Last month, the Medical Journal of Australia called for manuscript submissions on the topic of “Women in medicine and medical leadership in Australia — is there gender equity?”
A two-letter one word response ‘No’ was rejected as a formal submission so a group of female doctors, myself included, co-authored a letter in response which was published on Monday.
The answer is ‘NO’. There is not #genderequity.
— Dr Jill Tomlinson (@jilltomlinson) November 17, 2019
The question itself perpetuates gender disparity by suggesting that the answer is up for debate. We need to move on from asking the question about whether inequity exists, we need to enact solutions.
Gender inequity exists at multiple levels in medicine. How can this still be so? More than 20 years ago when I was completing medical school, we believed that increasing numbers of female medical students would result in more female consultants.
This so-called “pipeline theory” hoped that the gender parity in newly trained doctors would soon result in equity in leadership, research and in medicine as a whole.
Decades after gender parity has been achieved in medical schools in Australia, the disparity in both senior doctors and also leadership positions exists. Women represent only 28% of medical deans and 13% of hospital Chief Executive Officers.
— MJA (@theMJA) November 18, 2019
Associate Professor Marie Bismark’s research examining gender balance in medicine noted that women are “disproportionally under-represented at the senior management level”.
Heads of medical and surgical units in Australia are mostly male. Heads of departments at National Institutes of Health funded medical schools in the USA are more likely to have a moustache (19%) than be a woman (13%).
In medical research, the situation is no better. Females are significantly less likely to be awarded major medical grants than males. Only 29% of senior women (5 out of 17) who applied for an NHMRC grant were successful, compared with 49% (37 out of 75) male applicants who had the same level of experience.
The gender gap also extends to a significant gap in the earnings of male and female doctors in Australia. In 2016 there was a 34% pay gap for full-time medical specialists, and a 25% pay gap among full-time general practitioners.
When controlling for hours worked, the annual gross personal earnings for female specialists was on average 17% less than their male counterparts, and female GPs earned on average 25% less than male GPs.
The gender pay gap remains when differences in working hours are taken into account for many reasons. Possible hypotheses are that women are more likely to undervalue their work, claim less overtime, and perform more poorly remunerated tasks.
Anecdotes of micro-aggressions towards female doctors are abundant, and as a female senior doctor in a public hospital, I am no stranger to this.
Recently I consulted on a patient admitted to hospital with my team of juniors. I introduced myself as the senior doctor and spend time discussing treatment decisions he needed to make. After I summarised our discussion to the patient, he turned to my male medical student and asked, ‘What do you think, Doctor?’.
I hardly need to explain that the mortified medical student, a male, was far less qualified than any of the other more highly trained females in the room to offer an opinion.
A further example occurs at conferences, where female medical speakers are much less likely to be introduced using their title of Doctor or Professor than male speakers.
The inequity in medicine is more pronounced for those with different physical abilities, ethnicities and sexual orientation.
The Australian Medical association’s gender equity summit report 2019 nominated nine key action areas for change:
KEY ACTION AREAS
- Establish targets for gender diversity in representation and leadership.
- Report and publish gender equity data.
- Actively encourage women to apply for leadership roles.
- Provide equitable access to leave entitlements for all genders.
- Improve access and uptake of parental leave and flexible work and training arrangements for all genders.
- Provide interstate portability of leave entitlements.
- Implement transparent selection criteria and processes that disarm gender bias in entry into training and employment.
- Provide access to breastfeeding facilities and childcare at exams, conferences and work.
- Identify gender equity champions (and celebrate women in medicine).
Let’s not argue any more about whether equity exists. It does. We need to work to address inequity in order to provide better healthcare for our patients and working lives for all doctors.