Why do women in health seek mentoring—a descriptive study of a mentorship programme for women in Aotearoa New Zealand

In 1896, Dr Emily Siedeberg was the first woman to graduate from an Aotearoa New Zealand medical school.¹ For the next 20 years only one or two women per year joined her.¹ Today, women in medicine make up more than 50% of graduates.² However, wāhine (women) doctors are under-represented in some postgraduate training programmes, where the structure and requisites may require an assumption of “putting one’s life on hold”.³ Later in their careers, wāhine doctors do not achieve equitable pay⁴ or achieve proportionality in leadership positions that hold budget and/or decision-making power.⁵ Failure to support wāhine doctors to flourish in medicine may also be contributing to issues of burnout and workforce retention in Aotearoa New Zealand.² Despite these differences, there seems to have been no systematic implementation of structures or supports to address the career and workplace inequities experienced by women doctors.^6,7 

Women in medicine frequently manage numerous obstacles in their training and career, which may not be experienced by men.^8,9 Balancing family commitments, work life and personal life can limit networking opportunities.^4,8 Wāhine may choose to delay childbearing for training due to perceived career threats.¹⁰ Furthermore, discrimination, bullying¹¹ and implicit gender bias⁵ may hinder the progress and success of women doctors in postgraduate training. Women may also experience barriers to career advancement,⁴ leadership positions¹² and research opportunities.¹³ Additional challenges are faced by healthcare workers recruited from overseas to meet workforce demands¹⁴ and who also belong to minoritised groups.^5,15 While ultimately removing these obstacles at a systems level seems a moral imperative, in the interim processes, supporting women to navigate these barriers has the potential to benefit individual women, improve healthcare for New Zealanders and enhance research.^13,16

Mentorship, defined as a “partnership in personal and professional growth and development”,¹⁶ may be one mechanism to support women’s careers. Through mentoring, they may be empowered to better manage their progress by focusing on development of their skills¹³ and by receiving support through difficult stages of their career. Mentoring programmes potentially improve training and retention of doctors at risk of burnout,¹⁷ and there may be reciprocal benefits for both the mentor and mentee.¹³

Despite these potential benefits of mentoring, women perceive greater difficulty in finding mentors than their male colleagues.⁶ A lack of mentorship and sponsorship may contribute to structural barriers hindering women’s representation and achievement in medicine.^4,6,13,18 Wāhine Connect, a grassroots peer-mentoring organisation created in 2017 by a medical clinician, aimed to address an unmet need, enabling peer-to-peer wāhine mentorship in medicine and health in Aotearoa New Zealand. The primary aims of this research were to describe the women in the healthcare sector engaging with Wāhine Connect as mentees since 2017 in terms of demographics, career stage and location, and the concerns driving their participation in a mentoring programme.

Methods

This retrospective descriptive study analysed routinely collected registration and evaluation data from mentees in the Wāhine Connect programme from October 2017 to December 2023. Wāhine Connect was piloted initially with female doctors and then extended to other women health professionals from 2018.

The mentoring match process and the programme

Wāhine Connect offers two types of mentoring programmes: “Jump” is a short, focussed option in which a mentee has a single mentoring session with three different mentors; “Journey” is a longer option in which a mentee engages with a single mentor multiple times over 6 months.

During the study period, women seeking mentorship registered as a mentee via an online form. Mentee applications were considered by a matching committee convened by the Wāhine Connect administrative team consisting of women in the health sector. This included doctors from multiple specialties, allied health and non-clinical roles. They made recommendations regarding mentors and the mentoring programme based on mentee demographics, their stated issues and preferences. If there were no suitable mentors on the database, the committee used their networks or asked mentors for referrals to other women in the health sector who may be willing to support a mentee. After both mentor and mentee accepted the match, they were connected and provided resources for the Jump or Journey programme. Both programmes have an overview document, goal templates and a contract to guide mentors and mentees. These resources were developed by the Wāhine Connect team, with peer review by external academics, members of the NZ Women in Medicine community and legal review where relevant. Those in the longer Journey programme received monthly reminders about the month’s tasks. All mentees were sent an evaluation survey at the completion of their programme.

Data collection

At the registration website, mentees provided their demographic information (age, domicile region, ethnicity), profession (medical, nursing, allied health, dentistry, physiotherapy, pharmacy, other), employer and place of work, career stage and specialty. While the ethnicity question at registration was not collected entirely in line with the Statistics New Zealand census question, we used Ethnicity New Zealand Standard Classification (2005v2.1.0) to create prioritised ethnicity from the data collected.

Wāhine Connect does not deliver a clinical service and is not considered within the scope of the HISO 10001:2017 Ethnicity Data Protocols, which was published after the data collection began. Ethnicity data and results breakdown by ethnicity within this paper should be considered within these limitations.

Mentees also rated each item on a list of 39 reasons for seeking mentorship as being “very relevant or important to me right now”, “somewhat relevant” or “not relevant to me right now”. The 39 reasons were selected based on a thematic analysis of mentee submissions during the pilot phase programme. Registration questions are provided in Appendix A.

The programme completion evaluation survey includes five questions: two open-ended (free-text) questions, two using a five-point Likert scale and one question that asks participants to rate four separate aspects individually. Two scales were used: Strongly agree, agree, somewhat agree, disagree, strongly disagree; or Excellent, very good, good, fair, poor. Evaluation survey questions are provided in Appendix B.

Analysis

Mentee and programme data held on matches from the programme’s inception (October 2017) to December 2023 were analysed using Microsoft Excel 2022. This included an initial pilot, a period of organisational establishment without registrations (2018), and from 2019 onwards when regular mentorship matches were made.

No identifying data are reported and cells with fewer than five individuals have not been reported separately to reduce risk of identifying an individual. Consequently, Māori and Pacific mentee data on relevant issues were combined.

For medical mentees, career stage was defined as based on self-reported work status as follows: “Junior doctor”, if qualified with a medical degree and working as a house officer or senior house officer; “Registrar”, if working in a training or non-training position as a registrar; “Specialist”, if a vocationally-registered medical specialist, such as a consultant in hospital or private practice, or a specialist general practitioner (GP); “Fellow”, if indicated they worked in a specific position as a Fellow to develop sub-specialty skills or expertise; “Other”, if they were a Medical Officer of Specialist Scale (MOSS), or if none of the options applied. Where medical registrants were between these stages (such as coming to the end of registrar years but not yet in a specialist position), they were categorised by their most recent previous career stage. Analysis included descriptive summary statistics and frequencies.

Ethical considerations

This manuscript reports data provided to an independent charitable entity in a manner where every attempt has been made to remove all identifying details. At registration, prospective mentees consented to the use of their information for a variety of purposes including research (see Appendix A). Wāhine Connect committed to reporting data without identifying details and preserving anonymity.

Results

Mentee demographics and reasons for seeking mentoring

From 1 October 2017 to 31 December 2023, 670 women registered with Wāhine Connect for mentorship. After 28 women withdrew or were referred on to appropriate schemes such as employee assistance programmes, 642 women participated in mentorship programmes. These study participants (called mentees for further reporting) had a mean age of 34 years (range 23–64 years), with most frequent ethnicities being Pākehā/NZ European (59.8%) and Asian (19.2%) (Table 1). The majority lived in Aotearoa New Zealand with nine mentees located overseas. Of the 633 Aotearoa New Zealand-based participants, most were located in or around large cities, most frequently in the North Island (Auckland [28.2%], Wellington [18.7%], Hamilton [7.7%], Christchurch [12.9%]). Most mentees were doctors (85%, n=546). Of these, 100 (18.3%) were working in primary care, either as GPs or GP registrars. Three hundred and eighty-seven (70.9%) were pre-vocationally registered doctors (junior doctors or registrars). The majority of women participated in the Jump (short) programme (n=394, 61.4%) and the rest in the Journey (longer) programme (n=247, 38.5%). One mentee participated in both Jump and Journey programmes concurrently.

All 39 reasons offered for seeking mentorship were selected by at least three participants. In the early phase, a small number of mentees did not rate all 39 reasons. These were subsequently made mandatory. As mentees were asked to identify their most relevant reasons for accessing mentoring, it is likely that mentees would skip items less relevant to them resulting in minimal impact on rankings reported in this paper. The top three were “lack of confidence” (266/639, 41.6%), “juggling training/work with raising a family” (229/639, 35.8%) and “balancing your work/career needs with those of your partner” (197/639, 30.8%), with the remaining 17 most frequent reasons included in Figure 1.

Forty-six point two percent (30/65) Māori and Pacific participants chose “burnout due to work stress” compared with 25.5% (147/577) for non-Māori, non-Pacific mentees (Figure 2). Of Māori, Pacific and Asian participants about one-third nominated “identifying as an ethnic minority” as a mentorship reason being “very relevant or important for me right now”. 

View Table 1, Figure 1–3.

Mentee post-programme evaluations

There were 208 evaluations returned by 31 December 2023, a response rate of 40.8% (208/510). Overall, 97.6% (203/208) of respondents rated the value of the mentoring programme as excellent/very good/good (Figure 3). The quality of the match between mentee and mentor was rated excellent/very good/good by 96.6% (201/208).

Discussion

This manuscript describes over 600 women healthcare professionals in Aotearoa New Zealand, the majority doctors, accessing mentorship via Wāhine Connect over the last 5 years for a wide range of reasons with the most frequent including lack of confidence, juggling work with the needs of parenting or a partner and burnout due to work-related stress. Most mentees were in pre-vocationally registered roles (registrar and house officer). Interestingly, Māori and Pacific mentees nominated burnout and lack of confidence as reasons for seeking mentoring at higher rates than the overall cohort rates. The post-mentoring evaluation data suggest the mentoring was highly valued and mentoring matches were excellent for almost all mentees. These data evaluate what we believe to be the first pan-health mentoring programme for women in health professions in Aotearoa New Zealand. Most mentees in the study were in the early stages of their careers, a time when balancing work demands and social roles can be especially challenging, or when work-related burnout is more likely to occur. The preponderance of doctor mentees (85%) likely reflects the origins of Wāhine Connect from the medical profession, early targeted advertising to this group and word-of-mouth references from early participants in the programme. The wide range of ages of mentees (23–64) illustrates the need for mentorship at all career stages; however, 42% doctors seeking mentoring were registrars. These women will be at a time of high training demands and potentially limited flexibility of employment and are also often parenting younger children. The substantial number of senior medical officers seeking mentoring (130) indicates that the need for mentoring persists throughout a career but may have a different focus.

Our finding of lack of confidence being the most frequent reason for seeking mentoring across all mentees is consistent with the literature and suggests a predictable need for mentoring support at this career stage.¹⁹ Lack of confidence (sometimes called “imposter syndrome”) among women in medicine is well described²⁰ and may begin in medical school.²¹ It has been suggested that this is related to and reinforced by implicit gender biases and stereotypes experienced by women doctors,²² which also contributes to a gender gap and lack of women in leadership and senior positions.¹² Lack of confidence is heightened at career transitions,²³ which may explain the substantial proportion of doctor mentees who were in post-graduate vocational training. Seeking mentoring as a strategy to address a lack of confidence has been promoted in the scholarly literature,²⁴ with some empirical evidence showing mentorship for women doctors helped increase professional confidence.²⁵ Any future mentoring programmes in Aotearoa New Zealand should anticipate lack of confidence as common in mentees, particularly at earlier career stages and transitions. Mentoring could also be signposted in post-graduate training as a useful support during a period of transition.

Our finding that the second most frequent reason women cited for seeking mentoring was the difficulty of juggling family with work and training is also consistent with previous research.²⁶ Women in employment can experience discrimination related to being a mother, dubbed the “motherhood penalty”.²⁷ Women in medicine have reported discrimination due to pregnancy, maternity leave and breastfeeding, with employed mothers perceived as having less commitment to their work.²⁸ In addition to the self-reported experience of discrimination due to motherhood there is objective evidence of a motherhood penalty in medicine: women experience reduced earnings, slower career progression and increased domestic workload in relation to male counterparts.²⁹ Time spent on domestic labour has been shown to directly negatively impact on research outputs crucial for academic promotion.²⁶ While all organisations in Aotearoa New Zealand are legally obliged to avoid discrimination based on gender in the workplace, our data suggest women in healthcare frequently seek support to balance work with parenting roles, suggesting that more work needs to be done to systematically dismantle discriminatory workplace practices, and provision of mentoring may support women in the interim. 

Burnout was one of the top five reasons for seeking mentoring, with the first three reasons being potential antecedents to burnout. Several studies have found that women are more likely than men to experience burnout³⁰ including women doctors in Australia and Aotearoa New Zealand.³¹ It is likely that factors external to their employment, such as juggling family responsibilities and relationships with work, moving multiple times during training and a lack of family support, contribute to the burnout experienced by women in health. Though nearly 30% of mentees identified burnout due to work-related stress as a motivation for seeking a mentor, the work-related stress may not be felt as significantly if personal factors were not also at play. The higher burnout rate among women could be attributed to the unequal burden of work outside the workplace experienced by women (mental load, second shift of childcare and household duties).³² In addition, women are often disproportionately disadvantaged by both organisational and relational aspects within the workplace itself. For example, female GPs see a higher number of complex patients who often require longer consults and attract less remuneration,³³ and women surgeons experience disproportionate sexual harassment and disrespect from their colleagues in the workplace.³ Again, our health system employment and funding mechanisms have the potential to address some of the antecedents of burnout where women experience additional workplace burdens.

Of note, three of the top 20 reasons that women sought mentorship related to a career transition to a non-clinical career. This may reflect dissatisfaction with their original choice, or the inflexibility of clinical work, but may indicate a lack of visibility of patient-facing medical careers including research, education, technology, informatics, administration, or health policy. Internationally, non-clinical careers are increasingly visible through conferences (e.g., Non-Clinical Careers for Physicians), coaching and support services (e.g., The Doctor’s Crossing) and social media offerings including podcasts and networks (e.g., Creative Careers in Medicine).³⁴ Increasing numbers of women seeking non-clinical career pathways have implications for health workforce planning, particularly if clinical specialties with greater on-call requirements become less attractive.³⁴ It is of concern for clinical workforce planning that potentially, in a significant number of cases, a lack of support may result in women seeking non-clinical career pathways. It is possible that earlier contact with a mentor could have helped women “stay in the game”. As such, exploration of the reasons women in healthcare in Aotearoa New Zealand might be seeking these roles is needed.

Māori and Pacific women frequently ranked “burnout due to work-related stress” as a reason for seeking mentorship. They were less likely to identify a “lack of family or external support”, possibly due to strong whānau- and aiga-based cultures. More exploration of this hypothesis is an area for future research. In contrast, Asian women were noted to rank “identifying as an immigrant”, and the likely inter-related “lack of family or external support” as reasons for seeking mentorship compared to other ethnic groups.

Mentee numbers in minority ethnicity groups are small, and it is likely further qualitative research into the particular challenges they experience may provide a valuable contribution towards supporting and addressing the needs of an increasingly multi-ethnic society. This is especially given that Aotearoa New Zealand is heavily reliant on overseas-trained healthcare professionals to meet national staffing shortages.²

The evaluation data suggest Wāhine Connect is a successful mentoring intervention. Well-matched mentors with shared experience can provide practical guidance on time management, setting priorities and making choices that align with the mentees’ values and goals. Our study contributes novel insights in the Aotearoa New Zealand context that confirm that issues facing our women in health are consistent with overseas trends. One strength of our study is the systematic collection of demographic information and motivation for mentoring. A key limitation is that the data on mentee demographics and reasons for seeking mentoring come from a self-selected group who were made up primarily of doctors. As such, the issues they reported may not reflect the experiences of all women working in healthcare in Aotearoa New Zealand. Limitations of the post-programme evaluation are the modest response rate to evaluation surveys and a potential positive bias, which may both relate to the identifiability of responses at submission.

Conclusion

Our cohort of women in healthcare in Aotearoa New Zealand were seeking mentoring for reasons that have been previously reported and are predictable in our wāhine workforce. While mentoring experiences were generally positive, a future where predictable negative impacts are avoided by improved workplace and societal structures would be desirable. Until this gender discrimination is eliminated and supportive workplace practices are established, a need for mentoring specific to women is very likely to persist and should be supported by our healthcare system.

View Appendices.