Women in GP Supervision

GPSA recognises the pivotal role played by women GP Supervisors in GP Training. Recognising that there are many barriers for Women GP Supervisors, GPSA funded a narrative research project  interviewing female GP supervisors about why women GPs supervise registrars, or choose not to. 
This page presents some of the research findings and themes discovered.

This research was conducted in partnership with Monash University School of Rural Health, EV GP Training and Melbourne University.


I don’t remember doing any specific education on how to be a supervisor. I had to figure out a lot of stuff myself or by asking other people.

Research respondant




Key research themes discovered

  • Women GPs describe having limited control over the decision to supervise registrars and were not fully informed about the role.
  • Some women GPs play a key role in the formal and informal supervision workload in practices that is not appreciated as a valued contribution.
  • Some male registrars may disrespect women GP supervisors as mentor-teachers.
  • Some women GP supervisors felt unsupported by male superiors to manage male registrars who were not receptive to their feedback.
  • Some women GPs lead the teaching and learning in their practice, but, if engaged as a non-practice owner, they may not get adequate practice support to sustain the task.
  • Some women GPs describe being unaware of and unremunerated for aspects of the supervision role.
  • Women GPs can experience unsuccessful negotiations with male practice owners around pay for the structured teaching they did.
  • Women GP practice owners and non-practice owners with lead educational roles in the practice are inclined to remunerate women GPs for structured teaching.
  • Inadequate remuneration relative to the workload can affect early-career GPs interest in doing supervision work and mature GPs from continuing it.
  • Pay is valued as part of recognition by women GP supervisors of different demographics and career stages.
  • Women GPs believe they are sought out by registrars because they are approachable and value registrar learning and wellbeing, regardless of whether supervising formally or informally; but the time needed for frequent encounters is frustrating for women GPs when they are not the main supervisor.
  • Women GPs are asked to support registrar learning across women’s health, mental health, sexual health and complex care where they are perceived as experts, and this interrupts the time they need for their own patients (sensitive consultations).
  • The time commitment for supervising is worse if registrars are junior, unsafe or under-performing.
  • When women GPs take a break from or relinquish supervision roles, they express a sense of relief at not having to worry about learners and having time to do other things, such as invest in their own learning.
  • Women GPs of various ages describe the challenge of managing personal commitments, particularly to parents and children, with committing to supervise registrars over a 6-month term.
  • Informal supervision roles allow women to accommodate other life responsibilities whilst enabling them to be involved in supervision.
  • Women planning to have children describe potential career disruptions as a barrier to supervising.
  • The capacity to juggle children can vary depending on how family-friendly the practice is, and the proximity between practice and childcare/school.
  • Overall, women GPs may view supervision as an additional effort atop of their professional and personal lives.
  • Women GPs are intrinsically motivated to provide quality teaching and learning to create a positive experience for registrars. This could deter women from supervising unless they felt able to do it in a way that met their personal standards.
  • Women GPs actively pursued ways to build their supervision expertise to enable them to supervise to a high standard. To this end, women GPs noted a lack of educational support and guidance to foster understanding of the supervision role.
  • Women GPs preferred team supervision to provide backup for registrars and opportunities to share ideas.
  • Women GPs gained confidence from teaching medical students and overseeing registrar learning in other general practices (as an independent clinical educator).
  • Women GPs seek formal and informal opportunities to exchange ideas and share resources with other GP supervisors, such as supervision mentoring.
  • Women reflect on and reconcile the level of uncertainty involved in supervision which enables them to keep supervising even when registrars don’t progress.
  • Imposter syndrome is common in women GPs commencing supervision roles.
  • Early-career women GPs think they lack sufficient technical GP knowledge to be teaching, but perceive strength in their fresh knowledge of the GP training program and are encouraged if they are in a supportive team where they can learn to supervise and their value to the team is acknowledged.
  • The historical requirement for early-career GPs to get some experience before taking up supervision roles was viewed as a barrier to new women GPs to take up supervision
  • Some mid- and later-career women GPs experience imposter syndrome if they lack knowledge of current GP exams and clinical guidelines, but they draw confidence from their expertise in real-world practice, which helps them be assertive about their value.
  • Women GPs overcome imposter syndrome and build confidence in a supervisor identity when they can bounce ideas around a team, reflect on their practice, and realise their unique contribution is based on the types of patients that they see, the way that they teach, their specialisations, and the nature of medicine that they practise.


I actually didn’t put down my name to actually be an official … supervisor. Although I was teaching, I was doing it in an unofficial manner. But my boss [practice owner] took it on himself with his wife to forge my signature to say that I was going to be prepared to be doing this teaching. One day, three registrars arrived.
Research respondant



Discussion

Women GPs interviewed in the study agree that there is a lack of recognition and remuneration for teaching, which can deter them from taking on supervision roles. This included non-practice owners being left out of business decisions related to supervision, such as recognition and payment of supervisors. Commonly, women contributed to GP supervision in informal ways without pay or recognition. The quality of women GP Supervisors was seen as high, and they were often seen as more available and approachable. There was seen to be a gendered substructure within practice supervision, where women supervise around explicit and implicit rules according to their gender and position. 

Knowledge about supervision roles and payments for supervision should be more clearly communicated to women, as well as how to get involved and supports available such as the peak body. Practice supervision policies should require consultation with women GPs for inclusion in supervision, document supervision roles and activities available for remuneration. Policies should also be extended to enable women to enter and re-enter supervision roles across their career span

For Women GP supervisors who are more often covering sensitive topics like women’s health, mental health, and sexual health, there are difficulties in caring for their own patients and managing registrar interruptions. Women GPs often expressed a lack of confidence in supervising, seeking  validation through technical or real-world medicine. 

To break through stereotypes and support women GP Supervisors, respondents felt that better acknowledgement of the valued contribution of women GP supervisors, and more woman-specific mentorship networks for supervision are needed.  Promoting team-based supervision where women GPs have a clear role and can make a quality contribution through a shared commitment will also assist in this change.



… I think [the next generation of women] … have less barriers because they’re all more assertive…than maybe my generation was, or maybe I am.

Research respondant




Conclusion

This research expands understanding of the lived experience of Australian women GP supervisors as they navigate taking up and managing supervision roles. The research points to story arcs which were about power and control, pay, time, other life commitments, quality of supervision, and supervisor identity. These represent significant issues that intersect to potentially impact the interest and capacity for women to join and be retained in the GP supervision workforce. The findings can be applied to developing more specific resources, supports, and structures to enable women to participate in and sustain GP supervision at the level that they find acceptable and rewarding.