Doctors at Work: Essays on Medical Careers, Family, and Private Practice

Abstract

Australia has an excellent health system underpinned by a highly trained health workforce. As a critical building block of the health workforce, medical doctors profoundly influence the quality, accessibility, effectiveness and sustainability of the national health system. Australia’s healthcare system is a mix of public and private practice, with private medical practice playing a larger role. Doctors working in private medical practice represent about 80% of medical specialists and most general practitioners (GPs) (Scott et al. 2020). Over the past decade, private healthcare facilities and non-GP specialists in private practice groups have grown rapidly in Australia, which has tended to ‘crowd out’ healthcare provision in the public sector (Brekke & Sørgard 2007). In the wider context of falling private health insurance membership between 2015 and 2020 and reduced growth in the utilisation of personal medical care since the COVID-19 pandemic, the expansion of private practice is likely to put pressure on the public healthcare sector (Hall 2013, Van Doorslaer et al. 2008). Therefore, a good understanding of the distribution of the medical workforce and factors that influence doctors’ choices of public or private practice is important to enhancing the efficiency of healthcare delivery in the national healthcare system. Another issue is that the gender composition of the Australian medical workforce has changed significantly in recent decades, with women constituting an increasing share of medical graduates and the labour force. Despite more women in medicine, however, gender inequality in earnings remains stubbornly persistent. Lower working hours among female doctors are believed to be the main contributor to the remaining gender earnings gap (Ly et al. 2016, Frank et al. 2019). The onset of parenthood can worsen the earnings gap if children and family responsibilities affect the working hours of male and female doctors differently. Among female professions, not limited to medicine, balancing work and life is a challenge, as females remain primarily responsible for childbearing and domestic duties. Therefore, studying how children and family responsibilities impact working hours and earnings is essential to understand the barriers female doctors face in their medical careers.