A feminist investigation into the reasons for attrition of women doctors from the South African medical profession and practice : exploring the case of UCT medical school between 1996 and 2005

[摘要] ENGLISH ABSTRACT: This dissertation aims to establish the reasons underlying possible gendered attritiontrends in the South African medical profession between 1996 and 2005. Noting theinternational trend of the increasing feminisation of medical education and the profession,the dissertation illustrates that this is also a reality in our national context, and frames thisphenomenon as being plagued by difficulties very similar to those encountered in othertraditionally male-dominated fields. The particular relevance for further research anddebate is illustrated through the noticed discrepancy between women's representation inenrolment and graduation at medical schools in South Africa, and their representation inthe profession itself. The decision to approach this investigation from a feministorganisationalperspective was based on the fact that this would not only be a novel, butindeed also an appropriate, research approach to the study of gendered trends in medicaleducation and the profession within the South African context.The research project thus sets out three main objectives relevant to this investigation.Objective 1 aims to establish the sex composition of the cohort of medical graduates thathave not entered, or decided to exit, the medical profession. In terms of this objective,findings show an increasing rate of progression of men into the profession, accompaniedby a decreasing rate of progression of women into the profession.Objective 2 attempts to establish the reasons behind sex trends in South African medicalschools and in the profession. Thus, in an effort to comprehensively investigate the issuesunderlying attrition, I employ a mixed-methods approach to the primary data collectionand analysis. Firstly, the findings show, through a quantitative analysis of the interviewdata, that this sample of women felt that both institutional and societal factors influenceda women doctor's propensity to remain in the profession. Secondly, it is established thatwhether these respondents felt that they had appropriate role models in the profession wasthe most important factor in terms of their identification with, and propensity to stay in,the profession. Thirdly, it was also found that the respondents felt strongly that the cultureof the medical profession impacts negatively on a woman doctor's propensity to stay inthe profession, but similar to the findings of other studies, this does not bring us closer toan understanding of what that culture constitutes. Thus, lastly, through a qualitativeanalysis of the interview data I find that the respondents clearly recognise the presence ofa gendered substructure in medicine in the South African context, and identify someelements of this structure as most commonly linked to attrition.Objective 3, based on the outcomes of the previous objectives, aims to providerecommendations for the retention of medical doctors in general, and women doctorsspecifically, in the South African context. It concludes that flexibility1 in the medicalprofession is paramount to the retention of doctors, and women doctors specifically. Thisis a difficult challenge to overcome, as central values such as the importance of continuityof care in the medical profession would suggest that providing increased flexibility tomedical doctors would impact negatively on patient care. However, it appears that there isincreasing recognition amongst scholars, policy makers and medical practitionersthemselves of the importance of acknowledging alternative work patterns.On the basis of the outcomes of my research, it is clear that the national gender attritiontrends are a cause for concern in terms of resourcing the National Health System againstthe backdrop of a widely acknowledged shortage of doctors in South Africa andelsewhere. If women doctors do not progress effectively into the system, but form themajority of graduates, this is a tragic loss, as well as a waste of resources during training.This aspect also has policy implications, because it appears that the government, in tryingto retain doctors, has increasingly turned to measures that are restrictive (compulsorycommunity service, restrictions on foreign doctors), rather than focusing on ways inwhich to make doctors want to stay. The dissertation thus closes by suggesting two mainareas within which these findings and recommendations would be employed mostusefully: 1) medical schools/ training/education, and 2) the medical profession/culture.

[发布机构] Stellenbosch University