Hence, the questionnaire was distributed among all of them, but 53 of them responded the questionnaire which was used for analysis.The response rate was 63%.The questionnaire was both quantitative and qualitative.The respondents were asked to express their thoughts about the difficulties and challenges they encounter as a physician and that what solutions and strategies they suggest in order to solve the problems.
The completed free form comments were gathered and analyzed using Kawakito Jiro which was developed by Jiro Kawakito as an instrument for new idea generation (Kawakito, 2008).In this method, the respondents' comments were divided onto cards and then grouped based on their contents.After that, a specific name was given to each group illustrating its content.In the next step, larger groups were made out of the existing smaller groups and this grouping process was completed when the minimum groups were obtained.Finally, the conceptual content was drawn in a structural diagram.It is important to note that two analysts performed the www.hrmars.comabovementioned process to avoid bias or eliminate the preconceived notions.When the analysts achieved consensus, the analysis was completed.

Results
The respondents' demographic information is illustrated in table 2. After completing the analysis process, three main groups of challenges were identified that were associated with structural level, occupational level, and family level.Based on findings, one of the main complains of female physicians at structural level was an insufficient medical facility at workplace which seems to be potential stressors to the medical profession as they deal with this problem every day.Gender discrimination was another problem mentioned by our respondents, as they do not enjoy the equal opportunity as their male counterparts for promotions and leadership positions.This problem refers to some extent to the culture of the society as it is thought that female physicians undertake multi roles at home and at work, it would be better for them not to have high level responsibility such as leadership of a department or being the head of a medical team.Lack of reliable childcare provisions was an important challenge particularly among physician mothers with infants or children under five years old.Establishing childcare centers in hospitals would be a great help for physician mothers and would decrease their stress and concerns.In this way, they can better concentrate on their work and the patients would receive more attentions and care.Hospitals' rules and regulations were reported as a fundamental issue as physicians encounter with them in their daily activities.This issue was connected with another challenge at occupational level that is inflexible time and career structures which was expressed nearly by all physicians, and when this accompanies with high workload, high work related stress and threats and unfair income, it becomes a setback.Female physicians' family commitments caused another problem at family level which would be diminished by husband's support and other members of the family.The sub-factors of the main factors as well as the solutions offered by female physicians are summarized in table 3 and 4, respectively.

Conclusion
Physicians treat sick people and save lives, so physician wellness is so crucial to the delivery of high-quality health care.In this regard, addressing the challenges and difficulties they encounter should be noticed as a high priority.Heavy work responsibilities, psychosocial, ergonomic, and physic-chemical threats at work environment may undermine the energy and spirit physicians need for their work and may impact their work commitment and job status.These observations point to the need for finding solutions for female physicians' workload and work-family roles in order to prevent or alleviate adverse effects on them.Female physicians' total workloads appear to be somewhat greater and more diffusely distributed than those of men.Some of the negative consequences of workload for physicians can be the higher probability of failures of attention and more serious medical errors.These all emphasize the significance of physician career satisfaction and their wellness; despite the concerns outlined above, studying the difficulties and fundamental challenges of female physicians is underexplored; therefore, we set out to explore the challenges female physicians facing and provide some solutions to help them achieve a work-life balance.Based on our findings, the challenges identified in this study at three structural, occupational and family level have revealed that special attention needs to be paid to female physicians' challenges and fundamental changes need to be created to provide an appropriate conditions for medical professions and in sequence for optimal health care services.Policy makers and managers of medical profession should provide new career structures and instructions which allow female physicians to work shorter time, flexi time or on part time basis that would benefit both physicians and the health care systems.In this regard, it is also recommended policymakers perceive the strategy of increasing the number of medical students particularly in some fields which do not have sufficient physicians regarding the population increase.Another important issue is the insufficient medical facilities at hospitals which need to be addressed immediately as high-tech medical equipment would allow better and accurate diagnosis of diseases and superior cure for patients.High-tech equipment would also decrease the level of threats and stress since they would assist physicians in their decisions.Female physicians feel inequity in the way their partners share household work that must be addressed by support of husbands and other persons.Children rearing problem can also be diminished by providing child care centers at hospitals which would have a great positive impact on family-related issues.
It can be concluded that special career-support measures will have to be provided to achieve ideal health care systems and better work conditions for physicians, particularly female physicians.In this respect, more youth people especially young females would be encouraged to take up medicine as their career and the higher the number of physicians would make organizing working patterns easier for mangers and practitioners.
For further research, we recommend that more investigations should be carried out in this topic.www.hrmars.com

Table 1 :
The brief literature review of female physician challenges

Table 2 :
The Demographic Information of respondents

Table 4 :
Strategies for solving or diminishing female physician challenges