Gender differences in attrition rates of hospital-based medical specialty programs: attributable to gender composition of the clinical specialty?

Abstract

Background Since 1999 the Advisory Committee on Medical Manpower Planning (ACMMP) advises the Dutch government on the medical workforce capacity and the intake in training programs, as to achieve or maintain a balance on the labour market. One of the key parameters the ACMMP uses when calculating the required intake in training programs, is the attrition rate. Methods In total 11,579 trainees enrolled in hospital-based programs from January 1 st 2003 until 31 st of December 2012, for 26 specialisms. To explore possible explanations for the gender differences in attrition rate per specialty, additional information was gathered: the percentage of males per program, the total number of specialists in training, the duration of the training and the percentage of males currently working in that specialty. Results One training program was excluded, due to the small size of that training program (62 trainees) and the large outliers it produced. Regression analyses were done, showing significant explanations of the variation in the difference between male and female attrition rates (Y1), for the proportion of males working in the profession per 01-01-2003 (R 2 : .545, F(27,60), p<.000), the proportion of males in training per 01-01-2003 (R 2 : .417, F(16,01), p<.000) and a small effect for the relationship with the total attrition rate for each training program (R 2 : .163, F(4,46), p<.046). There was also a significant effect for the duration of the specialty training (R 2 : .299, F(9,85), p<.005). A Kruskal-Wallis test was preformed to analyse the difference in attrition by type of specialty. The difference between the types of specialisms were significant (H=6,66, p.0,036). Conclusions Attrition rates in Dutch hospital-based specialty programs differ between males and females in a way that more males tend to drop-out from training when the specialty is dominated by women and, importantly, vice versa as well. The relationships found needs to be explored, in particular as the duration and nature of the specialty training seem to interact with gender ratios in the training programs and occupations longer training programs tend to have more males on them. Furthermore, more insight is needed in the selection and identification processes among residents in specialty training.