Women widen horizons in medical world

By DIANA McCURDY

Emily Siedeberg ducked instinctively as the dismembered body parts came flying across the laboratory in her direction. It was the early 1890s and Siedeberg was on her way to becoming New Zealand's first female medical graduate.

Inevitably, her presence in the all-male medical faculty at Otago University was raising some hackles.

Siedeberg weathered the impromptu shower in dissection class with good humour and went on to graduate and be in practice for decades in New Zealand. She died in 1968, at the dawn of the modern flood of women into medicine.

Now, more than 100 years after Siedeberg graduated, metaphorical entrails are being thrown at female medical students once again. This time, though, they are not being flung from the hands of a few disaffected male students, but from a more powerful source: the head of the Royal College of Physicians in London.

Last month, Professor Carol Black - only the second woman to head that influential college in 500 years - spoke in the Independent newspaper about the dangers of "feminising" medicine.

She said the profession was in danger of losing its power and influence because too many women were scaling its ranks and medicine may be facing the same fate as teaching and nursing.

She cited Russia as an example. "In Russia, medicine is an almost entirely female profession.

"They are paid less and they are almost ignored by the Government.

"They have lost influence as a body that had competency, skills and a professional ethic. They have become just another part of the workforce. It is a case of downgrading professionalism."

The proportion of female medical students in Britain has increased steadily from about 20 to 25 per cent in 1968 to more than 50 per cent since 1991.

New Zealand's statistics are similar. This year, Auckland Medical School's intake was 58 per cent female; last year, it was 64 per cent female. In 30 years, there will be equal numbers of women and men in our medical workforce.

Black's stance drew support from Professor Colin Blakemore, chief executive at the Medical Research Council. He told the Independent that women were not advancing in the ranks in sufficient numbers.

Unless something was done to help women to pursue their careers alongside family commitments, major workforce problems could develop.

Is this Siedeberg's legacy? Is the presence of her gender downgrading the profession to which she so passionately dedicated her entire life?

If salary is a measure of status, then New Zealand doctors don't appear to be doing too badly - last year, fulltime equivalent salaries of specialists averaged $129,743.

But what of less-tangible concerns, such as status and influence? Phillippa Poole, associate dean of undergraduate medicine at Auckland University, says there is no denying the presence of women has changed the medical profession.

"But I'm very optimistic. I don't see it in a catastrophic way. Doctors now have a broader view of the health system, including the inequities, and a potentially greater sphere of influence than before."

There is little evidence that women who have achieved high positions in New Zealand's medical profession are any less appreciated than their male counterparts.

While the presence of women raises some practical workforce issues - such as the difficulties of pushing women up the ranks of a traditionally male-dominated profession - the good far outweighs the bad, she says.

Rosy Fenwicke, doctor and editor of a newly published book on the experience of women in medicine, In Practice, doesn't waste time pulling punches. "What [Black] said was appalling. She is blaming women for things that aren't anything to do with gender, but are to do with how the world is changing."

All the women doctors have been active in medico-politics and advocating for patient rights and health, Fenwicke says.

Robyn Toomath, for example, is a consultant endocrinologist, diabetologist and general physician who set up and led Fight the Obesity Epidemic; Belinda Scott is a breast and general surgeon who directs a breast clinic and chairs the medical committee of the Breast Cancer Foundation; and consultant pathologist Karen Wood is vice-president of the Royal Australasian College of Pathologists.

"Women are able to contribute at the highest level in medicine, they're able to do their jobs well, they're able to undergo difficult training and they don't let the profession down and I don't think that in any way they've decreased the so-called status of the profession by virtue of being women," says Fenwick.

The idea that professions lose status when women enter in large numbers is an old feminist truism, says Auckland University Sociology Professor Maureen Baker.

But she believes the changing structure of the health system has also played a role - increasing numbers of doctors are now employees rather than private practitioners.

Also, as the population has become more educated, it is less inclined to put professionals on pedestals.

So, while women have probably had an effect on the slipping status of the profession, they are certainly not the sole factor. At any rate, Baker asks, does it really matter if the prestige of the profession drops?

Poole doesn't think so. "In New Zealand, respect is earned, rather than because of the position you are in," she says. "It used to be the doctor told the patient what to do. Now they are equal.

"That may be perceived as a lack of status but now I think respect is being engendered in other ways. Doctors are seen as more caring."

For Poole, the debate over doctors' loss of status - whether real or imagined - is a side issue. More important is the challenge of fitting growing numbers of women into a profession that has traditionally been structured around the lives of white, middle-class men.

In the past, doctors could work long hours and let their wives pick up the pieces at home. As the sexual and ethnic mix of the profession changes, this becomes increasingly untenable.

In New Zealand, as in Britain, a disproportionately low number of women are going into specialties.

The most obvious reason for this is that many specialties are difficult to combine with family life.

Some women forgo family life to dedicate their lives to their careers, but a large percentage juggle both (a recent survey of Auckland University medical graduates between 1973 and 1997 found that 60 per cent had children).

It takes 14 years of tertiary training and examinations to become a specialist. For women, that overlaps with child-bearing years.

"Women are trying to combine working, training and family," says Poole. "That's potentially three full-time jobs in one."

This "juggling" exacerbates workforce shortages. Women tend to work fewer hours than men and are less likely to work in rural areas. According to the latest Medical Council workforce report, women doctors across all ages work an average of 41 hours a week compared with men, who work 50.

If women work only 80 per cent of the hours of men, Poole says, should women be restricted to 40 per cent of the places in medical school? She shrugs and laughs at the thought. But if our modern medical workforce works fewer hours, we need to train more doctors. No questions asked.

It's not just waiting lists that suffer. It is essential that doctors are in the thick of health policy decision-making. If they are overworked, or work only part time, effective research and committee contributions are more difficult.

So who is at fault? The women who unbalance the system by flooding into certain specialties and working only hours that are compatible with raising a family, or the male-oriented structure of the profession?

Neither, says Poole. Women haven't really changed the profession - the profession was changing anyway.

To deal with this, the health system needs to develop more flexible work practices, such as allowing doctors to interrupt specialist training for family commitments, then facilitate their re-entry and enable job sharing.

Fenwicke points out, also, that it is not just women who are demanding these changes. "Men and women want to have a life outside medicine and we're seeing men and women changing the specialties that they're going into based on being able to have a work-life balance."

Fenwicke believes the "problems" Black identifies are not really problems at all. "I don't think it's terribly good for people to work extremely long hours to the exclusion of everything else in their lives.

"And doctors are constantly preaching that to patients. It's about time they took their own medicine."

Striking a balance between work and private time is essential not only for family life, but also for maintaining the quality and influence of the profession, says consultant pathologist Karen Wood. Male and female doctors struggle to find time for medico-political issues and the professional colleges.

She says the future of the profession "is going to very much depend on who the leaders are going to be - whether they are male or female - and whether they are prepared to stand up and wave the flag and further the cause of the profession".

Everybody brings something different to the profession, says Medical Association chairwoman Tricia Briscoe.

"There are advantages to having plenty of women in medicine, just as there are advantages to having plenty of men in medicine and we need to ensure we support all of those people because we don't have enough of them.

"We need to ensure they have an environment they can work in that supports them and encourages them to stay."