Thesis (DPhil)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: This dissertation aims to establish the reasons underlying possible gendered attrition trends in the South African medical profession between 1996 and 2005. Noting the international trend of the increasing feminisation of medical education and the profession, the dissertation illustrates that this is also a reality in our national context, and frames this phenomenon as being plagued by difficulties very similar to those encountered in other traditionally male-dominated fields. The particular relevance for further research and debate is illustrated through the noticed discrepancy between women’s representation in enrolment and graduation at medical schools in South Africa, and their representation in the profession itself. The decision to approach this investigation from a feministorganisational perspective was based on the fact that this would not only be a novel, but indeed also an appropriate, research approach to the study of gendered trends in medical education and the profession within the South African context. The research project thus sets out three main objectives relevant to this investigation. Objective 1 aims to establish the sex composition of the cohort of medical graduates that have not entered, or decided to exit, the medical profession. In terms of this objective, findings show an increasing rate of progression of men into the profession, accompanied by a decreasing rate of progression of women into the profession. Objective 2 attempts to establish the reasons behind sex trends in South African medical schools and in the profession. Thus, in an effort to comprehensively investigate the issues underlying attrition, I employ a mixed-methods approach to the primary data collection and analysis. Firstly, the findings show, through a quantitative analysis of the interview data, that this sample of women felt that both institutional and societal factors influenced a women doctor’s propensity to remain in the profession. Secondly, it is established that whether these respondents felt that they had appropriate role models in the profession was the most important factor in terms of their identification with, and propensity to stay in, the profession. Thirdly, it was also found that the respondents felt strongly that the culture of the medical profession impacts negatively on a woman doctor’s propensity to stay in the profession, but similar to the findings of other studies, this does not bring us closer to an understanding of what that culture constitutes. Thus, lastly, through a qualitative analysis of the interview data I find that the respondents clearly recognise the presence of a gendered substructure in medicine in the South African context, and identify some elements of this structure as most commonly linked to attrition. Objective 3, based on the outcomes of the previous objectives, aims to provide recommendations for the retention of medical doctors in general, and women doctors specifically, in the South African context. It concludes that flexibility1 in the medical profession is paramount to the retention of doctors, and women doctors specifically. This is a difficult challenge to overcome, as central values such as the importance of continuity of care in the medical profession would suggest that providing increased flexibility to medical doctors would impact negatively on patient care. However, it appears that there is increasing recognition amongst scholars, policy makers and medical practitioners themselves of the importance of acknowledging alternative work patterns. On the basis of the outcomes of my research, it is clear that the national gender attrition trends are a cause for concern in terms of resourcing the National Health System against the backdrop of a widely acknowledged shortage of doctors in South Africa and elsewhere. If women doctors do not progress effectively into the system, but form the majority of graduates, this is a tragic loss, as well as a waste of resources during training. This aspect also has policy implications, because it appears that the government, in trying to retain doctors, has increasingly turned to measures that are restrictive (compulsory community service, restrictions on foreign doctors), rather than focusing on ways in which to make doctors want to stay. The dissertation thus closes by suggesting two main areas within which these findings and recommendations would be employed most usefully: 1) medical schools/ training/education, and 2) the medical profession/culture. / AFRIKAANSE OPSOMMING: Hierdie proefskrif het ten doel om die redes onderliggende aan geslagsverskille in die verlies van vroue uit die Suid-Afrikaanse mediese beroep tussen 1996 en 2005 vas te stel. Die internasionale tendens van die toenemende vervrouliking van mediese opleiding en die mediese beroep wys dat dit ook ‘n realiteit in die Suid-Afrikaanse nasionale konteks is. Hierdie verskynsel word veroorsaak deur probleme soortgelyk aan dié wat in ander, tradisioneel manlik gedomineerde beroepe ondervind word. Die spesifieke relevansie vir verdere navorsing en debat word geïllustreer deur die aangetoonde proporsionele verskil tussen vroue se inskrywing en graduering in mediese skole in Suid-Afrika, en hul verteenwoordiging in die beroep self. Die besluit om hierdie ondersoek uit ‘n feministies-organisatoriese perspektief te benader, is nie net omdat dit ‘n oorspronklike benadering sou wees nie, maar ook gepas vir ‘n studie van geslagstendense in die mediese onderwys en professie binne die Suid- Afrikaans konteks. Die navorsingsprojek bevestig dus drie hoofdoelstellings wat relevant tot hierdie ondersoek is. Doelstelling een probeer om die geslagsamestelling van die kohort van mediese gegradueerdes wat nie tot die beroep toegetree het nie, of dié wat besluit het om die beroep te verlaat, te bepaal. Daar is bevind dat daar ‘n verhoogde koers van vordering van mans tot die beroep is, gepaardgaande met ‘n verlaagde koers van vordering van vroue tot die beroep. Doelstelling twee probeer om die redes onderliggende aan die geslagstendense in die mediese skool en die beroep vas te stel. Dus, om ‘n omvattende ondersoek te doen om uit te vind wat onderliggend aan die verlies is, het ek van ‘n gemengde metode benadering tot data insameling en analise gebruik gemaak. Die resultate van die onderhoud data wys dat hierdie vroue voel dat beide institusionele en sosiale faktore ‘n vroulike dokter se besluit om in die beroep te bly, beïnvloed. Tweedens is daar vasgestel dat geskikte rolmodelle in die beroep die belangrikste faktor is in vroue se identifikasie met die beroep, en hulle besluit om in die beroep te bly. Derdens is gevind dat die respondente baie sterk voel dat die kultuur van die mediese beroep ’n negatiewe impak het op ‘n vroulike dokter se besluit om in die beroep te bly, maar soos ook in ander studies bevind is, bring dit ons nie nader aan ‘n begrip van die aard van die kultuur nie. Ten slotte is daar dus met die onderhoud data gevind dat die respondente duidelik bewus is van die teenwoordigheid van ‘n geslagsubstruktuur in die mediese beroep in Suid-Afrika. Ek identifiseer ook sekere elemente van hierdie struktuur wat bydra tot die verlies van vroulike dokters uit die mediese beroep. Doelstelling drie, gebaseer op die uitkomste van die vorige doelstellings, probeer om aanbevelings te maak vir die behoud van mediese dokters in die algemeen, en vroulike dokters spesifiek. Die gevolgtrekking is dat buigsaamheid in die werkskultuur van die mediese beroep van kardinale belang is vir die behoud van dokters in die algemeen, en vroulike dokters meer spesifiek. Dit is ‘n moeilike uitdaging om te oorkom omdat sentrale waardes, soos die belang van kontinuïteit van versorging in die beroep, persepsies laat ontstaan dat meer buigsaamheid in werksomstandighede ‘n negatiewe impak op die versorging van pasiënte sou hê. Dit blyk egter ook dat daar ‘n toenemende erkenning is deur akademici, beleidsontwerpers en mediese praktisyns self van die belang van alternatiewe werkspatrone. Gebaseer op die resultate van die ondersoek is dit duidelik dat die nasionale geslagsverliestendense ‘n rede tot kommer vir die verskaffing van menslike hulpbronne vir die nasionale gesondheidstelsel is, veral teen die agtergrond van ‘n algemeen erkende tekort aan dokters in Suid-Afrika. As vroulike dokters nie effektief in die stelsel opgeneem word nie, hoewel hulle die meerderheid van gegradueerdes is, is dit ‘n tragiese verlies en vermorsing van hulpbronne wat vir opleiding gebruik is. Dit het ook implikasies vir beleid omdat dit blyk dat die Suid-Afrikaanse regering, in sy pogings om dokters te behou, meermale maatreëls gebruik wat perke stel (verpligte gemeenskapsdiens, beperkings vir buitelandse dokters, ens.), waar hulle eerder behoort te fokus op maniere om dokters in Suid-Afrika te hou. Ten slotte stel die proefskrif twee hoofareas voor waarin hierdie bevindings en aanbevelings aangewend kan word: 1) mediese skole/opleiding/onderwys, en 2) die mediese beroep/kultuur.