成为高需求医学专业的住院医师：一场不平等的竞赛？来自西班牙住院医师市场的证据。
Becoming a resident in a high demanded medical specialty: an unequal race? Evidence from the Spanish resident market.
机构信息
HCD Economics,The Innovation Centre, Keckwick Ln, Daresbury, WA4 4FS, United Kingdom.
Centre for Health Economics, University of York, York, YO10 5DD, United Kingdom.
出版信息
Hum Resour Health. 2021 Jan 6;19(1):3. doi: 10.1186/s12960-020-00543-2.
BACKGROUND
Gender occupational segregation in medicine is associated with several undesired consequences such as earnings disparity, shortages of specialists or lower quality of care among others. This paper focuses on the persistent gender gap observed in the most popular specialties of the Spanish resident market. In particular, it explores the role of the specialty allocation system in perpetuating the occupational segregation. For that purpose, this paper studies the effect of a policy change in the ranking system that determines doctors' specialty choice order. The change increased the competitiveness of the process by increasing the weight of an entry examination from 75% to 90%, in detriment of doctors' grade point average that decreased from 25% to 10%. Findings from previous literature suggest that that male and female doctors might have reacted differently to the increased competitiveness of the process.
METHODS
Data come from administrative records of doctors' specialty choices for the years 2013 and 2015 and they are used to compute the difference between doctors' pre and post-change ranking positions. Then, differences in the distribution of rank differences between male and female doctors are tested by means of parametric (T-test) and non-parametric (Wilcoxon rank) approaches.
RESULTS
Results show that the policy change has overall favoured male doctors. On average, female doctors lose ranking positions, with respect to the position they would have achieved with the old weights, whilst male doctors gain positions. The differences are more pronounced in the top half of the ranking distribution, meaning that female doctors on average have reduced their probability of accessing the most demanded specialties.
CONCLUSIONS
The objective of the policy was the enhancement of the prospects of Spanish-graduate doctors with respect to international graduates by giving more weight to the less prone to bias examination scores. Nonetheless, the change have had the unintended consequence of reducing the probability of female doctors accessing highly demanded specialties and thus exacerbating the gender gap. The allocation system needs revision to make it accountable for the actual role of doctors in society.
背景
医学领域的性别职业隔离与多种不良后果相关，如收入差距、专科医生短缺以及医疗质量下降等。本文主要关注西班牙住院医师市场中最受欢迎专业中持续存在的性别差距。具体而言，本文探讨了专业分配制度在延续职业隔离方面的作用。为此，本文研究了决定医生专业选择顺序的排名系统政策变化的影响。该变化通过将入学考试成绩的权重从 75%提高到 90%，同时降低医生平均绩点的权重（从 25%降至 10%），提高了该过程的竞争力。来自以往文献的研究结果表明，男性和女性医生可能对该过程竞争力的提高做出了不同的反应。
方法
数据来自 2013 年和 2015 年医生专业选择的行政记录，用于计算医生排名变化前后的排名差异。然后，通过参数（T 检验）和非参数（Wilcoxon 秩检验）方法检验男女医生之间的秩差异分布差异。
结果
结果表明，政策变化总体上有利于男性医生。平均而言，与旧权重下的排名相比，女性医生的排名下降，而男性医生的排名上升。这种差异在排名分布的上半部分更为明显，这意味着女性医生获得最受欢迎专业的概率平均降低。
结论
该政策的目标是通过增加对不易产生偏差的考试成绩的重视，提高西班牙裔医生相对于国际毕业生的前景。然而，这一变化产生了意想不到的后果，降低了女性医生获得高需求专业的概率，从而加剧了性别差距。分配系统需要修订，以使其对医生在社会中的实际作用负责。
Zotero 插件