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Feminization and Family Physicians

Dr Casey Maddren MBBS (Hons) Department of General Practice University of Sydney APHCRI- Robert Graham Visiting Scholar 2012. Feminization and Family Physicians. A bit about me . . . Academic Registrar, GPET, Clinical work. Overview. Exciting Training Initiatives in Australia

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Feminization and Family Physicians

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  1. Dr Casey Maddren MBBS (Hons) Department of General Practice University of Sydney APHCRI- Robert Graham Visiting Scholar 2012 Feminization and Family Physicians

  2. A bit about me . . .

  3. Academic Registrar, GPET, Clinical work

  4. Overview • Exciting Training Initiatives in Australia • Brief Contextual Overview • Background • Research Questions • Quantitative Aspects • Qualitative Aspects • Literature Findings • Discussion • Implications

  5. Australian Initiatives

  6. Academic Program Initiatives .1 • Elective program, that counts towards training time to become a family physician • 12 months part time • Funded placements for registrar to undertake research in a University setting • Aim increase research literacy and capacity of the General Practice/Family Physician workforce

  7. Structure of an Academic Post Academic Registrar

  8. GPSN Initiatives .2 • GP student network • 8000 members, 2nd largest medical student body in the country • First wave scholarships • Guest Lectures • 2 day conferences – Canberra parliament • Video competitions • Promotional literature • Getting medical students to consider GP early and debunk some myths about general practice

  9. www.gpsn.org.au

  10. PGPP Initiatives .3 • ‘Prevocational General Practice Placement’ • Students choose their specialty after graduation and after internship – all have general internship • 3 month placement in clinic – experience life of general practitioner • Significant focus and consideration to expand this program in the future, - (Norway)

  11. Rural Clinical School

  12. Brief Contextual Overview

  13. Major Differences in Australia • General Practice = Family physician • Universal insurance system • Federally funded -Medicare • ALL • treatments, investigations, pharmaceuticals • exclusion of some cosmetic surgeries and some fertility treatments • General Practice – gatekeeper role • Managed through reimbursements from Medicare • Health System 9.8 % of GDP • 18% paid for privately

  14. REFORM • Harmonize state – federal bodies • National Primary Health Care Strategic Framework • Build a consumer-focused integrated primary care system • Improve access and reduce inequity • Increase focus on prevention, screening and early intervention • Improve quality, safety, performance and accountability Government AF. National Primary Health Care Strategic Framework Consultation Draft. In: Ageing DoHa, editor. www.health.gov.au2012

  15. Despite marked differences in the Australian and United States’ systems, common ground exists – conspicuously; feminisation of the workforce and predicted workforce shortage (likely to be far greater in the US than Australia). Additionally both share the intention to maximise efficiency whilst encouraging comprehensive health care in the primary care sector, both governments aim to achieve this in part through funding structures. These two commonalities are the focus of this research project.

  16. What does it look like and what does it mean? The Feminizing workforce

  17. Medical Deans Australia and New Zealand – 2012 annual tables – online access - http://www.medicaldeans.org.au/statistics/annualtables

  18. Adapted Medical Deans Australia And New Zealand 2012 Snapshot http://www.medicaldeans.org.au/wp-content/uploads/Table-1-Website-Stats-2012.pdf

  19. Medical Deans Australia and New Zealand – 2012 annual tables – online access http://www.medicaldeans.org.au/wp-content/uploads/2006-Table-3-Domestic-female.pdf

  20. AIHW – 2010 workforce data AIHW. AC. Medical workforce 2010. http://www.aihw.gov.au/publication-detail/?id=107374214802010 [Viewed 8 November 2012 ].

  21. BEACH Harrison Christopher BH. General Practice Workforce gaps now and in 2020 Australian Family Physician. 2011;40(1/2):12-5.

  22. General Literature Findings • More likely to work part time (1) • Specialty choice • Psych, Obs Gyn, (5) • Children – time out of workforce • Number of patients – how to measure productivity • Type of patients

  23. More interesting • Career counseling • Inherent differences in communication style • Partnership – discrimination • Work life balance • Generational changes • Career dissatisifaction

  24. Research Questions

  25. What are characteristics of family physicians that are discernable purely as a function of sex of the physician? (Quantitative) • What are the impacts of the feminizing workforce? (Qualitative)

  26. Quantitative

  27. What are characteristics of family physicians that are discernable purely as a function of sex of the physician? (Quant) • What are the impacts of the feminizing workforce? (Qual)

  28. Results • ED work • Rurality • Completion of SAMs • Significantly more likely to complete Maternity than men, adjusting for age, • Significantly less likely to complete ‘coronary’

  29. ABFM • Characteristics • Place of work • Age • Percentage time in sub specialty area

  30. OR of women to men reported scope of practice

  31. Qualitative

  32. What are characteristics of family physicians that are discernable purely as a function of sex of the physician? (quant) • What are the impacts of the feminizing workforce? (qual)

  33. Methods • In depth semi structured interviews • Primary care academics • Industry ‘stakeholders’ • Policy Advisors • 10 interviews booked, completed 6. • range of ages, backgrounds including trained locally and overseas and

  34. Preliminary Results • Payment disparity • PC to subspecialties • Perverse incentives • Not really rewarded for keeping people out of hospital – ACA is moving towards this • Medical student factors • Myths, push factors

  35. Preliminary results • Personal Experiences • Mentorship, discrimination • Non financial incentives • Rewards of practice, flexibility within a career • Communication style • Practice, negotiation for contracts

  36. Preliminary Results • Generational change • Opportunity for primary care • Offers flexibility • Females tend towards • Title 7

  37. Discussion - Questions

  38. Discussion • Why is it like this? • What does it mean for the future of the workforce? • How could this influence policy decisions for primary care? • What does this mean for recruitment into primary care and family medicine?

  39. What strategies can primary care and family medicine take to make best use of the opportunity presented by the feminizing workforce

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