The study results reveal that gender discrimination against women is markedly existent in the Korean medical community, with the phenomenon prevalent in all stages of employment, promotion, decision-making, and salary negotiations, as well as the resident, fellowship, and faculty recruitment process. Both women and men acknowledged that the main reason for gender discrimination is the burden of pregnancy, childbirth, and parenting on women doctors.
These results were comparable to those of previous studies such as the 2017 survey on training and work environment by the Korean Medical Association and Medical Policy Research Institute, and the Korea Women’s Medical Association studies conducted in 2010 and 2011[2-4] .There were reports that women were relatively disadvantaged in the matters of professional duties, senior administrative work, promotion, salary negotiations, and performance evaluation in hospitals [3,4]. In another domestic study, it was found that women doctors were struggling in a culture that was unfavorable to women, and they were in conflict with their peers, receiving negative attention from those around them during marriage and childbirth [5]. When it comes to domestic law, the “Working Standards Act” and “the Act on Supporting Gender Equity and Work-family Reconciliation” guarantee 90-day maternity leave, prohibit overtime work, offer childcare leave, allow a reduction of working hours for childcare, and provide paternity leave [6,7]. However, in reality, there is still a gap in implementation of the above-mentioned provisions in the medical field as physician resources are limited. In particular, the study stated that efforts should be made to improve the work environment for women in the medical health profession, as the law prohibits long work hours for pregnant women and bans discrimination due to childbirth [5]. Other studies have shown that women have a relatively low position in the hierarchy, and accept lower authority and lower economic rewards than men. Moreover, stereotypes that men are significantly superior to women still exist [8,9].
Many barriers to gender equity have been reported by international studies. Compensation, promotion and leadership, and academic work and recognition awards have been identified as barriers to gender equity in the medical field [10]. Above all, the most serious barrier is having children, which has been reported to be a “career stopper” in other countries. In an online survey of US physician moms, 66.3% reported having experienced gender discrimination, and 35.8% reported maternal discrimination, including at the time of pregnancy or maternity leave, and over breastfeeding [11]. Studies have reported that women doctors receive lower salaries than men, for example, women hospitalists work more but are paid less [12,13]. Neurologists and gastroenterologists also reported that men dominate faculty positions [14,15]. Moreover, women's leadership role in the medical society in Japan and Europe is limited [16, 17]. To overcome these barriers, it is necessary to secure women’s leadership positions in four gatekeeper organizations—medical schools/academic medical centers, funding agencies, journals, and medical societies [18]. It has been reported that the “pipeline theory” is impossible to be realized, so a political approach is necessary, rather than a vague expectation [19]. It is also difficult for gender equity to be achieved without fundamental changes in the social role of men and women in childcare, such as offering flexible on-site childcare and part time training options [20]. Finally, regulatory measures should be applied to various approaches: cultural gender equity policies, family support policies, and active work policies at organizational, structural, and individual levels [21-23]. To implement this, a formal central registry system and a monitoring system are needed to evaluate the current state of affairs and the developments [23]. A roadmap at the regional and national level to establish policy priorities is needed to solve the problems [24, 25].
In the question related to why gender discrimination takes place in the medical field, women indicated men’s vested rights, women’s lack of leadership opportunities, and the lack of mentoring as the reasons, in that order. Female doctors in South Korea accounted for 12.4% of the total in 1980, which allowed men to obtain leadership positions more easily in the medical community [1]. In addition, in the traditional Korean consciousness that emphasizes Confucianism, there is a perception that men, with male-centered thoughts, should assume representative positions [27]. There was a practice of reserving positions for men, resulting in relatively fewer opportunities for female doctors, such as leadership roles and mentoring. This gender discrimination is similarly observed in medical institutions in other countries [28, 29]. Several programs have indeed been developed to promote women's leadership in order to overcome this issue, with advocacy for gender equity and equality recently increasing [30]. In the future, as the proportion of women in the medical field rises, it is expected that the increase in female leadership will become a method to overcome gender discrimination.
Our study has some limitations. First, the answers to the survey can be subjective, rather than objective, leading to under-reporting or over-reporting. Second, the response rate was low and there was a lack of information on population samples covering the whole range of participants in terms of gender, age, and regional area. Third, although the study mainly revealed recent experiences as the participants were relatively young people in their 20s, 30s, and 40s, it did not reflect the changes over time or the trends. Fourth, relatively few specialists have responded gender discrimination in the fellowship and professorship application process. Nevertheless, this study is the first survey of Korean doctors, as far as we know, that helps identify the current status of gender equity in the medical field.