Becoming a Doctor at a Time of Reckoning with Gender Inequality and Safety
Written by Dr Lauren Chiu
In the wake of the recent Women’s March 4 Justice and ongoing Reclaim the Streets protests calling for women’s basic human rights to safety, non-discrimination, and an end to gender-based violence, it is time to revisit our own backyard. The recent revelations that have rocked parliament have highlighted sexism in workplace cultures, as well as how sexual assault and harassment is dealt with more broadly across Australian society. So where does medicine sit in its treatment of women?
I distinctly remember my first introduction to the plight of women in medicine. I was a bright-eyed, bushy-tailed medical student just beginning my first ever clinical rotation in a large metropolitan hospital. What an exciting, yet intimidating place to be!
I had Googled one of the senior consultants of the unit, as students often do out of curiosity, only to find that he had been accused of sexually harassing a female trainee a few years prior. After a long legal battle won by the trainee, she was dismissed and unable to find employment in the public health sector even years later. He meanwhile remained, and continues to remain, in his senior position on the unit.
Bewildered and unsettled to say the least, after this trip down the murky rabbit hole I was a little less bright-eyed and bushy-tailed than I was before.
Not long after this first epiphany, news had broken out in the media about Dr Yumiko Kadota’s severe mental and physical burnout following gender-based discrimination, harassment, racism, overwork and lack of support in her hospital workplace. I heard the hushed whisperings of ‘close insider knowledge’ that she had struggled to get onto the surgical training program due to her work ethic. Listening to this, I was firstly skeptical of the truth of this rumour, and secondly, struggled to figure out how this at all justified or was relevant to the discriminatory treatment she was subjected to. Ultimately though, as a young medical student I felt too deflated about the entire matter to ask any further.
Evidently, the price these women paid in showing courage to speak up for themselves is unacceptably high. I feel extremely fortunate to not have yet been at the receiving end of such experiences, however being young and female like both these trainee doctors, it lingers on my mind that such situations could easily happen to me too. As I progress in my career and learn of more incidences like these both inside and outside of medicine, I am tainted with the bitter and sad understanding that women are still so far from reaching equality with their male counterparts.
Within the first three weeks of my release into the hospital wilderness as a freshly-minted intern, I had been mistaken as a nurse on at least three separate occasions, one by a young male patient, another by a patient’s female relative over the phone, and by a male orderly. I would frequently see these gaffes happen to my female medical colleagues too.
Evidently, the price these women paid in showing courage to speak up for themselves is unacceptably high.
This was by no means a foreign experience to me, having been called a nurse multiple times by patients while in medical school, despite introducing myself as a medical student and also bearing a name badge stating this. In my final year, when a female consultant took me on a hospital orientation along with three fellow female medical students, I overheard one of the security guards audibly assuming we were the “student nurses” arriving for placement. I’ve seen, too, non-medical male colleagues presumed to be doctors. I have even caught myself sporadically falling into a similar trap in my own thoughts.
I reflect on this with the utmost respect and appreciation for our nurses. In an often thankless and underpaid position, they form the vital backbone of our healthcare system, and confer strength to the provision of excellent patient care. However, I cannot help but ask myself: in the hospital, would I ever be assumed to be anything but a doctor if I were male?
All medical students and junior doctors are more than familiar with the dreaded million dollar question of future specialisation, but with females it can often come with gender bias too. I recall one such conversation panning out a little like this:
Them: So what are you thinking of specialising in one day?
Me: I don’t really know yet (nervous laughter). I guess there are some things I like more than others, but I think it’s too early to tell so far.
Them: Would you consider just becoming a GP?
Me: Well, it’s not “just”... GP’s are very impor-
Them: You’d have a great work-life balance. Besides, eventually down the track you’ll need to factor in having kids and raising a family.
Against the backdrop of the current medical training crisis, structural barriers are still very much a reality for female doctors, including those who are planning for motherhood. Female professionals are hit with a double whammy of disadvantage. As a fledgling doctor with my own career hopes and aspirations, the overwhelming prospect of navigating this in the near future is only further compounded by the inherent expectation in society for mothers to sacrifice their careers for family.
Furthermore, the gender gap in positions of power in medicine remains an omnipresent elephant in the room. While the gender balance of all students enrolled in Australian medical schools is respectable at 55.4%, and has been balanced for at least the last few decades, women are still disproportionately under-represented in positions of medical leadership, comprising 28% of medical deans and 12.5% of hospital chief executive officers. These disparities are even greater for Aboriginal and Torres Strait Islander women, women of colour and women with disabilities.
One oft-quoted remark in response to such statistics is that medicine is a meritocracy. However, comments such as this ignore the structural barriers and unconscious bias that prevent women from attaining these roles, and instead imply that women are not capable nor of high enough calibre to hold positions of leadership.
There also exists a gap in career earnings, with a reported 34% pay gap for full-time medical specialists, and a 25% pay gap among full-time general practitioners. Accounting for hours worked, this gap decreases slightly to an average of 16.6% difference in annual gross personal earnings. The hypotheses to explain these numbers are plentiful, and range from women claiming less overtime to undertaking work that is less highly remunerated. Another example of the gap is found in general practice, in which female GP’s with dependent children typically earn less than those without dependent children, and the reverse trend is observed in male GPs.
In academic medicine, a study analysing 321 forms of address at medical grand rounds found that female speakers were less likely to be introduced by their professional title compared to male speakers. Furthermore, nearly 8 in 10 chief editorial roles for Australasian medical journals are occupied by men.
These sobering statistics also cannot be mentioned in isolation of other toxic cultures within medicine, with recent surveys suggesting a third of trainee doctors have been subjected to or witnessed bullying, harassment and discrimination in the workplace.
With jarring experiences and facts such as these, it is no wonder that in response to the question posed by the Medical Journal of Australia, “Is there gender equity in medicine?”, the answer was a resounding no.
However, what brings reassurance is the countless accomplished, inspirational and trailblazing women leaders in medicine, all of whom empower me to hold endless belief there will be many more of us in the near future. Drs Kerryn Phelps, Nikki Stamp, Kate Ahmad, and the late Professor Priscilla Kincaid-Smith are some of the more well-known doctors to name a few, in addition to the female role models in medicine I myself have had the privilege to encounter along the way. The success of Dr Kadota’s new memoir Emotional Female also gives me hope in the growing chorus of women speaking out in unified solidarity.
I anticipate the day gender equality becomes the unspoken norm, and is no longer considered to be a groundbreaking, newsworthy accomplishment. Where discriminatory remarks and bullying behaviour are met with accountability, and where women are proportionately represented in positions of power and decision making in the medical sector.
Until then, the message stands loud and clear. We must be better.
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