Estructura de la tesis

As the preceding discussion revealed, the prevalence of conventional notions about the role of men and women was particularly illustrated in the way in which the participants organised their work and non-work lives. These gendered ideologies were reinforced by practices and beliefs held in the medical profession and in the family domain. This finding was consistent with the aspect of Wharton’s (2004, 2005) institutional approach that speaks to the perpetuation of social constructions of gender within social systems.

Firstly, besides the physical dangers associated with being on-call, the masculinity inherent in this working arrangement and in the wider T&T medical profession, was illustrated in this notion of doctors having to be ‘invincible’ to prove their worth. There was an implicit expectation by senior managers that doctors were to remain in a state of availability (via telephones and other forms of technology), even when not on duty. A committed doctor was one who allowed medicine (including being on-call) to take priority over all aspects of their non-work lives. This finding matched Turk et al. (2014) who posited that “many of the implicit ‘rules for success’ in the workplace [such as commitment] are closely aligned with traditional images of masculinity” (p. 444). They argued that “in a majority of workplaces, the definition of commitment remains rooted in a traditional concept of the ideal worker as someone for whom work is primary, and the demands of family and community are secondary” (p. 444). This might explain why more men relative to women spoke about the difficulties they experienced in psychologically detaching from work and why overall all divorced and separated doctors were men. The prioritisation of work over family by the men who were doctors in the study was in line with their roles as breadwinners as argued by Wharton (2005).

However, it was not that women doctors thought of themselves as less committed to their careers than their counterparts who were men. Instead, they were expected to be more concerned about the fulfilment of their caretaker roles within the family domain (Wharton, 2005).

Hence, doing femininity and being a committed doctor on-call appeared to be mutually exclusive. The data revealed that for men, the level of commitment expected by managers for success as a doctor, was relatively easier to achieve because their wives were ultimately responsible for domestic and childcaring duties. Women doctors on the other hand, although they had support from their husbands, were still primarily responsible for the home and hence, struggled to reconcile their on-call responsibilities with their social role expectations as caretakers (Wharton, 2005). Consequently, they considered switching to lighter-weight specialties (perceived by men as ‘lazy medicine’) in order to be more available for their families. However, while women doctors spoke about wanting to switch, none of them did. Consequently, the feelings of guilt which ensued, may have been due to the inconsistency between continuing to work within their current on-call specialties and their internalisation of the normative view that they should be more available for their families (Wharton, 2005).

Secondly, apart from gender being sustained within the institutional practice of medicine, traditional gendered ideologies were also sustained within the institution of the family, and this was especially so among SOs. As was previously discussed, there was an expectation by their partners who were men, that women SOs would leave or restrain their careers to fulfil their caretaker roles and support their partner’s medical career including on-call responsibilities. These expectations remained even in instances

where they and their partners were both doctors or were in careers of similar prestige and income. This suggests that women’s social status as professionals was not relevant in guiding decisions about their work and home lives. The expectation within the family unit that they and not men should sacrifice career for family, therefore served to reproduce inequalities relating to the division of domestic labour between men and women (Wharton, 2005).

5.6. Chapter summary

The preceding study revealed that while there were some similarities in the ways in which proximal and distal doctors defined their experiences of being on-call, there were nuances relating to what these definitions meant to them. The study added more in- depth knowledge on the distal on-call experience in particular, through its qualitative (interpretive) inquiry by allowing the distal on-call doctors to define their experiences in their own terms and ways. As such, the findings highlighted; that the distal on-call experience is more complex than presented in at least one recent study (Ziebertz et al., 2015). Furthermore, it defined the negative aspects of the distal on-call experience in other ways besides being stressful. Finally, it revealed additional prominent sources of distal on-call stress besides the anxiety associated with the unpredictability of being on- call not mentioned in other studies in the literature (e.g. Bamberg et al., 2012; Rout, 1996).

Meijman and Mulder’s (1998) E-R theory was used as a framework within which to situate the experiences of both distal and proximal on-call doctors. Few studies in the past have been explicit about their theoretical framework. Furthermore, discussions in the on-call literature regarding psychological detachment, a core component of recovery, have occurred only in the context of distal on-call systems and have mainly focused on difficulties detaching during the on-call period. In this study, psychological detachment has been found to be relevant not only to the distal but to the proximal on- call experience. Additionally, difficulties detaching have been found to extend beyond the on-call period for both proximal and distal doctors, implying longer term impacts for health and well-being.

The study also offered more current evidence on the experiences of both on-call doctors and SOs of on-call doctors. Sullivan and Smithson (2007) proposed that in the context of work-family research, it is important to explore the perspectives of the worker’s family members. Therefore, while the current findings add to the body of knowledge on the impact of being on-call on family and social life, it does so from the perspective of on-call doctors and their SOs. The findings were also evident of how being on-call hinders the family and social lives of proximal doctors post-call. Thus, it contributes to the limited knowledge on the social aspect of the on-call experience among this group.

Finally, the purposeful recruitment of gender balanced samples contributed more conclusive evidence on the implications of social constructions about gender in the experience of being on-call especially with regards to family and social life. Furthermore, the current evidence demonstrated how these constructions were reproduced or reinforced within social structures and practices (Wharton, 2004, 2005). More specifically, traditional ideologies about men and women’s roles as it relates to paid and unpaid work were reinforced within the T&T medical environment (through idealistic managerial notions about commitment and the physical dangers of on-call) and family unit (through expectations that women would sacrifice their careers to facilitate their caring and domestic responsibilities).