It’s hard to imagine another workplace like it. A workplace where employees are regularly propositioned, grabbed, and expected to do procedures on men who proceed to make comments related to appearance, relationship status or sexual acts. Or in the most extreme cases, a workplace where employees deal with men who masturbate while receiving treatment.
And then, after being subject to this treatment from some male patients, these employees may also potentially be approached romantically and sexually by senior male colleagues — sometimes with a proposed or implicit contractual arrangement promising career opportunities/advancement in exchange for sexual favours.
Yes, this is still medicine in the twenty-first century, where over half the graduating doctors are female.
I recently undertook an informal survey of more than 100 female doctors working within the Australian healthcare system to help uncover the extent of the problem. The findings suggest that current efforts to address gender inequity are not yet sufficient.
Of those who participated, three quarters said they have experienced unequal treatment, discrimination or loss of opportunity at work based on gender, while another 15 per cent said they feel that this may have occurred. Nearly 90 per cent revealed they have experienced implicit gendered behaviour at work that makes them uncomfortable – this includes events that are difficult to report such as being called ‘too pretty’ or ‘too young to be a doctor’. Other such thing include assumptions that they are a nurse, being asked to make cups of tea, and being addressed as ‘ladies’ in meetings when men are referred to as doctors.
Nearly 60 per cent of the respondents reported overt sexual harassment, some of which could be considered criminal assault. A recurring theme is having to do procedures on patients which require kneeling down next to them – where some male patients see this as an invitation to ask the doctor to perform sexual acts on them. In some instances, teaching may be offered on a one-on-one basis at home by senior male clinicians. Rural rotations may present additional danger from other colleagues given the relative isolation and separation from family. Female doctors also describe experience stalking and sexual assault.
Perhaps most sadly, only 17 per cent of participants said they had tried to report their experience to their supervisor or hospital. Only a minority of those who did report it said they had a positive experience. Many describe that their reports were ignored, that the perpetrator was defended as those involved in the reporting process knew him as a ‘good guy’, or that it was a ‘he said/she said’ situation. Sometimes, the perpetrator was informed of the report, and the complaint was turned around. A few saw constructive and appropriate action, though this was often where there was a solution which didn’t involve addressing the behaviour of senior male staff. Sexual harassment by patients seems even less likely to be reported, and the potential avenues of management are not clear.
Given that our reproductive years align with the time most of us are training and early in our career, it’s not surprising that pregnancy and childbirth are not well accommodated. Many female doctors report that women with children are taken less seriously, not offered promotions or have leadership opportunities retracted. There is a scarcity of dedicated lactation rooms and some doctors are forced to pump milk in toilets or storage rooms without privacy or appropriate facilities.
As for other working conditions these women experience? Part time training is limited and many colleges send trainees interstate and to regional areas every three to six months. Parental leave is often seen as a ‘holiday’ and there may be an expectation that research projects will be completed in these months where a woman is trying to sustain a new life. Men continue to have children without similar challenges, and their parental status appears far less likely to affect their career prospects.
And all of the discrimination and poor behaviour is amplified for women of colour, who face the double bind of sexism and racism. These women have to fight even harder to even be recognised as a doctor.
It is clear that gains have been made over the passing decades. We are now at least talking about gender inequity, and many hospitals have a women’s society or similar. There are leadership programs targeting women; paternity leave is now available for fathers in NSW (though whether they take it is another matter), and some hospitals are designing dedicated lactation rooms. Reporting continues to be a problem, as it disadvantages the victim who is usually in a junior position compared to the perpetrator. Anonymous reporting systems remain uncommon and even with good intentions, hospitals seem to struggle with appropriate action towards perpetrators of sexual harassment.
So what can be done?
From my own, and the experiences of my female colleagues, it appears likely that more definitive and assertive action is required to address this issue.
Hospitals and medical colleges need a rating system which requires them to meet specific criteria around recruitment, leadership, reporting, consequences for perpetrators, and facilities. This rating system would need to be regularly audited to ensure progression.
Colleges need to provide part time training and address distant secondments, while also doing more to support female leadership.
A charter of rights for female staff perhaps needs to be presented to patients, and no one should be expected to treat people who assault or demean them.
As female doctors, we are past the stage of sitting in circles and talking. We need action to keep women in medicine and to allow them the same opportunities afforded to men.