The findings of this study supported different aspects of the psychometrics of the Japanese translation of the JSE. For example, the method using contrasted groups [11
] showed that there were significant differences between physicians in people-oriented and technology-oriented specialties. This also confirmed the validity of the Japanese version of the JSE, because this finding was in the expected direction, consistent with findings previously reported in the literature. The significant item-total score correlations indicated that each single item contributed significantly to the total score. The internal consistency reliability of the Japanese scale was supported by the Cronbach’s coefficient alpha.
Female medical students and physicians have previously been reported to score higher than their male counterparts [2
]. In Japanese medical students, for example, we noticed that the mean scores of the JSE were 103.7 and 107 for men and women, resprctively [10
]. The gender difference in empathy has been attributed to intrinsic factors (e.g.
, evolutionary-biological gender characteristics) as well as extrinsic factors (e.g.
, socialization, gender role expectations, etc.
]. In the present study, we further analyzed the factors that contribute to variations in female physicians’ empathy scores.
To accomplish this analysis, we first examined the differences in empathy scores between female physicians in different specialties. Those in people-oriented specialties outscored those in technology-oriented specialties. Consistent with our findings, several previous studies reported that people-oriented specialists had higher empathy scores [5
]. Medical students who pursued their training in people-oriented specialties have been reported to score higher in empathy in all years of medical school [1
]. Our previous study also revealed that female students outscored their male counterparts in medical school, and proportionally more female students chose people-oriented specialties [10
]. In Japan, students can freely choose their specialties, and female medical students are more interested in choosing internal medicine and pediatrics as their specialties [13
]. This trend was expected that female students outscored in empathy and choose people-oriented specialties. Our study group comprised 30.9% internists, which could have contributed to the higher empathy score reported by physicians in people-oriented specialties in this study. However, if female physicians practicing in people-oriented specialties experience a decline in empathy because of difficulties in balancing work and life and unable to continue their career; this may present problems for a society in which there is a shortage of physicians in this important area [14
Consistent with previous findings [2
], we noticed that empathy score was higher in physicians who were practicing in people-oriented specialties (e.g.
, general internal medicine). This implies that empathy can be better manifested and maintained in specialties that require continuous care. This speculation is justified considering that people-oriented specialties often require first encounter and continuous care that is likely to lead to an empathic engagement in a long-term patient-physician relationship.
Rotor et al. reported that female physicians engaged in significantly more active partnership behaviors, positive talk, psychosocial counseling, psychosocial question asking, and emotionally focused talk [15
]. These features of communication seen in female physicians are important aspects of empathy. In addition, if physicians have more variety of experiences in their life, their attitude and understanding for patients’ life could be more insightful. From this standpoint, it is advantageous for female physicians who are juggling their work and personal life to pursue people-oriented specialties. These experiences could ensure the enhancement of communication that would strengthen their empathic engagement in patient care.
We investigated the factors that could contribute to the variations in empathy scores among female physicians such as the work place, working style, living arrangements, job satisfaction, experience of leaving the job, marital status, and having children. Among these factors, only the living arrangement had a significant association with empathy scores. Female physicians in Japan traditionally perform their social roles as mothers or home makers in addition to their professional responsibilities as physicians. In Japan, mothers are expected to be the primary care provider for their children. Because the number of employed mothers is increasing in Japan, the number of childcare centers and kindergartens is insufficient, and there are many children on waiting lists to enter these facilities. In such situations, female physicians who have children face difficulties juggling their career and raising children. However, when they live with their parents or extended family, they may benefit from increased family support. When female physicians have optimal family support, they are likely to continue their career with less stress and exhaustion. It is to note that the empathy of physicians with no children who were living with or close to their parents (M
=111.0), and for those with children who were living in a nuclear family (M =
110.06) was similar. A previous study revealed that having children decreased female physicians’ stress [16
]. Our study suggested that the presence of “significant others” would increase the empathy of female physicians. Although we did not ask about close friends and supporters of female physicians, such relationships may influence their empathy.
Female physicians are often married to male physicians in Japan, and this same occurrence also been reported in other countries [18
]. In our survey, more than 70% of married female physicians reported having physician husbands (data not shown). In such relationships, the pressure and work demands would be greater, and controlling their lifestyle and workload would be more difficult than for couples where the spouse had a less demanding career. On the other hand, one can argue that marrying to a male physician could be beneficial to female physicians because they would have more support and understanding from the spouse. In the physician work-life study, female physicians were reported to have 1.6 times the odds of experiencing burnout compared with males (P
.05), with the odds of burnout by the female physicians increasing by 12% to 15% for each additional five hours worked per week over 40 hours (P
]. Excessive stress, sleep deprivation, and a demanding lifestyle can increase the risk of burnout, leading to erosion of empathy in physicians. In the same report, the authors suggested that for female physicians with young children, the odds of burnout decreased 40% when they were supported by colleagues, a spouse, or significant others to help them balance career and home responsibilities [16
]. Taking on multiple roles as a physician, wife, and mother is challenging for female physicians. However, our study suggests that living with extended family could contribute to maintaining high empathy, regardless of the marital status of physicians. This could be a key factor that may help to avoid the risk of burnout and exhaustion in female physicians. At the same time, the understanding of their surrounding people such as husbands, and colleagues is important. In addition, better work based child care facilities would be beneficial to female physicians to maintain their clinical career.
Empathy is essential for achieving optimal outcomes in patient care. Our findings suggest that there are several factors, such as the choice of specialty and living arrangements, that can mitigate the risk of erosion of empathy in the practice of medicine among female physicians in Japan.