Academic Unit of General Practice and Community Health,
ANU Medical School
ReadyRetortstoSexist
Comments
Christine Phillips
Social Foundations of Medicine
Sexist comments about
workforce participation
What to say when someone tells you that you should do a
particular career because you are a man or a woman, or are
destroying the profession
“Training all these women doctors is a mistake. They don’t
work as long hours as men, and all the male doctors end up
working twice as hard.”
What you should say:
It is incorrect to blame women for this trend. In fact the greatest decrease in
working hours has occurred among young male doctors. Between 1995 and 2009,
the hours per week worked by medical practitioners decreased from 48.3 hours to
42.2 hours; overall male working hours declined by 11%, whereas average working
hours by female doctors declined by 6.2%..1
It is certainly true that there is a shortage of general practitioners and many other
medical subdisciplines across Australia and particularly in Canberra and South
East NSW. This is a result of decisions made to decrease the intake of medical
schools through the 1980s and to decrease the intake into general practice in the
late 1990s (see box).
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Joyce et al 2006.; AIHW 2011
When intake numbers are decreased, it is always some years before the impacts on
workforce become apparent. Many doctors will have noted only over the last ten
years the decrease in juniors coming up the ranks.
The other noticeable aspect of the modern medical workforce is the increased
participation by women. The average age of women doctors is younger than male
doctors because historically men have been over-represented among medical
schools (gender parity among medical
students was not achieved until 1996
It was felt in the 1980s that Australia had an
oversupply of doctors, which would drive
in Australia). The younger age of
Medicare costs up. Intakes were decreased in all
women doctors and the absolute
medical schools over the 1980s, resulting in
reduction in new general practitioners
approximately 250 fewer graduates in 1990 than
create an impression that women do
in 1980 (Joyce et al 2007). Medical school
not work the same hours as older male
intakes remained static until the late 1990s,
when policymakers became convinced there was
doctors. In fact this is largely due to
an undersupply, and the intake was rapidly
the parenting load carried by young
expanded with new medical schools. The
women, something which older men
annual general practice training program intake
do not have to carry in the same
was decreased to approximately 400 per year in
degree. This parenting load is also
the late 1990s to early 2000s, though the intake
has since returned to 600 per year.
carried by younger men, who tend to
partner with other professionals,
rather than a partner who is able to
support their work and run the family while working within the home.
We are in a transition period. Younger males and younger female doctors work
fewer hours. This is particularly the case in general practice, where many GPs
continue working limited hours while rearing their children rather than stepping
out of the workforce; they tend to increase their hours of work when the children
get older. Older male general practitioners work the longest hours of any general
practitioners. The observation that your interlocutor is making probably reflects
primarily intergenerational differences in work patterns and home support, and to
a lesser degree a gender effect.
“ Women doctors do the “softer” forms of medicine. This is
because women are better at listening and nurturing than men.“
What you should say:
Although there appears to be some evidence for gender concordance (that is, women
preferring female GPs and men preferring male GPs) much of this evidence dates
from a time when women doctors were rarities. If female GPs get locked into a
particular practice style by referrals from their male colleagues for Pap smears and
counselling, this is not necessarily evidence for an innate female suitability for this type
of practice, but rather gendered internal referral patterns in the practice. The notion
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that rural practice is man’s work flies in the face of everyday and historical experience.
One of the pioneers of rural practice in SE
NSW was a woman, the astonishing Dr Ina
Dr Ina Berents was the skiing doctor
Berents (see box)
based at Cabramurra for the Snowy
Mountain Scheme in the 1950s. She
was the only doctor covering the region
and used to ski around on home made
skis to provide trauma care to the
workers of the Snowy Mountain
Hydroelectric Scheme.
http://users.bigpond.net.au/snowy/wo
men.html
The argument that women are biologically or
socially suited to pediatrics and psychiatry
could as well be used to make an argument
for the suitability of women for surgery, since
they have for generations been responsible
for needlework within the home. The
evidence that women are better at counselling
than men is very uncertain, and appears to be contradicted by evidence on the ground.
Everyone can point to instances of very empathic men and completely unempathic
women. .
8.6% of the nursing workforce was male
in 2003, and the proportion of men in
nursing is expected to continue to
increase. The situation in nursing is a
reverse gender mirror of the situation in
medicine – most male nurses are
younger than the older cohort of female
nurses who dominate nursing policy
making. (AIHW 2005)
“You’re a woman, you must be a
nurse.”
What you should say:
I am a medical student. It’s a brave new
world out there.
If you are a nurse and you are a
man, say:
I am a nurse. It’s a brave new world out there.
“You’re a man, and you’re interested in gynaecology and
obstetrics? You must be a sexist voyeur.”
What you should say:
Don’t say anything. This person is an idiot, and further conversation is pointless.
Walk away.
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“You’re a woman, so you’ll end up in general practice working
half a session a week doing sore throats and children’s
medicine….”
What you should say:
In medicine, the largest proportionate career growth areas for women are in surgery
and obstetrics, not general practice. You could also point out that this caricature of
general practice indicates that the person you are talking to has no idea about general
practice.
A selection of statements about surgical training
“Women can’t get into surgery. It’s an old boy’s club”
Women can get into surgical training. The Women in Surgery group (look on the
Royal Australian College of Surgeons website) has interesting resources and
networks for women interested in entering surgery. The College is trying to
improve the proportion of women undertaking surgery.
“Women can get into surgery really easily. Because of
affirmative action you are more likely as a woman to get into
surgical training than men.”
There is no affirmative action, although the College has made a policy of
attempting to encourage women into surgical training. Some women may choose
not to enter surgical training, believing it to be incompatible with young families.
This is a structural issue best addressed through advocating for shared positions,
campus hospital care, and the apprenticeship model of training (all of which seem
likely to happen in the future, and have already happened in other countries)
“Women have a particularly difficult time doing surgery.”
Surgical training is challenging and consuming. There are pockets of sexism, but
this is not indicative of the approach of the discipline as a whole in Australia.
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Much of the research into the highly macho culture of surgery is American, and
therefore reflects a different medical system with different internal hierarchies.
Sexist comments about
workforce policy
What to say when someone says we don’t want to be like Communist Russia
and that Singapore has the right idea.
“If we have too many women doctors, the status of the
profession will fall. It’s not politically correct, but that’s the
reality. Look at Russia. Look at Poland.”
What you should say:
This statement is premised on two observations: medicine in eastern Europe had
comparatively low prestige in the last century, and there were many female
doctors; and two assumptions: that the eastern European medical system is
analogous to the Australian medical system and that the role of women within the
body politic of post-revolutionary Russia is the same as the role of women in 21st
century Australia.
It is true that in post-revolutionary Russia and subsequently in much of
Communist eastern Europe, medicine had comparatively little prestige. It was
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regarded as “women’s work”, analogous to other nurturing disciplines. An
ambitious and clever man would not undertake medicine, but engineering or
physics; there were more prestigious and better-paid jobs in these fields. A further
straitjacket around medicine was the fact that Lenin held a view that in the health
fields there were to be no differences in status, so all (nurses, doctors, assistants)
were paid the same salary. Thus medicine had low prestige from the start, and
women could be more easily streamed to it as it fitted more with prevailing
cultural notions of “proper work” for women. Women ended up in it because of
its low prestige, rather than women causing prestige levels to fall.
These conditions do not obtain in 21st century Australia. Medicine is a profession
with some social prestige, and is paid accordingly. The notion of “proper work”
for women is much broader in Australia than it was in mid 20th century eastern
Europe or Russia. The idea that the feminisation of medicine in Australia will
result in a loss of prestige is asocial and apolitical, and has no place in workforce
debate.
“I know it’s not going to make popular, but I really think
Singapore has the right idea. They have a quota for women
medical students.”
What you should say:
Singapore did indeed have a highly controversial quota for women medical
students which was put in place in 1979. The rationale for this was that at that
time the attrition rate of women doctors was around 17% while that of men was
about 7%. The quota was lifted in 2002, after it became clear that the attrition of
women was no longer of that order and that of men had risen (so they were
roughly equivalent). It had also become an embarrassment that men with lesser
qualifications to enter medical school were edging out more qualified women. If
even Singapore junked the idea of having a quota nine years ago, the idea has little
role in public debate in Australia.
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References
Australian Institute for Health and Welfare. Labour force – nurses and midwives.
http://www.aihw.gov.au/labourforce/nurses.cfm
Joyce CM, Stoelwinder JU, McNeil JJ More doctors, but not enough: Australian
medical workforce supply 2001–2012. MJA 2006; 184 (9): 441-446
Joyce CM, Stoelwinder JU, McNeil JJ, Piterman L. Riding the wave: current and
emerging trends in graduates from Australian university medical schools. MJA
2007; 186 (6): 309-312
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