“Never Ask a Woman to do a Man’s Job” – The Challenges Facing Women in Medicine

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Medicine dates back all the way to Egyptian times some 3000 years BC with the first known physician Imhotep; no one can deny that it has always been an intrinsic part of our history. This summer I visited the Science Museum’s medical exhibitions with a friend and whilst we saw the vast collections that show the evolution of medicine, we came to the same conclusion: we have come a long way since then. However, we could not help but notice the number of male physicians in the photographs or medical innovations discovered by male doctors. There was not a single mention of a female doctor that we saw prior to the 1970’s. And this got me thinking – why, despite the role of women being typically nurses, midwives and carers, had there been a lack of women doctors? How had the scene for women in medicine changed so quickly? Do women still face challenges in medicine?

Introducing medical education for women

For centuries women have been predominantly midwives and nurses, whilst men were doctors, physicians and surgeons. The main problem women faced, apart from convention, was access to education. Universities simply would not admit women for medicine. When they rarely did, some were then asked to leave the university part way through their medical degree.(2) Despite several medical schools being founded specifically for the education of women towards the end of the 19th century, the first being London School of Medicine for Women in 1874(1)(5) and later Edinburgh School of Medicine for Women in 1886(2), access to medical education continued to be difficult.

Other medical faculties in the UK became co- educational in 1947 upon the recommendation of the Goodenough Committee, which recommended that 1/5th of medical students should be women.(5) However, the number of women graduating and practising as doctors did not increase until the 1970’s during which more than 20,000 women graduated with medical degrees, more than all the women collectively in the previous 40 years.(3) The number of women both applying and graduating from medical schools slowly increased until in 1996 there were equal numbers of both men and women applying to medical schools, with more successful female applicants than male. Since then women have continued to outnumber men not just within medical schools, but now in application numbers too.

Lessons in gender representations

The impact of more women coming into medicine has changed the gender representations within medical specialties, in which there are large imbalances. Women account for 1/4 of NHS consultant physicians and yet 57% of consultants under the age of 34 are female. This indicates that the picture is changing with incoming medical graduates contributing towards the aim of equal consultant numbers. There is also large over- representation of women in certain specialties such as genito-urinary medicine, dermatology, palliative medicine and clinical genetics. This may be due to the fact that some women choose specialties early on that fit with the ‘9-5’ lifestyle, making raising children easier and thereby accounting for this gender imbalance. I admit that I have caught myself being put off from specialties such as cardiology because it would make having a family more difficult later on in my life. Some evidence suggests that women do not only experience this so called horizontal discrimination with a perceived restricted range of specialties to choose from, but also vertical segregation, meaning that they have a lower chance of achieving senior status during their medical careers. Thankfully, there is evidence that the current situation is improving, with the increase in numbers of female consultants exceeding the average growth of the workforce.(5)

This issue of gender imbalance is relevant to all specialties, including those that are male dominated such as cardiology, hepatology and gastroenterology, as there is a potential danger that these specialties could fail to meet the demands put on them if female doctors do not choose to follow these particular career paths. Talented female doctors are not grasping opportunities in specialised clinical or academic posts due to their perceived gender barriers, and with women becoming the majority in the medical workforce this could have damaging consequences on the NHS, putting the public’s health at risk. This further highlights the need for women to be able to work equally in medicine with men.

The economic response to widening women’s opportunities in medicine

There are many reasons behind this change to the medical demographic. These include political influences, wider access to education and cultural changes, such as an increasing social acceptability towards women becoming doctors and the feminist movement of the 70’s. Not forgetting of course, the invention of the contraceptive pill. In a memorable lecture last year, Susie Whiten described how the pill gave women the power to control their fertility and in doing so enabled women to pursue the careers they wanted. Dr. Whiten then went on to point out that when she was our age there were very few women studying medicine, and that more than half of our class were women. This gave me a sense of equality, ambition and determination. “We’re finally beginning to get there”, I thought. “We’re finally beginning to get a level playing field.”

So you can understand my slight disappointment when I read that Tory MP Anne McIntosh said in June 2013, “female doctors who would go on to have children and work part-time would put a tremendous burden on the health service.” And then Health Minister Anna Soubry went on to agree with these “unintended consequences” of training women who go on to have families and live normal lives, before issuing a later statement saying that she “fully support[s] women GPs.”(4)

What they say is true – it is undeniable that a large number of female doctors, predominantly GPs, do become part time in order to raise their families. I remember a friend telling me that her mother only managed to keep her consultant job because she fought for it: she could not work full time whilst raising several young children, and because of this the hospital wanted her to quit. Interestingly, only after threatening that they were discriminating against her for this did they give her part-time work.

What disappointed me about Ms McIntosh’s and Ms Soubry’s comments wasn’t simply their thoughtlessness, but also the lack of suggestions for solutions to this problem. It is all very well stating that training female doctors is a waste of government money, but isn’t it time to come up with a solution?

There are several potential solutions to the problem raised by the politicians above, and we are going to look at three main ones: division of maternity leave, a national childcare service and the ultimate workplace crèche.

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The editors acknowledge the inaccuracy of this image on reviewal of the NHS guidelines. The first 8 weeks are provided at full play (plus statutory maternity pay/allowance), the following 18 weeks at half pay (plus SMP/MA), which is followed by the final 13 weeks, provided at statutory maternity pay/allowance. Mothers are then entitled a further 13 weeks of unpaid allowance. This brings the final figure to 52, which is correctly referenced in the diagram. This can be extended in exceptional circumstances (pre-term birth, multiple births).

The first of the solutions is paternity leave and the sharing of childcare between both parents with the aim of childrearing not having a dramatic impact on solely the mother’s career. Whilst it may not be the best available option for some people, it does equally distribute both the responsibility and the impact on both parents’ careers.

In summary, women are entitled to 52 weeks’ leave and men a mere 2. It is not just that traditionally the father goes back to work whilst the mother looks after her baby at home, but also that men don’t have the same degree of choice when it comes to paternity leave as women do. They are indirectly forced to go back to work, and in doing so leave parents with no choice in raising their newborn child. This is a potentially huge problem that both the NHS and the government need to address. However, there have been recent changes to paternity leave with the creation of Additional Paternity Leave in April 2010; now fathers are entitled to up to 26 weeks additional leave upon the condition that the mother has returned to work. Whilst this is a step in the right direction, the restrictions of it being between 5-12 months of the baby’s age limit the choices parents can make about the early upbringing of their child. Sadly, few men seem to choose this option.(7)

National Childcare Service

Another big idea is a national childcare service, on the same lines as our national education system and our beloved NHS. It could either be free or have a uniform fee for all parents.(6) This would solve affordability issues for parents. However it would not solve the ‘out of hours’ childcare problems many doctors face, as the hours’ nurseries open do not necessarily fit the work shifts of some parents. Unless, that is, nurseries became 24/7. The BBC recently published an article about night nurseries in Sweden that provide around the clock childcare. And the best part about them: every child has the right to this service, parents aren’t charged more than 3% of their salary and there is a cap on the fees too! (8) In Austria childcare has been free of charge since 2009 for children under 5 years old. (10)

Whilst I do not believe that free childcare is currently economically viable in the UK, I do believe that partially subsidised childcare would be a serious contender in possible solutions to the problems parents face when raising their children. It would take the pressure off both parents – they do not have to worry about picking up their child because the nursery closes at 6pm, feeding their child once they are home or putting their child to bed. It would also enable women not to take their ‘foot off the gas’ with regard to their career because they are focusing on their home life, both current and future, something that Sheryl Sandberg believes is one of the reasons why fewer women than men reach the top of their professions.(9)

The Ultimate Workplace Crèche

The last (and my preferred proposition), not dissimilar to the previous idea, is ‘the ultimate workplace crèche’ or nurseries on site at hospitals. It is not very different from what a hospital functions to do – care for people. Imagine: you arrive at work with your children, drop them off at your hospital crèche on the ground floor and say your goodbyes before heading off to ward rounds. Easy.

The best example of this kind of crèche is during WWII in US shipyards. These crèches were open 24/7, fed and even had an on site nurse to care for sick children. Furthermore the crèche was incorporated within the infrastructure of the shipyard, so that the children could watch the ships being assembled from the windows. Most importantly, the reason behind their opening was to have a guaranteed workforce, to ensure that the women could do their job (sounds familiar?) and run their family life. Sadly these ended with the war, but some large UK employers do provide on site crèches.(6)

Conclusion

The title of this article, “Never ask a woman to do a man’s job” was something I heard one male medical professional say to another during a practical session at our medical school. The shocking thing is, I was the only one who openly objected. This kind of casual, unacceptable yet tolerated attitude that women are still inferior in the medical profession needs to change. This could start with minimising the impact of having children on the medical career paths of women, allowing both men and women to achieve their full potential in their careers. Maybe then, one day such comments will finally cease and medicine will be “a level playing field”

References

1. University College London, “Bloomsbury Project”, http://www.ucl.ac.uk/bloomsbury- project/institutions/ london_school_medicine_women.htm (accessed July 4th, 2013).

2. Somerville, JM, “Dr Sophia Jex-Blake and the Edinburgh School of Medicine for Women, 1886– 1898” Royal College of Physicians Edinburgh, (2005), 35:261–267. 3. Paludi, Michele A. and Gertrude A. Streuernage, “Foundations for a Feminist

3. Restructuring of the Academic Disciplines” New York, Harrington Park Press, (1990), 236.

4. The Guardian, “Health minister forced to clarify remarks on female doctors”, http:// http://www.guardian.co.uk/society/2013/jun/05/health- minister-female-doctors-anna-soubry (accessed July 4th, 2013).

5. BMA Equal Opportunities Committee, “Equality and diversity in UK medical schools”, British Medical Association, (2009), pg 63-71.
6. BBC News Magazine, “Eight radical solutions to the childcare issue”, http:// http://www.bbc.co.uk/ news/magazine-18826587 (accessed July 6th, 2013).

7. British Medical Association, “Maternity leave (for NHS medical staff), Membership guidance note – NHS employment”, (2011), pg 42-44.

8. BBC News Magazine, “Night nurseries:

Sweden’s round-the-clock childcare”, http:// http://www.bbc.co.uk/news/magazine-21784716 (accessed July 6th, 2013).

9. TED Talks, “Sheryl Sandberg: Why we have too few women leaders”, http:// http://www.ted.com/ talks/ sheryl_sandberg_why_we_have_too_few_wome n_leaders.html (accessed 7th July, 2013).

10. Austrian Federal Ministry of Economy, Family and Youth, “Child care in Austria”, http:// http://www.en.bmwfj.gv.at/Family/ChildCareInAustria/ Seiten/default.aspx (accessed 6th July, 2013).

11. Image: Imhotep- Founder of Medicine [Online] Available at: <http://www.vopus.org/en/gnosis/ great-characters/imhotep-master-of- sciences.html> Accessed 9th August 2013

12. Image: Sign- London School of Medicine for Women [Online] Available at: http://www.english- heritage.org.uk/discover/people-and-places/ womens-history/women-and-healthcare/former- london-school-of-medicine-for-women/ (accessed 9th August 2013)

13. Image: Contraceptive pills [Online] Available at: http://www.smartcape.org.za/women/womans- health/birth-control/birth-control-pills.html (accessed 9th August 2013)

14. Image: Baby dressed as a doctor [Online] Available at: http://www.masterfile.com/stock- photography/image/846-05646025/1960s-BABY- DOCTOR-AND-NURSE-WITH-CHART-AND- STETHOSCOPE (accessed 9th August 2013)

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