*Dr. Madeleine Thomas is the pen name of a GP working in Ireland.
When asked to write a piece in reaction to comments made recently by Dr. Gabrielle McMullins, an Australian Vascular Surgeon on the topic of sexism in Medicine, which attracted much controversy, I must admit I had to stop and think carefully before agreeing to do so. I am an Irish, Irish educated female doctor. I graduated from Med School nearly 7 years ago. I have never before written about my experiences working as a female medic, I simply vent to poor unfortunate friends & family instead.
To recap, Dr. McMullins, who Irish media pointedly referred to as having studied in Trinity College Dublin, for reasons I’m not sure why, (was it there that her view of gender in the workplace was meant to have been corrupted?) was attending the launch of her book entitled ‘Pathways to Gender Equality: The role of Merit & Quotas’ when she made comments that referenced the case of Dr. Caroline Tan, an Australian surgical trainee who, after successfully winning a sexual harassment case against her boss at the time, Dr. Chris Xenos, subsequently failed to secure work in her chosen area of speciality in any Australian public hospital. Dr. Tan herself, in an interview made to an Australian paper, in light of the furore surrounding the comments made by Dr. McMullins, reported that she had been shunned by her fellow colleagues following the case and had been overlooked for positions, she feels as a direct consequence of speaking out. Her previous boss, Dr. Xenos continues to work in the hospital where Dr. Tan was sexually harassed.
But what did Dr. McMullins actually say? Ok, admittedly it doesn’t sound good on first reading: “What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to comply with the request.” I confess, I initially read this quote as presented, almost entirely out of context and was shocked. But is that what she really was trying to say? She went on to further clarify her comments after the headlines had been grabbed and condemnation had come from everywhere. “Of course I don’t condone any form of sexual harassment, and the advice that I gave to potential surgical trainees was irony, but unfortunately that is the truth at the moment, that women do not get supported if they make a complaint. It’s not dealt with properly: women still feel that their careers are compromised if they complain, just like rape victims are victimised if they complain.”
The reactions of condemnation from Australian Medical Training Bodies to her comments were swift and predictable. Michael Grigg, President of the Royal Australasian College of Surgeons (RACS), said the idea female surgical trainees should “silently endure sexual harassment (was) disappointing and quite appalling”. He said complaints about sexual harassment were taken seriously by the college and “investigated and acted upon at the highest level”. Kate Drummond, chair of the RACS Women in Surgery committee, told ABC that sexual harassment does happen, but she said the idea that speaking out is a career-ending move is incorrect. So was this simply a case of a doctor with a book to sell overstepping the mark and encouraging a culture of silence and submission or was she trying to call out the sexism that she feels still clearly exists within Medicine? It’s all very well to encourage women to be vocal about cases of sexual harassment in the workplace, but if there is no practical, robust response to such complaints, nor adequate support for those who have been victims, how could anybody have any confidence in the systems that are meant to ensure equitable working conditions and career opportunities? Is there a fear that by speaking out, you’ve effectively isolated yourself professionally and irreversibly damaged your career in the process? In other words, can we honestly say that case of Dr. Tan is an isolated event? Sadly, I believe it not to be.
Of course sexism exists in a variety of workplaces, but Dr. McMullins specific reference to sexism as experienced in medicine resonated with me as a female doctor. Have I ever encountered examples of sexist behavior in medicine? Of course I have. Have I personally ever experienced sexual harassment? Straight up, no I have not. Have I made career decisions that have been in some way influenced by expectations of gender? I don’t believe so. Do I know others who have? Certainly. Have others said to me on numerous occasions that my chosen area of speciality training, General Practice, was a good choice for reasons of starting a family, that “it’s less hardcore than surgical training” or “hospitals are tough for women”? Yes, many times.
Where are these attitudes born out of though? There are more women in medicine than ever before, yet still there are few women holding senior medical academic posts and completing training in disciplines such as surgery in proportion to their male colleagues. There is a growing debate, albeit mostly from UK based media sources, about the feminisation of medicine. In an article by Professor J Meirion Thomas, a self described feminist, (probably part of the ‘but I love women! Some of my best friends are women’ club) “Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon”, he argues that because there is now a gender imbalance within the NHS, continuity and delivery of service is being steadily hampered by female doctors having the temerity to choose part time work in order to facilitate selfish lifestyle choices like, raising a family and pursuing post graduate academic careers, among others. He even states that “Women in hospital medicine tend to avoid the more demanding specialities which require greater commitment, have more anti-social working hours, and include responsibility for management.” Of course, he also references the great British taxpayer in his piece, questioning whether they should accept such a flagrant waste of their money in training these female doctors, only for them to go off and have families and not want to spend every waking hour entrenched at the coal face of hospital medicine, the very cheek. As it happens, female doctors often do spend every waking hour working in hospitals, it’s called being ‘on call’. We even work weekends, just like our fully dedicated male colleagues.
The reality is that his is not a singular opinion. The face of the Medical Workforce in Ireland is changing, just like in the UK. In a report by the Medical Council of Ireland, the proportion of female doctors registered on the Medical Register has risen from 37% in 2008 to just over 40% in 2012. Interestingly, amongst graduates from Irish medical schools, there is a higher proportion of female versus male graduates in all age groups up to the age of 45. There is no doubt that this will present challenges for workforce planning in the future, but is it necessarily a bad thing that the status quo, which in some cases has previously taken the form of a boys club arrangement, will stand to be changed?
Is there really a boys club mentality still in existence? Surely not, it’s 2015 and female doctors, as Professor Thomas has indicated are basically ruling the roost, right? Well, not quite; In terms of where women fit into the medical workplace, there are still huge barriers to female doctors working in the specialities they have chosen. Undeniably the training path of a surgical trainee, for example can at times be arduous and punishing, with demanding workloads, 36 hour shifts on a regular basis and the pressure to maintain academic pursuits. Many, if not most trainees will be expected to complete Masters degrees and PhDs in order to be considered for Consultancy posts. The notion of achieving any form of work/life balance after all this can, for the most part be just that, a notion. But hey, this is the life we signed up for and sympathy is hard won at any rate. What really stings, is when it can transpire that at times, you’re just not really on the same playing field as everybody else when it comes to long term career prospects. Not only did you not get to tog out to go on the pitch, but you’re not even going to be invited for the post match drinks.
Of course Ireland is a small country, the Irish medical community is even smaller and job interviews can sometimes take the form of a casual word of mouth process. It is for this reason that I fear doctors of both genders can often be reticent to call out mistreatment or inappropriate behavior by a colleague or superior. People need solid references in order to progress unhindered in their careers and when you have people striving to gain a position that they have spent anything up to a decade or more of their lives working and studying to achieve, when they have families to support or student loans to pay off, the stakes are undeniably high. Nobody wishes to become the difficult member of the team, to be spoken about in hushed terms, to not be considered for a post because of their attitude and thus often behavior that on paper would be considered to be reprehensible often goes unchecked. I think this is really what Dr. McMullins was trying to highlight, although I feel she, as a Senior Medic would have preferred to have conveyed her argument more constructively.
As a GP trainee, I have overall had incredibly supportive male colleagues and mentors, but nearing the end of my training I am faced with the prospect of interviewing for GP jobs for which I may not be considered as equal as some of my male peers. Irish GP practices are primarily run as Small or Medium Enterprises, or in other words, as businesses. A female GP is more likely to work on a part time basis than a male colleague for reasons such as maternity leave and family commitments. I’m not saying my male colleagues are any less dedicated to raising their children, but the creche or child minder probably has Mam on speed dial and as for the maternity leave, well, I know I’m the doctor here, but you don’t need me to explain that to you right? GP practices can often have to arrange expensive locum doctor cover to replace any doctor that is on leave and this can affect the running of the business and concurrently the income generated. Whilst you could never question a job candidate openly about her family life for fear of being hauled in front of an employment tribunal, there’s no law preventing you from thinking that it may. As a Practice Manager once told me, it would be easier just to hire the male candidate.
A female colleague I met at a conference told me how she had recently discovered that a male doctor who started work at her practice at roughly the same time as her, was at the start of his employment, offered a three year contract with the prospect of partnership in the business. She, who was equally qualified, was offered just a one year contract. Whilst women’s presence in medicine is stronger than ever before, the glass ceiling for women, just like in other careers, definitively exists. With still relatively few women in senior positions, especially in leading academic roles in universities and colleges, is there any hope of meaningfully challenging gender bias and the status quo? Will we, in years time be reminiscing over Dr. McMullins comments and denying that there was any basis to what she was saying, or will we have acknowledged that an open discussion about issues such as sexual harassment, discrimination against female doctors, and the career paths open to women in Medicine needed to be had? Being a doctor is tough enough, but try not to be difficult about it, ok?