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FACTORS THAT HINDER FEMALE DENTISTS IN PURSUING THEIR CAREER.

Byline: TAHIR S. BASHIR A. and KHAN J.S.

ABSTRACT

Dentistry is a profession where due to the phenomenal growth of Pakistani population the ratio of den-tists to population has greatly decreased and is currently 1:16426. Another contributing phenomenon in this regard is female dropouts from the profession. Many females occupy a place initially and leave the profession eventually whereas a male student having studied dentistry on this seat would have prac-ticed his profession. The Pakistani government spends 7500 US dollars on the education of a dentist. It actually becomes a double loss of the society. The designated role of a homemaker for females in the family centred society of Pakistan affects the professional lives of these women adversely as it is a heroic task to balance both family and professional life. The overwhelming household and motherhood res-ponsibilities consequently results in women leaving their occupation at a rate twice that of men.

Also women feel strongly that males have stronger personal and professional support systems than women. The government of Pakistan / parents spend millions of rupees on this highly technical and professional education; shall it be transformed into well educated good house wives Pakistan Medical and dental Council (PMDC) does not allow part time work options in teaching institutions and government hospitals. Accepting the women and understanding their requirements to keep up with their family needs and professional demands is one step forward and this change agent will definitely bring many improvements and reforms.

Key words: Dentistry female drop outs motherhood professional support. INTRODUCTION

History of Dentistry

The history of females taking up dentistry as a profess-ion goes back to middle of nineteenth century and Lucy B. Hobbs Taylor has the honour of being the first female graduate who was granted a degree by dental college. She got admission into dental college of Ohio and was awarded a graduate degree in 1866 (King 1945). The number of women entering the field of den-tistry gradually increased as they started coming to America for further studies especially from Europe where females were not allowed to get admission in dental institutes in their own countries. Initially dental colleges in America were also not very keen to offer admission to females. However ladies were mostly accepted in many dental institutions by 1880. We are indebted to these pioneer women in dentistry for en-joying the privilege of education in the field of our cho-ice today. In Europe the timeline began in 1895 when Lilian Lindsay became the first woman who qualified as a dentist in the United Kingdom (UK) and from there onwards the gradual increase of women in the profess-ion started. It is said that by 2020 over 50% of all den-tists in the UK will be females (Murray 2002). In Pakistan the first women dentist was Moh-tarma Fatima Jinnah sister of Quaid-e-Azam Moha-mmad Ali Jinnah the founder of Pakistan. She went to Calcutta University in 1919 and got admission in R Ahmad Dental College. In 1923 she established a private dental clinic in Bombay after her graduation (Commire 2000).

Global Perspective

As the women entering dentistry and medicine are in-creasing day by day this makes the issue of balancing family work all the more important if we want to uti-lize this work force in future. Women are competing for higher education and procuring different professional degrees with great en-thusiasm at a pace higher than that of men but even today they are immensely under represented when leading positions are considered. Research has eviden-ced that women are more likely to be found in special-ties such as pediatrics obstetrics and gynecology psy-chiatry pathology and family practice (Jagsi et al. 2007) and they are prepared for under-representation in top positions in medical organizations and medical school faculties. Women try to balance their work and family life in many different ways (Bowles and Mc-Ginn 2005). Females with higher degrees tend to fall out of profession because they want to have children and not because their work is devalued. Women also think there is a lack of female mentorship and profess-ional support as they do not know where to find locum during their maternity leave (Davidson et al 2012). Motherhood has its effects on the professional lives of these women as it is a heroic task to balance both family and professional life. The plan to have chi-ldren consequently results in women leaving their occupation at a rate twice that of men (Windy 2012). With regards to keeping stability between the demands of family life and dentistry women automatically take the onus of double shift". According to a survey by American dental association in 1995 women in dentis-try spend about 15 hours per week with children child-care consumes about 11 hours weekly and housework takes about 9 hours. Women in dentistry spend about double the amount of time in household chores and child care as compared to their male counterparts adding to an extensive amount of work to their lives (Ross et al 2014). In a study by Sophia Mobiloson life style and professional balance" people mentioned that there was a definite link between specialty choice and your life style issues.

Balanced lifestyle required certain career decisions and sacrifices. Participants appeared to accept these sacrifices with resignation and they saw them as being inherent part of practicing medicine (Mobilos et al 2008). According to a recent report by Organization for Economic Co-operation and Development (OECD) Centre June 2013 the benefits of maternity leave for women's empowerment include both health and eco-nomic outcomes. In spite of the increasing attention of developed countries on such policies this study shows that the vast majority of developing countries still lag behind the 14 week conventional duration of mater-nity leave (Cerise et al 2013). According to Dr Susan Torres a community health dentist in Chicago flexibi-lity was an important factor as to why she opted for career in dentistry (Kramer 2008). Most female professionals felt that they were req-uired to make more compromises and sacrifices than their male counterparts (Belkin 2008; Craig 2006; Pailhe and Solaz 2006). Females took it as a journey with challenges not only near the top but all along the way. Some women decide to remain single the others plan to marry but not to have children and still others choose to be ambidextrous and try to strike a balance between their personal and professional life (Hewlett 2002; Nieva and Gutek 1981). As compared to men females are not well versed when it comes to training education and work experience as they cannot allocate more time to these activities due to other responsibili-ties at hand (Eagly and Carli 2004 2007). This results in lack of learned women in queue which is occasion-ally referred to as pipeline problem". In dentistry number of females in this queue has tremendously in-creased during the recent years but a closer examinat-ion shows that the females are indeed in the

pipeline but the pipeline is leaking". Those who make use of the company policies and flexible working condition are often sidelined whereas on the contrary if females leave their profession and want to re-enter they find it hard to do so and sometimes even have to take posit-ions lower than what they previously left at (Williams 2010). This gap can be explained by the fact that this irregularity and erratic trend in the labour ratio is bec-ause women self-select themselves out of the profess-ional track for motherhood" which does not lead to the upper end of hierarchy in their vocation (Belkin 2003). According to Lisa Tedesco the glass ceiling" exis-ts because culturally it is believed that career of ladies is easily diverted by problems in raising a family. Also women can't be tough and are only competent in cer-tain roles. This is also reflected in the phrase the hig-her the fewer" and is strongly supported by research (Turner and West 2006). If women are to move thro-ugh the glass ceiling health care institutions must be-come sensitized to the factors that prevent women's advancement and facilitate entry level opportunities for women in administration (Davidson and Cooper 1992; Hamel et al. 2006). Doctors in fact are seeking careers that involve less occupational stress while hav-ing a potential for controllable lifestyle' (Ek et al. 2005). In order to facilitate the females there should be aided in a way that they have facility in the form of flexible working hours and day care center in the vici-nity (Mobilos et al 2008). Active mentoring is important in personal and professional growth and development (Sambunjak et al. 2006; Weinert et al. 2005; Mayer et al. 2008). Bic-kel and Clark (2000) have noted that women receive inadequate mentoring and encouragement in their career development which is partly because of wo-men's tendency to think of relationships in terms of support and affiliation whereas men are more accus-tomed to competition and hierarchy which is the ten-dency to view relationships in professional educat-ional and / or workplace context. Since the role of wo-men as home makers is considered superior to their professional growth so least priority is given to their profession. They are the first ones to quit the job if the-ir family needs them. The unavailability of jobs with flexible working hours disrupts the balance maintai-ned by the super woman" juggling her personal and professional life.

Better job offers with provision of part time and flexible hours proper maternity leave and day care facilities can prevent major dropout. Fe-males are in constant battle with the odds and often end up contributing much less than their true poten-tial. The working conditions of doctors over work and extended working hours are different reasons that affect doctor's level of job satisfaction (Murray 2001). For females to progress in career not only provides the opportunity for personal growth but can also sati-sfy status and security needs and simultaneously pro-vides an opportunity for self actualization". Majo-rity of doctors working at primary health care establi-shments are not satisfied with their jobs because of social status and workload (Lithuania I. 2005). In me-dical profession the level of job satisfaction of doctors and health care workers directly affect their attitude towards the patients and colleagues (Sohag 2012). Therefore steps should be taken to solve this problem (Sultana and Watts 2008) as we see women facilitat-ing others everywhere but how often do we see women leading others

Pakistani Perspective

Medical and dental professions are taken up by both males and females with great zeal and fervour. The parents of these children dream nothing short of mak-ing them a specialist in these fields. The students as-pire to take up these fields right from their childhood as their parents inculcate their wishes and dreams into their children's mind as they grow up. Young boys and girls have always been attracted to join medical and dental profession not only in Pakistan but also around the world. After Pakistan came into being the medical and dental students got admission into professional colle-ges according to merit. The numbers of seats in medi-cal colleges were limited for girls compared to those for boys. Due to the quota system there were 80% sea-ts for boys and 20% for girls (Santana 2013). There-fore the merit for girls was always higher than that for boys as there were limited seats for girls. In 1991 the father of an affected student (girl) filed a writ petition in the high court stating that girls having the same marks as boys were not admitted to medical college and in order to treat both genders alike merit should be applied equally. The Supreme Court's decision was announced in favour of girls lifting the quota system (Santana 2013) and ever since there has been open merit for both boys and girls. As a result more girls started entering medical colleges (as they are more en-thusiastic to pursue a career at this stage).

Number of boys in class has been reduced ever since as girls are hard working with regards to their studies. Moreover higher education in public institutions is almost free. Apart from this girls enjoy the privilege of girls' only medical colleges as well. Hence there are better chan-ces for girls to get in to medical colleges than boys; still we do not find more lady doctors than male doctors in hospitals and clinics. It is observed that though it is prestigious highly competitive and difficult to get ad-mission in a medical and dental college surprisingly after all this effort females drop out from the profess-ion which of course is a pity. It is a national loss and possibly a psychological trauma for the individual. In Pakistan the literacy rate is also very low and more so in the case of females. According to a survey in 2008-2009 the literacy rate is 47% in females and 70% in males in Pakistan (Husnain 2012). Dentistry is a field where the man power is less. The ratio of dentists to the population has greatly dec-reased during the last few years. So the demand for dentistry is greater than ever before. There is increased public awareness about the dental health. There is a wave of women dentists surging through health scien-ces. However the future for women in dentistry seems to be promising to those who have the enthusiasm ability and the will power to succeed. Another perspective according to a recent publi-cation is that the prevalent trend to become a doctor or a dentist is to earn a certain title. It is a belief in the society that these females would get better proposals if they have the status of a doctor (Imtiaz 2012). Many females occupy a place initially and leave the profess-ion eventually whereas a male student could have stu-died dentistry and practiced his profession. For those who continue to pursue their career there is continu-ous instability between family and professional needs and this becomes extremely challenging when dealing with family and work together. The most frequently cited reasons for women not pursuing their careers are to have a better balance with family life lack of time and financial sacrifice. However there are still dropouts in dentistry in Pakistan. PMDC does not allow part time work options in teaching institutions and government hospitals. Accepting the women and understanding their req-uirements to keep up with their family needs and pro-fessional demands is one step forward and this change agent will definitely bring many improvements and re-forms. The question arising from this situation is about the utility of a large number of female medical/dental graduates; will they become part of and contribute to the health profession or take up their destined business of house wives The government of Pakistan / parents spend millions of rupees on this highly technical and professional education; shall it be transformed into well educated good house wives

In the traditional chauvinistic society of Pakistan very few professions are considered dignified for wo-men medicine being one of them leaving a void in rest of the professions. In order to raise the acceptance of the society to females in other professions apart from the ones considered nobel increase in the literacy rate of the country and the awareness of the population is needed. More so many women desirous of pursuing higher education are forced to choose either medicine or education as their specialty despite their aptitude and interest in other fields. The obvious outcome is that they are not keen to practice medicine afterwards. If we talk about women empowerment then education must be made mandatory for all. According to Yas-meen (2005) the strict cultural and traditional mind set of our society has led to even highly educated wo-men not receiving equal rights as those of men. Most of the inequality is based on societal expectations in our culture.

Many women have self imposed obstac-les due to guilt they feel if they weren't available for their family whereas males wouldn't feel the same guilt nor have the same restraints. Hence an aware-ness campaign about prejudiced traditional practices based on the idea of the inferiority of women at all lev-els in society should be undertaken.This may change attitude of the society and minimize gender discrimi-nation. Women feel strongly that males have stronger per-sonal and professional support systems than women. Some female dentists have voluntarily chosen to leave the dental profession despite the considerable time effort and financial expenditures involved in their educations. We cannot deny the fact that most female dentists after graduation either leave their profession behind or move forward with some other profession. Some good examples of attractive jobs that female dentists prefer to adopt are media teaching Non-Governmental Organization (NGO) or health manage-ment. Nationwide when we see the women dental sur-geons the number of females working as Consultants is even more disappointing. This becomes of para-mount importance when we see the dentist to patient ratio in Pakistan being 1:16426 (Anwar 2012) and it becomes glaringly exaggerated if the ratio is taken out for female dentist to female patient. It actually beco-mes a double loss of the society.

The Pakistan govern-ment spends 7500 US dollars on the education of a dentist (Ghausi 2002). According to Pakistan Medical and dental Council (PMDC) officials the ratio between the population and the health care facilities has impro-ved during the recent years but even now our country has to strive for the optimal ratio required for 1000 people accepted internationally (Achakzai 2008). The skimpy pay scale and unkempt work places serve only to dampen down the spirit and enthusiasm of young female physicians (Imtiaz 2012). Still unkind is the attitude of the government towards female physicians. No incentives and perks are provided whatsoever. In Pakistan harassment faced by lady doctors both in the streets and in workplaces is another reason for leaving the profession. A bill called The Protection against Harassment of Women at the Workplace Act 2010" has been passed but the compliance has been very low. Just passing a piece of legislation has done little for rectifying this issue. Women are still facing adverse and biased attitudes at the hands of investiga-tors and disciplinary committees when they complain against work place based harassments. Policies extending the period and coverage of maternity leave are thus required in order to improve women's professional growth. Maternity leave is just one factor for women to keep up with their profession and the family requirements. Interventions like part time work options and provision of proper child care facility are also very important factors for women to resume their professional responsibilities especially in a family centered society of Pakistan (Khawaja 2004).

According to a famous saying when you educate a man you are educating one person; but when you edu-cate a woman you educate a whole nation. The yawn-ing gap between the number of women and men (If the number of medical and dental graduates registered by the Pakistan Medical and Dental Council (PMDC) over the last one and a half years is authentic) then women continue to be on the march. Currently there are about 70% female students studying dentistry in Pakistan as opposed to only 30% male students. Accor-ding to PMDC statistics up to 28th March 2013 regis-tered dental practitioners for BDS were 11840 in total registered females are 6840 (57.7%) while number of registered males is 5000 (42.2%) (www.PMDC.org).

Though there has been increase in the ratio of fem-ale to male students in the institutions since 1990 but when it comes to faculty members the rise is not equ-ally dramatic. There still remains a scarcity of women as Deans / Head of the Departments in both private and government learning institutions. The question is why don't women pursue a career in dentistry when they always seem to take more interest than their male counterparts (Dental Tribune 2013). Though the sta-tistics in both the academic medicine and dentistry show progress but there is still much room for impro-vement in the status and role of women in Pakistan. The leadership potential of women can be capitalized in medical and dental academics. But this talented lot is being underutilized unfulfilled and unrealized in our part of the world. The authorities should take ser-ious notice and action to address this growing chall-enge.

Moreover the occupational stress multiplies into family stress usually produced by uncooperative hus-band / or in laws lack of the facilities for a proper day care for children insufficient income to afford day care for infants etc therefore it is imperative that steps should be taken in order to reduce the misery of professional women (Bano et al 2005). A few even said that their lives have been a ride on a roller coaster with too much ups and downs in their emotional life. In our society support of the husband and family matters the most in achieving success. The females need to know exactly what they want in life do careful planning and take cautious steps to convert every chance into opportunity. This requires mastery in communication the art of convincing others by as-serting oneself (Imtiaz 2012).

We can take good examples from western countries where the enrolment of females in dental schools is increasing day by day (from 40 percent to over 50 percent in some schools) (Dental Tribune 2013). This can be attributed to the better working policies on site day care centres replacement staff for maternity leave and the option of part time working facility. There is a need for continual monitoring of workplace rules and increased gender balance in shouldering the responsibilities especially regarding the work home balance. This will facilitate females to pursue their pro-fessional roles. The structural changes at societal level regarding equal distribution of raising the children and household responsibility will help women to achieve their professional aspirations to a larger degree (Ayers et al 2008). In medical profession the level of job satisfaction of health care workers and doctors directly affect their attitudes towards the patients and colleagues.Quality of medical care and doctor patient relationship is also dependent on the level of job satisfaction and fem-ale doctors are less satisfied as compared to their male counterparts. Removal of these barriers will facilitate the women to ensure equal opportunity and these re-sources will help them to achieve their required skill set which will help the nation to have access to this greatest talent pool and hence add to organizational success. Most of the conclusions drawn regarding females arise due to different roles of women in the society de-pending on the cultural back ground. Therefore most of the deductions made cannot be applied to different cultures as the roles of women and men are different. Hence carrying out research in Pakistani perspective will highlight many different aspects which might be different from those of the western cultures.

RECOMMENDATIONS

In order to reduce the misery of professional women following recommendations are made:

Four months maternity leave and replacement staff for this time period.

On site day care centers with good child care facility.

Active mentoring of females.

Education and awareness of people on mass media so as to change the attitude of the society making them realize the need of women dentists in our society.

Increased gender balance in shouldering the res-ponsibility regarding work home balance so that females have enough time and are well versed when it comes to education training and expe-rience.

Option of part time job offers and flexible working hours.

Improvement of working conditions at primary Health Care centers. Work places must be organi-zed and well equipped with instruments and mate-rial so that there is less frustration during working.

Also improvement of residential conditions social status and security at primary Health care centers.

Strict enforcement of the bill The protection aga-inst harassment of women at work place Act 2010." It is concluded that research indicates that while men's careers benefit from having children at home women's careers are hindered by it. Previous research tells us that what seems right for men in terms of car-eer growth and advancement goes wrong with the wo-men. Though many female physicians marry either other physicians or highly career oriented profession-als still they fail to follow a smooth career path. Gen-der has been shown to play an important role in deter-mining the extent to which children and the employ-ment status of one's spouse influence one's attitude toward relocating for the sake of career (Landau et al. 1992). If immediate steps are not taken to rectify the cur-rent situation and amendments are not made to cha-nge the trends Pakistan will be facing a gross shortfall of women in its medical work field which is a disaster waiting to happen. Professional bodies and associa-tions are required for females to cultivate professional attitudes and reinforce support for their careers. It is an appeal to the government and health sector is to plan something before the situation goes from bad to worse.

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