In German medicine, there is a gap between the increasing number of female medical students and the backlog of women at different turning points of their career. In hospitals, which can be regarded as ‘gendered organizations’, female doctors are confronted with structural discrimination, which is interpreted as gendering processes. In a qualitative, longitudinal study with twenty female physicians who were interviewed three times over the course of 5 years, discriminatory processes were shown on two levels. First, female physicians were categorized as females, and their gender role rather than their professional role as a physician was emphasized. Second, if they were (expectant) mothers, they became even more stereotyped as a female. This stereotyping occurred by reinforcing the conflict between the role of a mother and the role of a professional. It is shown how the women themselves, organizational peculiarities of hospitals, job conditions, and behaviours of male staff members may all contribute to maintaining vertical gender inequality in medicine.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Compared to other countries, women's access to a medical school in Germany in 1899 was granted late .
The results presented herein are derived from the qualitative part of an interdisciplinary study which was part of the project KarMed “Physicians’ Career Paths and Career Interruptions during and after Postgraduate Medical Education” at the University of Leipzig and the University Hospital Hamburg-Eppendorf.
See Guide for Interviews in Annex.
The snowball principle is a procedure for the conscious selection of a sample, after which selected cases address new cases, etc., which then enter into the sample.
The sample included only female physicians who were born and raised in Germany. The sample did not include doctors who had immigrated to Germany in the first generation, who worked in rural areas, who left their profession permanently or who had abandoned employment. We have not recorded the number of hospitals in which the doctors have ever worked. Participants were selected from whole Germany, therefore it can be assumed that there are no specific geographic features that could influence the interviews and their results.
Because qualitative data work closely with the language of the participants, the results of qualitative analysis are usually presented using verbatim quotes. These results have been translated literally but not analogously.
References from the interviews are given in brackets as follows: DC I, II, III refers to first, second, third or fourth interview; two letters, e.g., PJ, are an acronym for the interviewee.
Acker, J. (1990). Hierarchies, jobs, bodies. A theory of gendered organizations. Gender and Society, 4(2), 139–158.
Acker, J. (1992). Gendered institutions: From sex roles to gendered institutions. Contemporary Sociology, 21, 565–569.
Acker, J. (2006). Inequality regimes: Gender, class, and organization. Gender and Society, 20(4), 441–464.
Adler, M. A., & Brayfield, A. (1996). East-West differences in attitudes about employment and family in Germany. The Sociological Quarterly, 37(2), 245–260.
Allen, I. (2005). Women doctors and their careers: What now? British Medical Journal, 331(7516), 569–572.
Bass, B. L., & Napolitano, L. M. (2004). Gender and diversity considerations in surgical training. Surgical Clinics, 84(6), 1537–1555.
Berger, P. L., & Luckmann, T. (1967). The social construction of reality. A treatise in the sociology of knowledge. Garden City, NY: Anchor Books.
Borges, N. J., Navarro, A. M., Grover, A., & Hoban, J. D. (2010). How, when, and why do physicians choose careers in academic medicine? A literature review. Academic Medicine, 85(4), 680–686.
Bourdieu, P. (1982). Die feinen Unterschiede. Kritik der gesellschaftlichen Urteilskraft. Frankfurt am Main: Suhrkamp.
Brinkschulte, E. (2006). Historische Einführung: Medizinstudium und ärztliche Praxis von Frauen in den letzten zwei Jahrhunderten. In S. Dettmer, G. Kaczmarczyk, & A. Bühren (Eds.), Karriereplanung für Ärztinnen (pp. 9–35). Heidelberg: Springer.
Britton, D. (2000). The epistemology of the gendered organization. Gender and Society, 14(3), 418–434.
Buddeberg-Fischer, B., Stamm, M., Buddeberg, C., Bauer, G., Hämmig, O., Knecht, M., et al. (2010). The impact of gender and parenthood on physicians’ careers—professional and personal situation seven years after graduation. BMC Health Services Research, 10, 40.
Buddeberg-Fischer, B., Stamm, M., Buddeberg, C., & Klaghofer, R. (2010). Chronic stress experience in young physicians: impact of person- and workplace-related factors. International Archives of Occupational and Environmental Health, 83(4), 373–379.
Bundesärztekammer (2011). Ärztestatistik. Anzahl der erteilten Anerkennungen [Doctor´s statistics]. http://www.bundesaerztekammer.de/page.asp?his=0.3.10275. Accessed March 07, 2016.
Connell, R. W. (1987). Gender and power. Cambridge, CA: Stanford University Press.
Cook, A., & Glass, C. (2014). Women and top leadership positions: Towards an institutional analysis. Gender, Work and Organization, 21(1), 91–103.
Crompton, R., & Lyonette, C. (2011). Women’s career success and work-life adaptations in the accountancy and medical professions in Britain. Gender, Work and Organization, 18(2), 231–254.
Dumelow, C., Littlejohns, P., & Griffiths, S. (2000). Relation between a career and family life for English hospital consultants: Qualitative, semistructured interview study. British Medical Journal, 320(7247), 1437–1440.
Fried, L. P., Francomano, C. A., MacDonald, S. M., Wagner, E. M., Stokes, E. J., Carbone, K. M., et al. (1996). Career development for women in academic medicine. Journal of the American Medical Association, 276(11), 898–904.
Gatrell, C. (2008). Embodying women’s work. Maidenhead, UK: Open University Press.
Gedrose, B., von Leitner, E.-C., & van den Bussche, H. (2010). Feminising medicine: Reasons and consequences. In H. van den Bussche (Ed.), Career entry and career perspectives of young medical graduates in selected OECD countries (pp. 203–218). Cahiers de Sociologie et de Démographie Médicales (numéro special).
Gemeinsame Wissenschaftskonferenz (2013). Chancengleichheit in Wissenschaft und Forschung. [Gender equality in science and research]. 17. Fortschreibung des Datenmaterials (2011/2012) zu Frauen in Hochschulen und außerhochschulischen Forschungseinrichtungen. Bonn: GWK.
Gjerberg, E. (2003). Women doctors in Norway: The challenging balance between career and family life. Social Science and Medicine, 57(7), 1327–1341.
Habermann-Horstmeier, L. (2007). Karrierehindernisse für Frauen in Führungspositionen. Villingen: Petaurus.
Hinze, S. W. (2000). Inside medical marriages. The effect of gender on income. Work and Occupations, 27(4), 465–499.
Isaac, C., Byars-Winston, A., McSorley, R., Schultz, A., Kaatz, A., & Carnes, M. L. (2014). A qualitative study of work-life choices in academic internal medicine. Advances in Health Sciences Education, 19(1), 29–41.
Klingenberg, A., Bahrs, O., & Szecsenyi, J. (1996). Was wünschen Patienten vom Hausarzt? Erste Ergebnisse aus einer europäischen Gemeinschaftstudie. Zeitschrift für Allgemeinmedizin, 72, 180–186.
Mayring, P. (2010). Qualitative Inhaltsanalyse. Grundlagen und Techniken [Qualitative content analysis. Fundamentals and techniques]. Weinheim/Basel: Beltz.
Merton, R. K. (1949). Social theory and social structure. Toward the Codification of theory and research. Glencoe, IL: Free Press.
National Institute of Health (2010). NHS Hospital and Community Health Services: Medical and Dental Workforce Census England (30 September 2009). The Health and Social Care Information Centre.
Nomura, K., & Gohchi, K. (2012). Impact of gender-based career obstacles on the working status of women physicians in Japan. Social Science and Medicine, 75(7), 1612–1616.
Norwegian Medical Association (2015). General statistics on doctors in Norway. Oslo: Norwegian Medical Association. http://legeforeningen.no/emner/andreemner/legestatistikk/english/general-statistics-on-doctors-in-norway-2015/. Accessed March 07, 2016.
Oikelome, F., & Healy, G. (2013). Gender, migration and place of qualification of doctors in the UK: Perceptions of inequality, morale, and career aspiration. Journal of Ethnic and Migration Studies, 39(4), 557–577.
Schueller-Weidekamm, C., & Kautzky-Willer, A. (2012). Challenges of work-life balance for women physicians/mothers working in leadership positions. Gender Medicine, 9(4), 244–250.
Schwarzer, A., & Fabian, G. (2012). Medizinerreport 2012—Berufsstart und Berufsverlauf von Humanmedizinerinnen und Humanmedizinern [Physicians’ report 2012 - career start and course of female and male physicians] HIS: Datenbericht.
Statistisches Bundesamt (2012). Bildung und Kultur. Prüfungen an Hochschulen 2011. [Education and Culture. Exams in colleges and universities 2011]. Fachserie 11, Reihe 4.2.
Statistisches Bundesamt (2014). Studierendenzahlen Fachbereich Humanmedizin. [Numbers of students in medical schools.]. https://www.destatis.de/DE/ZahlenFakten/Indikatoren/LangeReihen/Bildung/lrbil05.html?cms_gtp=152382_list%253D1&https=1. Accessed March 07, 2016.
Strauss, A. L., & Corbin, J. (1990). Basics of Qualitative Research. Los Angeles: SAGE.
Wagner, A. K., Elligott, J. M., Chan, L., Wagner, E. P., Segal, N. A., & Gerber, L. H. (2007). How gender impacts career development and leadership in rehabilitation medicine: A report from the AAPM&R research committee. Archives of Physical Medicine and Rehabilitation, 88(5), 560–568.
Walsh, J. (2013). Gender, the work-life interface and wellbeing: A study of hospital doctors. Gender, Work and Organization, 20(4), 439–453.
West, C., & Zimmermann, D. H. (1987). Doing gender. Gender & Society, 2, 125–151.
Witzel, A. (2000). Das problemzentrierte Interview. [The problem-centered interview]. Forum Qualitative Sozialforschung/Forum Qualitative Social Research, 1(1), Art. 22.
Acknowledgments und Funding
The project received funding from Bundesministerium für Bildung und Forschung (BMBF) and Europäischer Sozialfonds der Europäischen Union (ESF) (promotional references for the subproject in Leipzig are 01FP0801/01FP0802 and 01FP1243/01FP1244). The authors are responsible for the content of the publication.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Annex: Guide for Interviews I to IV with Dual-Career Couples (DC)
Annex: Guide for Interviews I to IV with Dual-Career Couples (DC)
First Interview (DC I)
Thanking for the participation, introduction of the interviewer, the method and the use of the recording.
Project presentation: This is a collaborative project of the University Hospital Hamburg-Eppendorf and the University of Leipzig. In Leipzig, we conduct interviews and would like to know how female doctors who are in a partnership or are married and are working as doctors perform their personal and professional life.
“Please describe your professional life, how do the structures look like, the working hours, where there are problems and complications. Please describe an average working day, e.g. yesterday, from morning till night, how did it look out, when did you get up, and how did you see all day?”
“What would be your goal/wishes for the future? When you think of yourself in 10 years, where do you see them?”
Objectives: To find out via narratives of the participants (also by asking additional immanent questions) about:
Job details, like concrete working conditions, working structures, organization, daily routines, working schedule, planning
Details of relationship/family life, like kids, everyday life, communication, agreements, organization, planning
Are there conflicts, where is satisfaction, which goals and wishes
Second Interview (DC II)
Thanking for renewed participation
“How is your professional and private situation, what has possibly changed in the one and a half years, in the time since the last interview, what has remained the same?”
“Please tell how you came to the medicine.”
“Please describe how you grew up.”
Objectives: To clarify changes and constant factors since the last interview—in work and private life.
Additional questions about partnership, children, organization of everyday life and child caring, household and accommodation, etc., and their evaluation in the eyes of the interviewee
Additional questions about autobiographical data in retrospect (e.g. parents, childhood, university education, relationships, parental role)
Additional questions about job situation, career status, tasks, etc., and their evaluation in the eyes of the interviewee
Third Interview (DC III)
Thanking for renewed participation.
“Please tell and describe what has developed with you professionally and privately since the last interview a year and a half ago and what has remained the same?”
About this article
Cite this article
Reimann, S., Alfermann, D. Female Doctors in Conflict: How Gendering Processes in German Hospitals Influence Female Physicians’ Careers. Gend. Issues 35, 52–70 (2018). https://doi.org/10.1007/s12147-017-9186-9
- Conflicting gender role
- Female doctors
- Gendered organization
- Vertical segregation