Girl talk

In some countries, the number of female undergraduates outweighs men - the so called feminisation of medicine. But is this something to worry about, as some people have suggested? Finola Lynch finds out

Unless you were holidaying on Mars last summer it seemed impossible to miss the furore created by Carol Black. The president of the United Kingdom's Royal College of Physicians was quoted as saying that the medical profession had too many female doctors. As a result of the increasing proportion of women, the status of medicine was in danger of diminishing.¹ Although Black later distanced herself from these comments, she sparked an enormous debate in the press and gave the kiss of life to a word now synonymous with what is happening to the state of medicine - feminisation.

Straw poll

Do a quick straw poll among your medical peers, however, and it is soon clear that most undergraduates were blissfully unaware of the media storm. Is that necessarily a bad thing? Isn't it the job of undergraduates to pass medical degrees, not worry about the state of a profession that they will not be joining for several years? Besides, it could be argued that medical schools are already feminised. Women make up at least 60% of medical undergraduate numbers.² By 2012, it is predicted that female doctors will outnumber male doctors.³ Surely demographics can take care of equality?

Selena Gray, president of the Medical Women's Federation, is not so sure. "Clearly the medical student population has been feminised," she says. "However it's not clear whether these changes will automatically find their way into equal numbers in the competition for all consultant posts. Some specialties now have a high proportion of female doctors, including general practice. But medicine as a whole has not been feminised, despite the impression this is happening very quickly."

Glass ceiling

A cursory glance at the profession's top hierarchy shows substantial chips in the "glass ceiling" that used to exclude women from medicine's most prestigious posts. As well as Professor Black, who is only the second female president in the Royal College of Physicians' 500 year history, Janet Husband is president of the Royal College of Radiologists, and there is one female head of a medical school - Yvonne Carter at Warwick University.² But scratch the surface and a different pattern starts to emerge. Just 4% of surgeons are women and a quarter of consultants are female, although numbers have doubled in the past 10 years.³

Will the changing profile of the average medical graduate tackle this as well? According to the 2004 Royal College of Physicians's Joint Committee on Higher Medical Training (JCHMT) database, 43% of all 3674 medical specialist registrars in training are women. It would seem that equity is arriving through sheer volume of numbers.⁴

Out of the 26 different clinical specialties recognised by the JCHMT, however, the proportions of female graduates in each one swings violently from 83% in clinical genetics to just 15% in cardiology.⁴

Traditionally, it has been argued that men and women gravitate naturally towards different areas of medicine. Jobs that require technical expertise and procedural roles have attracted men in greater numbers than women. Specialties that are less technically challenging and more patient centred are dominated by women. Incidentally, they also happen to be less well paid.

BURGER/PHANIE/REX

The changing sex balance of doctors

This is an argument that Gray refutes outright: "It's a myth that there are areas of medicine women don't want to do," she says. "Women want to enter all branches of medicine and when you talk to undergraduates there are no gender differences in terms of ambition or drive." Amanda Howe, deputy chairwoman of the Working Party on Women in Family Medicine, agrees. "It's more a question of how long it takes women to penetrate some of the specialties, where selection processes and role models have been quite adverse," she says. "Once more women enter, then we can look forward to a more open culture."

Family friendly

Emily Musgrave, aged 21 and a third year undergraduate at the University of East Anglia's School of Medicine, Health Policy, and Practice, has not ruled out any specialty and does not see any reason why she should. "I don't really know what I want to do when I qualify but then most undergraduates are unsure," she says. "However, I don't feel any specialty is barred to me, just because I'm female."

The bald statistics show, however, that women are choosing not to do certain branches of medicine, such as cardiology and gastroenterology, once they graduate and enter the workplace.⁴ Last year, Black said that this was because women were seeking specialties that allowed greater flexibility or were family friendly.¹

According to Tamara Everington, a 36 year old specialist registrar and member of the BMA's Junior Doctors Committee, this is another phenomenon which is holding women back and reducing their career choices. "I do believe there is a glass ceiling in career progression for women, but I don't think this can be put down to simple sex discrimination, although this may well be part of it," she says.

"Parents want and need to be the principal influence in their children's lives. It is possible to do this and to work even full time as a doctor. However, working parents are dependent on childcare facilities. NHS childcare facilities have insufficient capacity to meet demand and the hours of care offered do not reflect the needs of parents working in the NHS. Somebody has to look after the kids. If childcare facilities are insufficient parents will have to reduce working hours or even stop work to care for their children. Generally speaking it will be the mothers that do this. This reduction in work input almost inevitably impedes career progression. In other words the glass ceiling is at least in part an obstacle because working parents do not get the opportunity to even reach it, let alone break through it." But does it matter if men and women make different choices and are under-represented in certain areas of medicine? Let's not forget that men are choosing to avoid certain specialties too - general practice being uppermost.³

Problems

With the imminent change in the sex balance of doctors, Black anticipates that there could be problems ensuring 24 hour services in areas such as acute medicine or sufficient doctors in specialties with long hours in future.¹ This kind of sex polarity is also bad news for quality in clinical practice. Surely no specialty can afford to be recruiting from less than half the available workforce? Meanwhile no figures exist on the proportions of men and women in academic medicine.² "The problems for women here are similar but worse," explains Everington.

"Many academic grants do not have provision for maternity leave, the Research Assessment Exercise does not make any allowance for women on maternity leave and counts their absence as non-productive time. Then there is the fact that it is very difficult to combine individual research projects with extended periods of time out and the need for child care."

Everington believes that the debate needs to move away from being an issue about sex to an issue about family and flexibility for all. "Men also want to spend time with their families," she says. "We're losing sight of the fact that the working culture is changing. People don't want to bed down in the one job forever. They want to take on a number of different roles during their career and have a flexible career portfolio."

Mature students

Another factor needs to be thrown into the debate. It's not just the sex balance that is altering the face of medicine. The profession has also opened its doors to more mature students. In 2002, the University of East Anglia opened the first new medical school in 30 years. Not only was 70% of its intake women, but nearly 55% were older than 22.

This phenomenon is now affecting many medical schools. Emma Vallance, aged 33, was an opera singer before she decided to retrain at Southampton Medical School. She is typical of a new breed of medical student. "I am totally committed to medicine," she said. "But I also need to bear in mind my biological clock. I want to be an ear, nose, and throat surgeon but it's more than likely that I'm going to need flexible training throughout the early stages of my career while I have children. It may take me a little bit longer to get there but I would expect to compete with the men and the younger women for jobs once I returned to full time work."

If Vallance represents the kind of dynamism inherent in today's medical undergraduates, it could be argued that Black has little to worry about. Everington, however, believes that lack of childcare support for doctors will perpetuate the sex imbalances still inherent in medicine. "The government needs to address the need for 24 hour childcare support, particularly among junior doctors, who have moved to shift patterns in order to comply with the European Working Time Directive," she says.

"Without adequate childcare support, the NHS will just continue to lose women doctors who will have to cut down or stop clinical practice in order to care for their children. Not only is that a complete waste of training and talent. It is also worrying at a time when women are becoming the dominant workforce in medicine."

Finola Lynch, third year medical student, University of East Anglia
Email: f.lynch@uea.ac.uk


studentBMJ 2005;13:221-264 June ISSN 0966-6494

1. Jones S. Women doctors at top "harm status." Guardian 2004 Aug 2.
2. Gray S. Our work is not yet done. Hospital Doctor 2004 Oct 14.
3. Roberts J. The feminisation of medicine. BMJ Careers 2005;330:13-5.
4. Dornhorst A. Getting the balance right among the different medical spr clinical specialities. Med Woman 2004;23(3):14-5.

   

           

	LIFE Girl talk       Finola Lynch (June 2005)
	Abdul Moiz Khan (June 05, 2005)       Final Year medical student M, B,. B, S, The Aga Khan University Medical School Karachi, PAKISTAN moiz2005@yahoo.com
	EDITOR- Increasing number of female medical students are a visible phenomenon even in Pakistani medical schools. For the past decade the ratio has almost reversed from male dominance to female preponderance. This could partly be due to better college performance of Female students in years before joining medical schools. Female student cosistantly take all the top positions in the local examinations before joining medical school. Increasing awareness in Pakistan towards educating women is also a factor that needs to be kept in mind. Furthermore female doctors act as an added source of income in the family and help support their husbands. Female doctors mostly used to opt for the field of obstetrics and gynecology. The reason being the comfort of our female population towards visiting a female gynecologist as compared to a male gynecologist. But for the past half decade the trend is also seeing a change. More and more female doctors are taking up different and versatile fields. Apart from allopathic medicines female homeopathics are also an emerging phenomenon in our country.