Background: While more than 50% of medical students and residents are women, their proportion drastically diminishes within higher ranks and in leadership roles in hospitals. Although a considerable proportion of rheumatologists is leaving their hospitals to seek employment in private practices, however, data on the motivation for this transition are scarce.

Objectives: This study aimed to evaluate the ex-post reasons to leave the hospital for private practice among female as well as male rheumatologists across Europe, already working in single or group private practice.

Methods: Experts in the field of business and economics developed a questionnaire comprising 50 thematic blocks with overall 172 items, with a scientific focus on the leaky pipeline among rheumatologists. The questions were related to factors that define the specific work environment’s quality, including operational issues but also comprising the individual’s personal situation in its social context, e.g. work-family- as well as family-work conflict, etc. The factors judged as relevant for the respondents´ decisions to leave their hospitals for private practice were labelled as ex-post reasons to leave the hospital . Respondents were asked to assess to what extent the statements applied to them personally and their work environment on a 7-point Likert-scale, ranging from 1 (representing no extent) to 7 (representing to a large extent). The questionnaire was distributed electronically by national scientific societies of EULAR countries and by individual contacts. We performed common factor analysis, univariate t-tests and regression analyses to appraise our dataset using Stata Version 18 (StataCorp, College Station, TX, USA).

Results: A total of 104 rheumatologists in private practice from 23/45 EULAR countries (58.7% females, 41.3% males, p=0.002) answered the questionnaire. Female rheumatologists are leaving the hospital earlier, at a lower hierarchical level than their male peers with the most prominent difference at the training level (26.2% females vs. 7% males, p=0.03). Among the main ex-post reasons to leave the hospital we identified operational issues like e.g. nightshifts as well as reasons indicating an in equitable work environment. In both categories, significant differences between female and male respondents were to be noted, with the highest differences occurring for unfair promotion decisions (p=0.001), poor communication at the working place (p=0.001), and a lack of career perspectives at the department (p<0.01, Table 1).

Conclusion: To the best of our knowledge, this is the first study identifying gender-specific reasons for the transition from hospital to private practice among European rheumatologists, highlighting an earlier loss of females at lower hierarchical levels. As previously shown for hospital-based rheumatologists, females perceive worse job opportunities and satisfaction than males. This is also reflected in the ex-post reasons of female rheumatologists for leaving their hospitals in favor of private practice.

REFERENCES: [1] Sautner J, Grabner I, Posch A, Duftner C. How to plug the leaky pipeline in clinical rheumatology across Europe-lessons to be learned from experiences in business. Rheumatology (Oxford). 2023 Nov 2;62(11):3538-3546. doi: 10.1093/rheumatology/kead090.

Acknowledgements: NIL.

Disclosure of Interests: Judith Sautner UCB, Astra Zeneca, Johnson and Johnson, Eli Lilly, Arthur Posch: None declared , Christina Duftner Galapagos, Isabella Grabner: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.