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IN staffrooms around the country, there are conversations going on about gender equity in the workplace. Medicine is no different.
Some say that we have achieved gender equity in medicine, as there are now more commencing female medical students than male (51.3%). They are wrong. Let’s talk facts:
- In 2016, 40.7% of the medical workforce were female.
- In 2015, 28% of medical deans were female.
- In 2020, 32% of practising adult medicine physician consultants were female.
- In 2018, 11.1% of active Royal Australasian College of Surgeons Fellows were female (788/7121).
- In 2018, 37.6% of first authors were female and only 27.9% of last authors were female.
These statistics speak for themselves. There have been massive strides with gender equity in medicine since the days of Dr Georgina Dagmar Berne, the first female medical student in Australia, but there are still large gaps with respect to leadership and retention for women in medicine.
The elephant in the room is the gender pay gap. In 2016, female medical practitioners were paid 33.6% less than their male counterparts. This is despite the overwhelming research that female medical practitioners have been significantly associated with better patient outcomes, across both medical and surgical specialties (here, here and here). The important question we all need to ask is why, after more than 100 years of women practising medicine in Australia, are we not closer to equal standing.
Training programs can be an entirely different experience for women than for men. Female medical practitioners have actively considered methods for disguising pregnancy due to discrimination experienced or witnessed based on pregnancy or childcare needs. Furthermore, for our general practice trainees, paid parental leave is currently not required by the National Terms and Conditions for the Employment of Registrars. GP trainees are only eligible for the government’s Paid Parental Leave Scheme, which has strict salary capping.
Pre-vocational female doctors also experience high rates of sexual harassment in comparison to their male counterparts (here, here, here and here).
Female junior doctors are significantly more likely to experience bullying from consultants and other staff members (here, here and here). Aside from discouraging these women from continuing in their interested specialties, female practitioners have also expressed concern that if they seek reprisal for sexual harassment or bullying their careers will be negatively affected.
Racism, sexism and discrimination are unacceptable behaviour in any workplace but what’s worse is the subsequent effect on the leadership opportunities and potential for women in medicine. A qualitative study investigating the opinions of current medical leaders in Australia found that principal concerns for women in medical leadership positions related to capability, capacity and credibility. In its simplest meaning, women were noted to be reluctant to self-promote, were concerned about not being taken seriously, and were lacking in mentorship. This has been further corroborated by a survey of women physicians’ experience that found common barriers for running for leadership positions were lack of institutional support and mentorship.
In an endeavour to better support women in surgery, the Royal Australasian College of Surgeons surveyed over 1600 female medical students and doctors about their experiences, drivers and barriers to pursuing a career in surgery. This survey further corroborated the findings of Bismark et al and Shillcutt et al, noting that there were significant concerns regarding the lack of flexibility of the Surgical Education and Training program, the behaviour of supervisors and the potential impact on their health. Surveyed Australian medical leaders suggested recognising unconscious bias, development of a peer support model of aspiring female medical leaders, development of flexible family options and improved reporting of gender-related issues.
Gender equity in medicine, akin to the world, is not black and white, rather shades of grey. While it is easy to lament the negative, it is imperative that we recognise the improvements and endeavours to address gender discrimination in medicine. The Royal Australasian College of Surgeons, in support of addressing the existing issues of gender inequity in surgery, produced the Women in Surgery Business Plan 2017–2021. This document provided key indicators for monitoring progress in leadership, role modelling, advocacy and flexible training.
In 2020, the Australian Medical Association (AMA) called on governments, medical administrators, medical schools, colleges and the profession to urgently act to address the barriers to gender equity in medicine. In addition, the 2020 AMA Position Statement on Medical Parents calls on the government to commit to the development of a single-employer model to ensure equitable remuneration and employment conditions for GP trainees seeking parental leave.
For us to see tangible and sustainable change for women in medicine, we need to prioritise equality in leadership, practical support for women during training programs and ensuring persons at all levels are aware of the scope of the situation. Until this can be achieved, we will continue to see the same people discussing the same issues, and the same structures and ideas orchestrating the delivery of health care. “Women in medicine” is no longer a question of getting our foot in the door but rather about tackling the glass ceiling that still looms above us.
Dr Natasha Abeysekera is an executive member of the AMA Queensland Council of Doctors in Training. She is working as a resident medical officer at the Royal Brisbane and Women’s Hospital.
Dr Helena Franco is an Orthopaedic Principal House Officer at the Cairns Hospital.
Dr Emily Shao is a PhD candidate at the University of Queensland and Dermatology Registrar at the Royal Brisbane and Women’s Hospital.
Dr Maddison Taylor is a Medical Registrar at the Townsville Hospital.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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SIngle mum of two boys one I receive carers payment for and recently denied a flexible work arrangment – requesting arrival at 8.30 rather than 8
Gender equity in medicine has not been attained, and the gender pay gap is real. I didn’t realise that this was still the case when I started medicine as a naive 18 year old nearly 30 years ago. Yes, advances have certainly occurred, but a degree of inequity persists, more insidious and more difficult to recognise. I was able to take maternity leave and work part time during my registrar training, and for this I am very grateful. The support of my colleagues, junior and senior, was invaluable during this time, and I worked very hard with great loyalty for the department that treated me well. However, as a junior consultant at a different institution, I had paid maternity leave refused, until the union had this overturned. When I returned to work, all my entitlements such as sick leave, LSL, etc, had been “forfeited”, as I had been “unemployed” whilst on maternity leave, and my service was therefore considered discontinuous by the hospital. Another call to the union sorted this out. It seemed worth the fight when the next staff member was able to access maternity leave without argument. All doctors work more than their paid hours, but this disproportionately affects part time workers, who more often than not are women. For example, TESL is not paid for days not normally worked, meaning that days spent at conferences, teaching, college meetings, etc, that would be paid for a full time staff member, are not paid for those who attend anyway on days they would not otherwise have worked. This adds up in the end, when considering advancement within the award, as only paid days of work seem to count – not hours of actual work, contribution to the department and the college, merit. I am paid less than more junior male colleagues, whom I have helped to train before they were consultants. According to the award, this is fair. I beg to differ.
This article on Women in Medicine contains at least two generalisations worthy of challenge. (I suspect I have to be over cautious with my language here, as there is a tendency on Ausdoc to not publish dissenting views – a tmidity unworthy of honest journalism).
The first relates to the word ‘bullying’. Of course if you invite junior doctors to state whether they’ve been ‘bullied’, you’ll get a majority replying in the affirmative. But in my experience, the definition is entirely subjective, and relates to junior doctors’ feeling uncomfortable – when a disinterested observer would not necessarily see intentional power-driven interaction on the part of the alleged ‘bully’. Some examples: leaning forwards to a softly spoken over shy female resident because of consultant presbycusis (denounced as bullying); suggesting that a female RMO stay in the room for her own education during a difficult conversation about an incident regarding another RMO – reported to authorities as being “ordered” to stay against her will, when two others in the room clearly saw this as a mere suggestion; taking an RMO into a separate room and forcefully explaining he’d just put a patient’s life at risk as well as set the hospital up for massive legal damages (reported as bullying!). There’s more! Usually involving very young (I.e. little life experience) RMOs making reports when simply speaking up would clear the air. This comes across as an unattractive lack of character at least, and borderline cowardice at most. As a former consultant of many years’ experience, I also reject the oft stated contention that juniors won’t speak up because it may damage their careers: I found this generalisation a slur on my character, failing to acknowledge many a time I felt a certain pull of admiration for that RMO ready to stand up for him/herself.
The second trope needing challenging is the way statistics are misused and the cry of gender pay gap. To state that equity relates to percentages in certain positions hides the debate about actual percentages doing the work. When, say consultant positions are compared simply according to gender, women are paid less. When women’s hours worked per year are compared with men’s hours per year, it’s usually shown they work less. In General Practice, however they also are paid less because they find it difficult to avoid long conversations and complex background issues: they have a case there, and it should be argued strongly with Medicare, but it represents THEIR choice – NOT discrimination.
Border control means just that and quarantine of returned travellers is just one aspect of border control. It is a Federal responsibility. Once that role has been delegated to the states travellers have crossed the national border and control of subsequent movements is less controllable because each state my create local rules and have different standards of enforcement.
Previous quarantine stations have become museums, at least that is the case in NSW because travel has changed from ships entering ports with pestilence to aeroplanes quickly moving incubating travellers. Fortunately it is rare that we are faced with a pandemic such as COVID-19 and vaccination had ameliorated risks from 19th century travel-related diseases, such as yellow fever.
Hotel quarantine solved a problem that was too great for Howard Springs alone and Christmas Island being impractical. It also provided a cash flow to fil the void created by abrupt cessation of travel.
Clearly hotel quarantine is a second best (if that) option and COVID-19 is unlikely to be the last pandemic we will face. It’s time for the Federal Government to act decisively. Maybe divert the $600m from an unnecessary gas-powered power station to a purpose built quarantine station using local labour and materials.