Contribution of Women to Medicine in Bahrain: Leadership and Workforce | Human resources for health

The discussion part is divided into three main sections; leadership, workforce and the medical student to provide greater insight into the status and contribution of women in the Kingdom of Bahrain and highlight existing literature in related fields.

Leadership

Despite the increase in the number of women enrolled in medical schools, women still struggle to break through the glass ceiling to take up leadership positions [20,21,22,23]. Although improvements have been observed both locally and globally, permanent leadership positions are still largely held by men [24, 25]. For example, only 25% of African ministers of health are women and 24% of directors of global health centers in the top 50 US medical schools are women. [26]. In Kuwait, the number of female department heads in several public hospitals increased to a high of 73%, while the lowest rate reported in these hospitals was 44%. [27].

In our study, management positions were divided into several levels. Senior administrative position which includes undersecretaries, general managers, heads of medical staff, heads of training departments, heads of departments, heads of committees, and academic positions. Women occupy 40.6% of all these positions, while men represent 59.4%. There are more men in the Heads of Department and Heads of Committee categories than women (70.3% vs. 29.7% and 63.6% vs. 36.4%, respectively). Bahraini men and women also dominate the academic position (Table 1). All leadership positions were dominated by Bahraini women compared to non-Bahraini women.

Number of doctors

Among the various medical and surgical specialties, female physicians are still under-represented in some specialties and more concentrated in others. It is well documented in the literature that female doctors are underrepresented in several specialties: mainly surgical specialties, such as general surgery, orthopedic surgery, neurosurgery and emergency medicine [28,29,30,31]. The reasons for this low number of female physicians in certain specialties have been attributed to many factors, including male dominance, physical demands, extended hours [29] family care [32]lack of support during pregnancy and childcare [33]and the lack of female role models [32]. On the other hand, female physicians focus more on so-called “people-oriented” specialties, such as pediatrics, psychiatry [34, 35]and primary care [36].

At the time of the study, 3734 physicians were registered and licensed with the NHRA, of whom 47.8% were male and 52.2% were female. Women significantly dominate the general license category compared to men (62.3% versus 37.3%). However, the specialist and consultant licensing categories were dominated by male physicians rather than female physicians (62.2% versus 37.8% and 56.7% versus 43.3%, respectively). Female Bahraini doctors at the specialist and consultant levels slightly outpaced male Bahraini doctors (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Further analysis revealed that Bahraini women held more consultant licenses than non-Bahraini consultants (33.2% and 10.1%). On the other hand, non-Bahraini male and female physicians dominated the specialist licensing category compared to Bahraini physicians (51.8% versus 10.4% and 26% versus 11.9%).

In terms of specialties, our data showed that female physicians far outnumber male physicians in primary care (75.7% versus 24.3%) and obstetrics and gynecology (87.9% versus 12, 1%) only (Table 3). The higher number of female doctors in obstetrics and gynecology may be explained by the cultural preferences of female patients. Being a conservative society, women always prefer to be examined by female doctors. There were also more women in family medicine. On the other hand, male consultants far outnumber women in all other specialties, which is more important in surgical specialties and orthopedic surgery. The surprising finding is the total absence of female doctors in intensive care (table 3). However, this can be explained by two factors, one is that most intensive care units in Bahrain are run by anesthesiologists, and second, some doctors may not have renewed their license in time and do not were therefore not included in the data because the extracted data only included physicians with valid licensure. Another specialty that is totally lacking in female physicians is neurosurgery (Supplementary file 1: Table 5 appendix).

Medical students

A review of the literature on gender distribution in medical schools shows a clear trend in which women openly dominate graduate medical student seats, where this global phenomenon has already been observed in some European countries. [37]United States [38]Canada [39]and australia [40]. In the Arab Gulf States, this is also seen in Kuwait [27] and Oman [41].

In this study, the number of medical students reflects similar trends, with the number of female medical students exceeding the number of male medical students in Bahrain since 2004 (Supplementary File 1: Appendix Table 6). Most female medical students were non-Bahraini. If only Bahraini medical students are considered, female medical students far outnumber their male counterparts.

The study reflects encouraging data regarding the state of women’s contribution to medicine in Bahrain. However, more attention needs to be given to female physicians to enable them to move into higher leadership positions. Mentoring and scholarships have been recommended in the literature to fill these gaps and achieve gender equity. Introducing the concept of mentoring in academic institutions with supportive interventions targeting gender equity can advance and retain women in pursuing their academic and professional careers, provided these interventions are well researched and hold. account for the variety of needs of women from diverse backgrounds, including nationality, socio-economic status, cultural and educational background as well as other factors [42, 43].The concept of sponsorship programs has been applied in the field of business and it is advocated that it can be applied to advance women in academic medicine [44]. Sponsorship is defined as “the public support of a powerful and influential person for the advancement and promotion of an individual in whom he or she sees untapped or unappreciated talent or leadership potential” [44]. It is very common in the Arab Gulf States to provide government sponsorships for postgraduate study abroad in various medical disciplines. No data has been published on government sponsorships of female doctors in Bahrain. A respectable example is the King Abdullah Scholarship program in Saudi Arabia, which began in 2005 and sponsored prominent Saudi university residents, and the number of female beneficiaries increased from 16% in 2005 to 44% in 2017. [45].

The study demonstrated that the gap between graduation and working in medicine for women in Bahrain is better than for their male counterparts, except in some leadership positions.

Strengths and limitations

To our knowledge, this is the first study to assess the contribution of women in the medical field in the Kingdom of Bahrain. One of the limitations was that data was only collected from government institutions and the two medical schools in the Kingdom. As private medical institutions were not included in the study, the contribution of women in the private sector was not assessed. Second, the NHRA data was collected at a point in time, reflecting the number of physicians with active valid licenses in a single year, which may not be an accurate estimate of the actual number. Physicians who may have been in the process of renewing their license or those who had not renewed their license were not included.

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