Women’s contribution to medicine in Bahrain: leadership and workforce | Human Resources for Health

The discussion part is divided into three main sections; the leadership, workforce, and medical student to give a better insight on the women status and contribution in the kingdom of Bahrain and highlight the existing literature in the related fields.

Leadership

Despite the increase in the number of females being enrolled into medical schools, women still struggle to shatter the glass ceiling to hold leadership positions [20,21,22,23]. Although improvements have been observed both locally and globally, permanent leadership positions are still held largely by men [24, 25]. For example, only 25% of African ministers of heath have been females and 24% of global health center directors at the top 50 US medical schools are females [26]. In Kuwait, the number of female heads of departments in several governmental hospitals has increased to reach a maximum of 73%, whereas the lowest rate reported in these hospitals was 44% [27].

In our study, leadership positions have been divided into multiple levels. Top administrative position which include Under Secretaries, Chief Executive Officers, Chiefs of Medical Staff, Heads of training Departments, Head of Departments, Head of Committees, and Academic Positions. Females make a 40.6% out of all these positions, whereas males make up 59.4%. There is a higher number of males in the heads of departments and heads of committees’ categories when compared to females (70.3% vs. 29.7% and 63.6% vs. 36.4%, respectively). Bahraini males and females equally dominate Academic position (Table 1). All leadership positions were dominated by Bahrain Females when compared to Non-Bahraini females.

Physicians’ workforce

Among the diverse medical and surgical specialties, female physicians are still underrepresented in some specialties and more focused in others. It is well-documented in the literature that female physicians are underrepresented in several specialties: mainly the surgical specialties, such as general surgery, orthopedic surgery, neurosurgery, and emergency medicine [28,29,30,31]. Reasons for these low numbers of female physicians in certain specialties have been attributed to many factors including male dominance, physical demand, extended hours [29] family care [32], lack of support during pregnancy and in childcare [33], and lack of female role models [32]. On the other hand, female physicians are more focused in what is termed “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 at NHRA out of whom 47.8% were males and 52.2% were females. Females considerably dominate the general license category compared to males (62.3% vs. 37.3%). However, the specialist and consultant license categories were dominated by male physicians rather than females (62.2% vs. 37.8% and 56.7% vs. 43.3%, respectively). Female Bahraini physicians at a specialist and consultant level slightly surpassed male Bahraini physicians (female to male: 11.9% vs. 10.4% and 33.2% vs. 30.4%, respectively). Further analysis revealed that Bahraini females held more consultant licenses than non-Bahraini female consultants (33.2% and 10.1%). On the other hand, non-Bahraini male and female physicians dominated the specialist license category compared to Bahraini physicians (51.8% vs. 10.4% and 26% vs. 11.9%).

Regarding specialties, our data showed that female physicians far exceed the number of males in primary care (75.7% vs. 24.3%) and Obstetrics and Gynecology (87.9% vs. 12.1%) only (Table 3). The higher number of female physicians in Obstetrics and Gynecology may be explained by cultural patient preferences. Being a conservative society, females still prefer to be examined by female physicians. There was also a larger number of females in family medicine. On the other hand, male consultants far exceeded females in all other specialties which is more significant in surgical specialties and orthopedic surgery. The surprising finding was the complete lack of female physician in intensive care (Table 3). However, this may be explained by two factors, one is that most intensive care units in Bahrain are run by anesthetists, and second, some physicians may have failed to renew their licenses on time and were, therefore, not included in the data as the data extracted only included physicians who hold valid licenses. Another specialty which completely lack female physicians is neurosurgery (Additional file 1: Table 5 Annex).

Medical students

A review of the literature on gender distribution in medical schools shows a clear trend in which women overtly dominate graduate medical student seats, where this global phenomenon has already been seen in some European countries [37], the 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 reflected similar trends with the number of female medical students exceeding the number of male medical students in Bahrain since 2004 (Additional file 1: Table 6 Annex). Most of the female medical students have been non-Bahraini. When considering only Bahraini medical students, female medical students far exceed their male counterparts.

The study reflects encouraging data regarding the status of women’s contribution to medicine in Bahrain. However, more focus needs to be directed toward female physicians to enable them to reach higher leadership positions. Mentorship and scholarships have been recommended in the literature to fill these gaps and achieve gender equity. Introducing the concept of mentorship in academic institutions with supportive interventions targeting gender equity can advance and retain women as they pursue their academic and professional careers, provided that these interventions are well-studied and take into account the variety of needs from women of diverse backgrounds, including nationality, socioeconomic status, cultural and educational background as well as other factors [42, 43].The concept of sponsorship programs has been applied in the business field and it is advocated that it can be applied to advance women in the academic medicine [44]. Sponsorship is defined as “the public support by a powerful, influential person for the advancement and promotion of an individual within whom he or she sees untapped or unappreciated leadership talent or potential” [44]. It is very common in the Arab Gulf States to provide governmental sponsorships for postgraduate studies abroad in various medical disciplines. No data has been published about governmental sponsorships of female physicians in Bahrain. One respectable example is King Abdullah Scholarship Program in Saudi Arabia which started in 2005 and sponsored distinguished academic Saudi residents, and the benefited number of women increased from 16% in 2005 to 44% in 2017 [45].

The study demonstrated that the graduation-to-work discrepancy in medicine for women in Bahrain is better than their male counterparts except in some leadership positions.

Strengths and limitation

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