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.
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.