Keywords working time models - equal opportunities - online survey - career goals - gender
differences
Schlüsselwörter Arbeitszeitmodelle - Gleichberechtigung - Online-Umfrage - Berufsziele - Geschlechterunterschiede
Introduction
Different age groups often have varying needs and priorities, particularly regarding
work-life balance, the reconciliation of family and career, and personal development.
Pregnancy and parenthood present significant challenges for women in balancing their
professional careers. Given the predominantly female medical staff, the field of gynecology
and obstetrics occupies a distinctive position in this context. Specifically, 14268
out of 19530 (73%) practicing gynecologists in Germany are female, and only 489 of
the 2819 (17%) gynecologists under 40 years old are male [1 ]
[2 ]. In Austria, the overall proportion of male colleagues in gynecology is significantly
higher, at 42%, while in Switzerland, 70% of gynecologists are female. However, 93%
of the specialist titles in gynecology in 2023 have been achieved by women. In total,
over 23000
physicians are registered in the DACH countries according to the respective national
medical statistics, with 6% working in Switzerland, 9% in Austria, and 85% in Germany
[1 ]
[3 ]
[4 ]
[5 ].
In an era where diversity and equality are becoming increasingly important, aspects
such as parental leave, flexible working models, and childcare services hold significant
value. Despite this relevance, there are only a few studies with substantiated statistical
data available on the topic [6 ]. Currently, opportunities for flexible and individualized working time arrangements
in medicine are limited, even though they are considered key to improving the reconciliation
of career and family while taking familial responsibilities into account [7 ].
While there is increasing societal and political discussion in many industries about
the introduction of a so-called four-day workweek [8 ]
[9 ]
[10 ], the strain on medical personnel caused by a general shortage of physicians, rising
patient volumes, and intense demands from night, weekend, and holiday shifts is significantly
higher compared to other professions [11 ]
[12 ]. In this context, structural improvements in professional training, focusing on
secure financing, regular feedback sessions with supervisors, and enhancements in
personnel management have recently been identified as potentially beneficial [13 ].
The Young Forum of the German Society for Gynecology and Obstetrics (DGGG e. V.),
in cross-border collaboration with the Young Gynaecology Group of the Austrian Society
for Gynaecology and Obstetrics (OEGGG) and the Young Forum of the Swiss Society for
Gynaecology and Obstetrics (SGGG), initiated a new survey twelve years following the
publication of the DGGG e. V. survey titled ‘Career and Family – A Question of Impossibility?’
[14 ]. This new survey focuses on additional content areas such as working time models,
professional goals, and family leave, aiming to identify potential improvements based
on the preferences of all current and future gynecologists and to continue pursuing
positive approaches [15 ].
Methods
Between October 2023 and May 2024, a total of 1364 participants responded to the online
survey, initiated by the Young Forums/Young Gynaecology Groups of the DGGG e. V.,
OEGGG, and SGGG, as well as the University of Luebeck (FARBEN [German: Colors]: FAvorisierte
aRBEitszeitmodelle in der GyNäkologie = Preferred Working Time Models in Gynaecology).
Participation was anonymous.
Questionnaire
The questionnaire was designed in consensus by representatives of the Young Forums/Young
Gynaecology Groups of the DGGG e. V., OEGGG, and SGGG (NT, NA, PF, AK, CB, RK), under
the mentorship of Prof. Dr. Maggie Banys-Paluchowski (University Hospital Schleswig-Holstein,
Luebeck Campus) and the Equality Officer of the University of Luebeck (Dr. Solveig
Simowitsch). Therefore, it is a self-created, non-validated questionnaire. Additionally,
the presidents of the national professional societies, Prof. Dr. Barbara Schmalfeldt
(DGGG e. V.) and Prof. Dr. Bettina Toth (OEGGG), provided advisory support.
The trilingual questionnaire was created using the online tool SurveyMonkey and comprised
a total of 62 questions, which could be answered in German, Italian, or French, allowing
all participants to respond in their native language. Of the 62 questions, 54 (Appendix,
online) were made available to all participants, regardless of nationality. In addition
to these 54 questions, one supplementary question was addressed to German participants,
three additional questions were posed to Austrian colleagues, and four country-specific
questions were directed to Swiss colleagues, focusing specifically on their national
training and healthcare systems. Overall, three of the 62 questions were formulated
as free-text responses. A positive ethics approval (File Number: 2023–644) was obtained
from the University of Luebeck. The wording of the questions was tailored to reflect
the specific circumstances of each participating country.
Recruitment and survey invitations
Participants were invited to take part through the social media channels of the Young
Forums/Young Gynaecology Groups (Instagram), print media [15 ], training sessions and conferences, newsletters of the respective national gynecological
societies, and during lectures for medical students. The target audience included
medical students with interest in Gynecology and Obstetrics, residents, specialists,
senior physicians, chief physicians, and gynecologists in outpatient practice.
Statistical analysis
Data analysis was conducted using Excel 2311 and SPSS Statistics (V. 29.0.2.0, Armonk,
NY: IBM Corp.). Multiple entries by the same individual were excluded through anonymous
IP address verification. Correlations between two factors were examined using the
chi-square test, with p values < 0.05 considered statistically significant. All reported
p values are two-sided.
Results
Participant characteristics
Of the 1364 participants, 75.3% worked in Germany, 12.9% in Austria, and 11.8% in
Switzerland (see [Fig. 1 ]
a ). Among these, 90.8% were female, 8.9% male, and 0.4% identified as diverse. Overall,
8.9% were students, 55.8% residents, 16.0% specialists, 12.3% senior physicians, 1.2%
chief physicians, and 5.8% gynecologists practicing in outpatient setting. A total
of 83.2% of respondents were aged between 21 and 40 years. Among them, 61.4% had a
doctorate, 26.0% did not hold an academic title, and 3.6% had completed a habilitation
(highest university degree in German-speaking countries) or held a professorship.
Among women, 61.9% held a doctorate, compared to 57.1% of male respondents.
Fig. 1
a Participants by country of origin in correlation with current professional position.
b Respondents’ professional objectives, categorized by gender. c Intention to pursue the highest university degree (habilitation), categorized by
gender. d Preferred working time model of all participants, categorized by gender.
Professional goals
Overall, the majority of participants (37.9%) indicated that their professional goal
was to establish their own practice (self-employment: 23.9%; employed: 14.0%), followed
by senior physician position (36.7%). In contrast, the chief physician position ranked
last with only 5.8% of votes. However, significant differences were observed by gender.
Men were significantly more likely to aspire to a chief physician role than women
(26.5% vs. 3.6%; p < 0.001) (see [Fig. 1 ]
b ). It is important to note that the desire for a chief physician position increased
with age, reaching the highest preference of 13.7% among those aged 41–60 (see [Table 1 ]).
Table 1
Analysis of the questions on the topic: professional objectives and career, categorized
by gender.
n (%)
Sex
Women
Men
Total **
1364 (100%)*
1238 (91%)
121 (9%)
p value
1) Habilitation = highest university degree in German-speaking countries; only respondents
without habilitation/professorship were asked this question
2) Only respondents whose professional goal was to work in an outpatient practice were
asked this question
* Due to the small overall number of diverse individuals, the table is only divided
into male and female categories
** The differing number of total responses per question is due to the fact that participants
were able to skip questions or prematurely end the survey
Your professional goal is this position:
n = 1364
n = 1238
n = 121
< 0.001
Chief physician
79 (5.8)
45 (3.6)
32 (26.5)
(Leading) senior physician
501 (36.7)
457 (36.9)
44 (36.4)
Employed medical specialist in the hospital
178 (13.1)
170 (13.7)
7 (5.8)
Employed in outpatient practice
191 (14.0)
185 (14.9)
5 (4.1)
Self-employed in outpatient practice
326 (23.9)
302 (24.4)
23 (19.0)
Other (please specify)
89 (6.5)
79 (6.4)
10 (8.3)
You would like to achieve habilitation1) :
n = 1147
n = 1060
n = 85
< 0.001
Yes
169 (14.7)
128 (12.1)
40 (47.1)
No
737 (64.3)
711 (67.1)
25 (29.4)
You do not know yet
241 (21.0)
221 (20.9)
20 (23.5)
Are gynecologists in specialty training disadvantaged in their professional career
because of gender?
n = 1171
n = 1071
n = 97
< 0.001
Do not agree at all
99 (8.5)
66 (6.2)
33 (34.0)
Largely disagree
92 (7.9)
81 (7.6)
11 (11.3)
Rather disagree
126 (10.8)
115 (10.8)
9 (9.3)
Neither
108 (9.2)
96 (9.0)
12 (12.4)
Rather agree
369 (31.5)
352 (32.9)
16 (16.5)
Largely agree
190 (16.2)
185 (17.3)
5 (5.2)
Strongly agree
187 (16.0)
176 (16.4)
11 (11.3)
Why would you not like to work in the hospital long-term? (multiple answers possible)2) :
n = 513
n = 483
n = 27
0.010
Too much responsibility
65 (12.7)
62 (12.8)
3 (11.1)
Too high workload
291 (56.7)
282 (58.3)
7 (25.9)
Too little work-life balance
344 (67.1)
330 (68.2)
13 (48.2)
Insufficient compatibility of family/work
380 (74.1)
366 (75.6)
13 (48.2)
Night and weekend shifts
424 (82.7)
405 (83.9)
17 (62.9)
Duties in the delivery room
137 (26.7)
130 (26.9)
7 (25.9)
Financially unattractive
97 (18.9)
85 (17.6)
12 (44.4)
Inflexible working hours
269 (52.4)
255 (52.7)
13 (48.2)
Participants cited night and weekend shifts (82.7%) as the primary reason against
working in a hospital setting, followed by inadequate work-life balance (67.1%) and
insufficient compatibility of family and professional career (74.1%).
Only 14.7% of participants expressed interest in pursuing habilitation for their careers,
while 64.3% did not aspire to it, and 21.0% were undecided. Gender analysis revealed
that only 12.1% of women desired habilitation, compared to 47.1% of men (p < 0.001)
(see [Fig. 1 ]
c ; [Table 1 ]).
Family and career compatibility
47.0% of the respondents reported having children (see [Table 2 ]). On average, surveyed parents had 1.9 children (1.8 for women, 2.2 for men) and
were 30.8 years old at the birth of their first child (30.7 for women, 31.4 for men).
When focusing specifically on the groups of senior and chief physicians, the average
number of children was significantly lower for women (1.9) than men (2.6, p = 0.013).
Interestingly, in these two professional categories, 9.9% of men were childless, compared
to 24.5% of female respondents.
Table 2
Analysis of the questions on the topic: family time off and childcare, categorized
by gender.
n (%)
Sex
Women
Men
Total**
1364 (100%)*
1238 (91%)
121 (9%)
p value
1) Only respondents in whose hospitals male colleagues have taken family leave were
asked this question
2) Only respondents with children who had not taken family leave were asked this question
3) Only respondents with children were asked this question
* Due to the small overall number of diverse individuals, the table is only divided
into male and female categories
** The differing number of total responses per question is due to the fact that participants
were able to skip questions or prematurely end the survey
Do you have children?
n = 1344
n = 1220
n = 120
0.78
Yes
632 (47.0)
573 (47.0)
58 (48.3)
No
712 (53.0)
647 (53.0)
62 (51.7)
The optimal time to become a parent is for you:
n = 1198
n = 1095
n = 100
< 0.001
During medical school
74 (6.2)
61 (5.6)
12 (12.0)
During specialty training
238 (19.9)
211 (19.3)
27 (27.0)
As medical specialist
263 (22.0)
233 (21.3)
29 (29.0)
As senior (leading) physician
48 (4.0)
46 (4.2)
2 (2.0)
As chief physician
1 (0.1)
1 (0.1)
0 (0.0)
As a physician in outpatient practice
9 (0.8)
6 (0.6)
3 (3.0)
There is no optimal time
565 (47.2)
537 (49.0)
27 (27.0)
How long does it take for fathers to return to work in your hospital after taking
time off?1)
n = 543
n = 482
n = 59
0.20
Usually the same as for mothers
531 (1.7)
6 (1.2)
2 (3.4)
Usually shorter than for mothers
531 (97.8)
474 (98.3)
56 (94.9)
Usually longer than for mothers
2 (0.6)
2 (0.4)
1 (1.7)
In your opinion, after what period of time does a ‘career break’ occur for parents
on family leave?
n = 1232
0.028
From 3–6 months
95 (7.7)
From 6–9 months
220 (17.9)
From 9–12 months
227 (18.4)
From 1–2 years
292 (23.7)
From > 2 years
105 (8.5)
Family leave does not cause a career break
38 (3.1)
Family leave causes a career break regardless of the duration
255 (20.7)
Why did you as a parent not take any family time off? (multiple answers possible)2)
n = 51
n = 20
n = 31
0.31
Not necessary/not desired in family constellation
14 (27.5)
4 (20.0)
10 (32.3)
Fear of professional disadvantage
11 (21.6)
7 (35.0)
4 (12.9)
Not compatible with career planning
17 (33.3)
6 (30.0)
11 (35.5)
Financial obligations
18 (35.3)
7 (35.0)
11 (35.5)
Other reasons (please specify)
11 (21.6)
6 (30.0)
5 (16.1)
In your opinion, which parts of specialty training in gynecology and obstetrics cannot
be adequately implemented due to family leave (multiple answers possible)
n = 1171
n = 1071
n = 97
0.40
Obstetric training
221 (18.9)
204 (19.1)
16 (16.5)
Acquisition of special skills in gynecological diagnostics (e.g. breast sonography,
dysplasia)
392 (33.5)
367 (34.3)
23 (23.7)
Surgical training
827 (70.6)
764 (71.3)
61 (62.9)
Care of inpatients
58 (5.0)
52 (4.9)
6 (6.2)
Conservative management of gynecological diseases
57 (4.9)
52 (11.1)
5 (5.2)
Management of gynecological emergencies
134 (11.4)
119 (26.1)
15 (15.5)
All parts of the training are adequately implemented despite family leave
311 (26.6)
280 (26.1)
31 (32.0)
How long did you not work after the birth? (please use multiple answers if you have
several children with different periods of absence)3)
n = 625
n = 568
n = 57
< 0.001
> 2 years per child
30 (4.8)
29 (5.1)
1 (1.8)
1–2 years per child
202 (32.3)
202 (35.6)
0 (0.0)
9–12 months per child
237 (37.9)
236 (41.6)
1 (1.8)
6–8 months per child
96 (15.4)
93 (16.4)
3 (5.4)
3–5 months per child
34 (5.4)
32 (5.6)
2 (3.6)
< 3 months per child
38 (6.1)
23 (4.1)
14 (25.0)
You have not taken any family leave
51 (8.2)
20 (3.5)
31 (55.4)
Other option (please specify)
35 (5.6)
30 (5.3)
5 (8.9)
Does your place of work (university) provide childcare with flexible hours and sufficient
capacity?
n = 1189
n = 1088
n = 98
0.003
Yes
183 (15.4)
158 (14.5)
23 (23.5)
No
777 (65.4)
727 (66.8)
49 (50.0)
You do not know
229 (9.3)
203 (18.7)
26 (26.5)
Would childcare close to work be a factor in choosing an employer?
n = 1189
n = 1088
n = 98
0.55
Yes, it would influence my choice of employer
903 (76.0)
829 (76.2)
72 (73.5)
No, it does not play a role
286 (24.1)
259 (23.8)
26 (26.5)
Additionally, 47.2% of the overall cohort stated there was no ‘perfect time’ to have
the first child, while 22.0% identified the optimal time as after obtaining specialist
qualification, and 19.9% during residency. Among all surveyed parents, only 8.2% did
not take any family leave.
Only 15.4% of respondents indicated that their workplace offered childcare with flexible
opening hours and sufficient capacity. Simultaneously, 76.0% of respondents noted
that on-site childcare was a factor in their choice of employer.
Working time models
When asked about their preferred working time model, only 12.5% of participants favored
full-time employment, with notable differences observed between genders. Whereas 39.8%
of men preferred full-time positions, only 10.8% of women shared this preference (see
[Fig. 1 ]
d ; [Table 3 ]). The percentage of participants favoring full-time work was highest in Austria
(22.8%), followed by Germany (11.8%) and Switzerland (6.4%).
Table 3
Analysis of the questions on the topic: working time models/part-time employment,
categorized by gender.
n (%)
Sex
Women
Men
Total **
1364 (100%)*
1238 (91%)
121 (9%)
p value
1) The survey was programmed so that this question was only asked of respondents working
full-time
2) Only full-time workers who stated that part-time employees are a burden on the team
were asked this question
3) Only part-time workers were asked this question
* Due to the small overall number of diverse individuals, the table is only divided
into male and female categories
** The differing number of total responses per question is due to the fact that participants
were able to skip questions or prematurely end the survey
Part-time workers lead to an increased burden on the team:1)
n = 636
n = 549
n = 86
0.10
Yes, regardless of fixed days off or reduced daily hours
154 (24.2)
125 (22.8)
29 (33.7)
Yes, but only with reduced daily working hours
209 (32.9)
180 (32.8)
29 (33.7)
Yes, but only with fixed days off
54 (8.5)
47 (8.6)
6 (7.0)
No, not at all
219 (34.4)
197 (35.9)
22 (25.6)
What solutions would you propose for avoiding a possible personnel burden due to part-time
workers? (multiple answers possible)2)
n = 412
n = 479
n = 88
0.22
Fixed job sharing (2 doctors each 50% with duty splitting)
210 (51.0)
182 (52.5)
28 (42.8)
Part-time employees work exclusively full days
215 (52.2)
180 (51.9)
35 (54.7)
I do not know
102 (24.8)
80 (23.1)
21 (32.8)
Other (please specify)
41 (10.0)
37 (10.7)
4 (6.3)
Did you reduce your working hours after the birth of your child?3)
n = 444
n = 434
n = 9
0.91
I have no children
92 (20.7)
89 (20.5)
2 (22.2)
Yes
318 (71.6)
312 (71.9)
6 (66.7)
No
34 (7.7)
33 (7.6)
1 (11.1)
Your reasons for working part-time are (multiple answers possible)3):
n = 440
n = 432
n = 8
0.98
Caring for children
333 (75.5)
327 (75.7)
6 (75.0)
Caring for relatives
17 (3.9)
17 (3.9)
0 (0.0)
Desire for a better work-life balance
269 (61.0)
263 (60.9)
6 (75.0)
Too extensive workload
211 (47.9)
207 (47.9)
4 (50.0)
Time needed for academic work
35 (8.2)
34 (7.9)
1 (12.5)
Other: (please specify)
57 (12.9)
56 (13.0)
1 (12.5)
Your preferred working time model is:
n = 1232
n = 1126
n = 103
< 0.001
100%
154 (12.5)
113 (10.0)
42 (39.8)
90–99%
69 (5.6)
61 (5.4)
8 (7.8)
80–89%
492 (39.9)
451 (40.1)
40 (38.8)
70–79%
322 (26.1)
312 (27.7)
9 (8.7)
60–69%
123 (10.0)
120 (10.7)
2 (1.9)
50–59%
64 (5.2)
61 (5.4)
3 (2.9)
< 50%
8 (0.7)
8 (0.7)
0 (0.0)
Despite 44.8% of all residents expressing a desire for a part-time position (80–89%),
and only 12.5% wishing for a full-time role, 63.0% of all residents were working full-time,
making them the second-largest group working full-time, after chief physicians (80%).
Part-time employment
Among respondents working full-time, 34.3% stated that part-time employees did not
burden the clinical team. In contrast, 24.2% viewed the staffing situation as a burden
irrespective of the part-time model. While 32.9% felt a burden was only created by
part-time employees with reduced daily hours, 8.5% reported a team burden only in
case of fixed days off. Many respondents proposed solutions to avoid staffing burdens,
such as fixed job-sharing arrangements (where two physicians share a position, including
on-call duties) or working full days with fixed days off.
Only 7.7% of respondents with children indicated that their part-time work was unrelated
to parenthood, while 20.7% of part-time workers were childless. The primary reasons
for choosing part-time employment were childcare responsibilities, followed by a desire
for a better work-life balance and excessive workload (see [Table 1 ]).
The respondents could propose potential solutions to reduce staffing burdens resulting
from part-time employment as free text responses. Common suggestions included the
introduction of part-time scheduled consultations to prevent additional workload that
needs to be covered by full-time staff. A higher staff-to-patient ratio was proposed
to ease staffing gaps due to pregnancy, resignations, or illness. Additionally, respondents
favored the option to work from home, especially for documentation tasks.
Diversity and equality in gynecology
63.7% of respondents agreed (to varying degrees) that gynecologists in training face
professional disadvantages due to their gender. Specific suggestions for improvement
included the implementation of support programs for returning to work after a career
break as well as structured training curricula for part-time workers. Overall, many
participants saw a reduction in administrative activities with a stronger focus on
practical skills as a possible key to improving the education and training. Targeted
surgical training during pregnancy was also highlighted as an important aspect of
structured medical training.
Discussion
This trinational survey aimed to assess the diverse preferences of professionals and
trainees in gynecology, focusing on working time models, work-life balance, and equal
opportunities. The analysis took into account factors such as professional positions,
age groups, gender, and country of residence.
The FARBEN survey is the second collaborative trinational study conducted by the Young
Forums. The results of the first “D-A-CH Study” were published in 2022, providing
an overview of the differences and similarities in the specialty training in obstetrics
and gynecology [16 ]
[17 ]. The recruited participants from each country roughly reflect the proportional national
share of all gynecologists working in the DACH region (Germany: 75% of survey participants
vs. 85% of all gynecologists in the DACH region; Austria: 13% vs. 9%; Switzerland:
12% vs. 6%), although Switzerland was able to recruit the highest proportion of participants
relative to the total number of national gynecologists. It should be noted that students
were also encouraged to respond to the survey. As a result, the proportions may have
been influenced.
Our results show important gender differences in aspirations and professional goals.
Importantly, significantly more (26.5%) male respondents aimed for a chief physician
position, while only 3.6% of women expressed the same ambition. Over the past few
decades, the number of women pursuing a medical career has steadily increased [18 ]. Despite this development, the increased representation of women has yet to reach
the upper echelons of the medical profession [19 ]. In Germany, women make up only 19% of all gynecological department heads, indicating
a significant underrepresentation [2 ]. In comparison, the proportion of female directors in other surgical specialties
remains even lower [2 ]
[20 ]. It remains a matter of debate whether this discrepancy stems from differing preferences
or is exacerbated by structural deficiencies, such as the lack of flexible childcare
options with adequate capacity or limited opportunities for individualized working
time models. It is undeniable that women face unique challenges in balancing family
and professional career due to pregnancy, maternity leave, and potentially breastfeeding
[6 ]
[14 ]
[21 ]
[22 ]
[23 ]. This may also explain why female gynecologists, on average, have fewer children
than their male counterparts,
and this difference is particularly high in upper hierarchical positions. Additionally,
it is noteworthy that women in senior positions are more likely to be childless. These
connections have also been described by Hancke et al. [14 ], who suggested that successful male physicians are often supported by a partner
who either does not work or works part-time, whereas successful women in senior positions
typically share their lives with equally successful partners [24 ].
In the FARBEN cohort, women were more likely to hold a doctorate but were less inclined
to pursue a habilitation (highest university degree in German-speaking countries).
This observation aligns with data from Häussler et al. [25 ], which found that young female residents are more frequently doctoral graduates
than their male counterparts, yet they publish significantly less, even though publication
rates at higher levels (such as department heads) were similar. Further study is needed
to determine whether improving work-life balance or offering targeted support, such
as mentoring programs, could increase women’s interest in pursuing higher academic
degrees.
Regarding preferred working time models, only 12.5% of respondents favored full-time
positions. It is important to note that the actual hours spent at work often exceed
the typical full-time weekly hours due to on-call duties during nights, weekends,
and holidays. Although 87.5% of respondents preferred part-time work, only 36.8% actually
had part-time employment. This discrepancy was particularly evident among residents,
with only 12.5% preferring full-time positions, yet 63.0% working full-time. This
context should include a discussion of the differences in full-time employment regulations
across the individual DACH countries (Germany, Austria and Switzerland), as well as
the varying legal provisions regarding parental leave and maternity protection (see
[Table 4 ]).
Table 4
Country-specific differences in full-time work, maternity leave and family leave.
Germany
Austria
Switzerland
Full-time in the hospital
40–42 h per week
40 h per week
46–50 h per week
Maternity leave
14 weeks (34 weeks’ gestation to 8 weeks’ post partum) or 18 weeks in the case of
multiple births (34 weeks’ gestation to 12 weeks post partum)
16–20 weeks (from 33 weeks’ gestation to 8 weeks post partum in the case of spontaneous
labour or 12 weeks post partum in the case of caesarean section or premature birth)
14 weeks (starting from the day of delivery)
Family time out
“Elternzeit”: Up to 36 months per parent possible; a maximum of 12 months basic parental allowance
for one parent or 14 months for both parents together with 65–100% of pre-birth income,
up to a maximum of 1800 euros (alternatively up to 24 or 28 months parental allowance+
with 32.5–50% of pre-birth income, up to a maximum of 900 euros). Up to 4 additional
months of parental allowance+ possible if both parents work part-time between 24 and
32 hours/week at the same time
“Elternkarenz” : up to 24 months after the end of maternity leave if both parents go on maternity
leave. If only one parent goes on maternity leave, only 22 months of maternity leave
is possible. State financial support is available in various forms.
Part-time parental leave: After this, a maximum of 7 years of part-time parental leave
can be taken until the child’s 8th birthday.
Two weeks paternity leave, no further leave planned
To address these circumstances and ensure that the field remains attractive for both
upcoming and young physicians in the long term, it is essential to promote solutions
such as expanding childcare facilities with flexible hours and adequate capacity,
as well as offering more flexible working hours. This will provide all physicians,
regardless of their life situation, with the best possible opportunities for career
development in alignment with their personal preferences. Although expanding childcare
capacity was already emphasized in 2012 by the DGGG e. V. Commission on Family and
Career [14 ], participant preferences have not changed, and the demand for flexible childcare
options remains as high as it was twelve years ago. While our survey did not assess
the need for and availability of care for school-aged children, adequate capacity
for homework assistance and holiday care is also essential to balance
both career and family responsibilities effectively. In line with our results, a recent
survey of medical students in Germany identified both work-life balance and working
hours as significant factors influencing their choice of future specialty [26 ].
With the anticipated increase in part-time workers, it is also important to discuss
the expansion of medical school placements, as more personnel will be needed to adequately
cover the workload at medical facilities. In this context, another critical issue
is the high cost of medical education, which the German Federal Ministry of Education
and Research currently estimates to be around € 200000 per person [27 ]. Although costs per student remain unchanged, more students will be required to
account for part-time work or longer professional interruptions. Delegating certain
tasks to non-medical personnel, such as documentation assistants, ward secretaries,
or physician assistants, could be another solution. This relatively new profession
in Germany is already well established in the United States [28 ]
[29 ]
[30 ].
Amid current and future challenges, maintaining the highest level of patient care
is essential. Appropriate measures and the establishment of new concepts should always
align with patient-centered interests while weighing potential advantages and disadvantages.
In this context, it should be noted that patients generally desire continuous care,
such as during a hospital stay or illness. Meeting this need is already complicated
by the participation of the medical team in on-call duties, which results in absences,
and poses a particular challenge in the case of part-time employment.
Strengths and Limitations
Strengths and Limitations
The proportion of women among the respondents was significantly higher than that of
men (90.8% vs 8.6%). This could possibly be attributed to the fact that the proportion
of women in specialist medical training for gynecology is much higher, and particularly
young female doctors tend to engage with topics such as the compatibility of career
and family, as well as working time models. Additionally, the young forums of the
respective participating national countries (Germany, Austria and Switzerland) represent
all doctors in training and thus have a high visibility in relation to this professional
group. This is also reflected in the age structure of the participants (83.6% were
between 18–40 years old). While 12.3% of the respondents were senior physicians with
personnel responsibility, the results must be critically discussed in terms of possible
implications and structural adjustments to particularly consider the opinions of senior
and, especially, chief physicians.
Furthermore, only a small percentage of gynecologists working in outpatient practices
participated in the survey (5.8%), which may be related to the recruitment process
of this survey, as it was promoted primarily through social media and clinical training
sessions, which are mainly targeted at younger colleagues. The opinions of self-employed
gynecologists on this consensus-based questionnaire are of great importance, as these
doctors have consciously chosen not to pursue a hospital career. However, conclusions
about this professional group are limited due to the small number of participants
in this subgroup.
Conclusions
This trinational survey systematically collected and analyzed preferences on topics
such as working time models and career goals for the first time. To the best of our
knowledge, surveys with larger sample size (n = 1364) have not been conducted. The
results indicate a need for more medical personnel in order to accommodate the expected
rise in family leave and part-time models among physicians in the future. It remains
unclear whether the high preference for a reduction in working hours can be attributed
to the increasing bureaucratic workload and the many additional hours spent on standby
duty. The survey clearly highlights the need for expanding and improving childcare
services to ease the professional burden on parents. It should also be emphasized
that patient interests remain a top priority, and any potential structural changes
should always take these interests into account.
Due to the high percentage of women in the field of gynecology and obstetrics, some
developments are becoming evident earlier than in other disciplines. Engaging in open
discourse around these developments and viewing them as opportunities can help address
future challenges in the job market successfully. This approach could enhance colleague
satisfaction, promote equality and individuality, and ultimately improve patient care
while ensuring long-term sustainability.
Contribution to the Manuscript and Online Survey
Contribution to the Manuscript and Online Survey
The entire boards of the DGGG e. V., OEGGG, and SGGG made an extraordinary contribution
to the success of the study and manuscript through discussions, substantive input,
and diverse support.
Details of Ethics Approval
Details of Ethics Approval
The manuscript was submitted to the Ethics Committee of the University of Luebeck
and was evaluated favourably. Date of approval 20.09.2023. Reference number 2023–644.
Supplementary Material
Appendix: Questionnaire, including all questions directed to participants from all
nations.
