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Rapid Responses: Rapid Responses published:
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Feminisation comment depressing
- Helen Fernandes (5 April 2008)
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An opportunity for change
- Charlotte L Allan (5 April 2008)
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Worthless ,Long, Skimpy Briefs
- A.A.W. Amarasinghe,MD, (5 April 2008)
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Retiring doctors?
- SF Gray (5 April 2008)
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But what is the impact on patient outcomes?
- Andrew J Ashworth (7 April 2008)
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Nursing is still a girl club.......
- Phillip J. Colquitt (7 April 2008)
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Complex modelling required to solve workforce issues
- Jan Coles, Dr Desiree Yap (7 April 2008)
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No gender bias but problems at workplace
- Naghman Bashir (7 April 2008)
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Husband seekers
- Dr. John A.J. MACLEOD (7 April 2008)
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Solving a problem
- Sylwia V Nilsson (7 April 2008)
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Discussion - 0, Emotional response - 1
- Tomi-Pekka Tuomainen (7 April 2008)
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women as mothers is the issue
- clarissa d fabre (8 April 2008)
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Representing the 60%
- J Drinkwater (8 April 2008)
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Men in Society
- Nandita M deSouza, Member of Medical Women's Federation (8 April 2008)
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Maybe it is not because I am a woman
- Lesley A MacDonald (8 April 2008)
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Lopsided distribution
- Kiran K Turaga, Gargi Bhagavatula (9 April 2008)
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what about maternal instincts?
- Antoine Kass-Iliyya (9 April 2008)
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why do men shun a career in medicine
- Beryl de Souza (9 April 2008)
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Creating a flexible, accommodating and productive workforce
- Co-Chairs Equal Opportunities Committee, Professor Bhupinder Sandhu MBBS, MD, FRCP, FRCPCH & Dr Justin Varney MBBS, MSc, MFPH. (9 April 2008)
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The reasons for a gender shift in medicine?
- W Juliane A Groning (10 April 2008)
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Also put a quota on mature students?
- Hannah J Smith (10 April 2008)
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Feminisation of medicine begins before medical school
- Barbara Pierscionek, Dr Patricia Hart (11 April 2008)
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Are there still barriers to women in Medicine?
- Pilar Arrizabalaga (28 April 2008)
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We rest our case
- Barbara Pierscionek (1 May 2008)
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Helen Fernandes, Chair of Women in Surgery and Consultant Neurosurgeon Addenbrooke's Hospital, Hills Road, Cambridge, Cambridgeshire CB2 0QQ
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It is a shame that there is still a debate to be had about the merits of women in medicine and Brian McKinstry’s comments on the "feminisation" of the medical workforce are both insiduous and depressing (Are there too many female medical graduates?, BMJ, April 5). McKinstry’s implies that that the increasing proportion of women in some specialties will lead to reduced service provision as more women than men currently work flexible hours. A redundant argument given that the forthcoming requirement of a 48-hour working week will mean all doctors work fewer hours than is currently the case. Rather than acknowledging that a change in attitude within the profession to training and practice is required, he suggests instead a “balanced” approach to recruitment – which in this context appears to be Orwellian double-speak for “don’t hire women”. Women in Surgery (WinS) is working to change institutional barriers to attract more women to surgery. Such activities will allow all medical specialties to take advantage of the diversity in the NHS and will highlight better working practices. True equity can only be achieved when all recruiting practices are fair and open to all. Fairness means ensuring the best candidates succeed, regardless of their gender. Patients’ needs can only be better served if the best and most able doctors progress through the career pathway in all specialties. Competing interests: None declared |
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Charlotte L Allan, Academic FY2 Doctor Leeds General Infirmary, Great George Street, Leeds LS1 3EX
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I find it amazing that Brian McKinstry can argue that too many female graduates are bad for medicine because of current attitudes held by society, where women have the major responsibility for child care, and therefore many female graduates work part-time. Surely, as one of the largest employers, the NHS has the potential to be a force for social change. It is not good enough to bemoan the increasing feminisation of the workforce. Instead, we need to find practical solutions so that women are able to continue working despite family commitments. Although increasing numbers of women in medicine do have implications for workforce planning, it is important to consider why women may choose to work part-time. If we understand these reasons it will be possible to find solutions, to enable women to continue working full-time and to hold senior positions. For example, the European Working Time Directive which comes into force in 2009 should make working hours more acceptable in all specialities, not only “family friendly” ones. The provision of high quality and accessible childcare would make it much easier for women to return to work even with young families. If medicine is to continue to attract bright and committed people, of both genders, to join the profession we need to create a working environment which is more flexible, and understanding of commitments outside of work. Increasing numbers of women in medicine should encourage a change of attitude amongst the profession and within society. The NHS should take this opportunity to be at the vanguard of family friendly policies. Competing interests: None declared |
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A.A.W. Amarasinghe,MD,, Consultant Psychiatrist 102 Bayberry Hills, McDonough,Georgia 30253-4005 USA
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You devoted several pages of your precious journal and several precious hours ( I am slow ) of your readers on a subject as trivial as the sex of the doctors. For me, they were non-compromising,opinionated, lenghthy,intellectually skimpy, briefs of low value packaged in glossy Madison Avenue - type facade. Competing interests: None declared |
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SF Gray, Professor of Public Health and Deputy Postgraduate Dean, Severn Deanery Severn Deanery, Bristol BS16 1DD
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I was suprised to see that Dr McKinstry believes that women doctors will retire earlier than their male colleagues. I was even more disturbed to learn that he made this statement on the basis of a single cross-sectional survey of general practitioners in Scotland asking GP principals when they were planning to, rather than when they actually did retire. This study demonstrated that "of those GP principals who were not planning to retire in the following 2 years, 73 (3.1%) planned to increase their sessions by an average of 1.5 sessions per week and 288 (13.3%) planned to decrease their sessions by an average of 2.0 sessions a week. Women were more likely than men to be planning an increase in sessions (p < 0.05). 178 (7%) planned to retire in the next two years. Doctors of both sexes planned to retire on or before 60. The mean planned age of retirement for women was 58.8 and for men 59.9." From this data it seems extraordinary to conclude that women doctors will retire earlier than their male colleagues. Anecdotal information shows that many women doctors have an increase in time and energy for work in their 50s, and many continue to need to work to maximise their pensions. It is disturbing that the real issues about ensuring that women doctors are able to make their real contribution to medicine, for example by providing adequate opportunties for part time working during key parts of careers, are obscured by value laden statements of dubious provenance about the overall contribution of one group of doctors compared to another. Competing interests: The author is a full time female doctor and past president of the Medical Women's Federation |
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Andrew J Ashworth, General Practitioner Davidsons Mains Medical Centre, 5 Quality Street, Edinburgh, EH4 5 BP
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Dacre argues for equality of opportunity for both genders while McInstry warns of changes in workforce efficiency. Mckinstry claims women retire early, Dacre that they retire later than men (it is a pity that these apparently conflicting claims were not resolved in the edit). Both argue on the basis of the question asked, which but this may be too restrictive to get to the meat of the debate about how this affects patients. Numbers of doctors are easy to measure by gender, their distribution is less so though both authors accept that feminisation of a specialty occurs where careers are more attractive to women. McInstry makes the case that the feminisation of General Practice is associated with reduced output by individual doctors over time and that ongoing feminisation of General Practice is therefore risky in workforce planning. Dacre argues for more flexible working. There has already been wide coverage in the media following this publication demonstrating that is a brave man who points out that masculinity may be good! In an accompanying editorial (1), medical performance is related to occupational rather than clinical outcomes by a woman defending the apparently lower outputs of women in medicine. We need a debate in the profession about the effects of feminisation on clinical outcomes not just workforce outputs. Feminist spin has led to a general acceptance of institutional favouring of women; Dacre, a senior member of an academic institution, chairs a gender-specific Royal College Research project on "women in medicine", nevertheless she alludes (in a leading Journal edited by a woman) to a glass ceiling for women. At the popular level the same spin has cloloured our views: women’s refuges abound with virtually no provision for male victims of partner abuse in the face of virtually equal need. The British Crime Study (2) shows remarkably similar prevalence of partner abuse: 1.8% of women and 1.6% of men had suffered severe force from their intimate partner in the preceding year. Without evidence of outcomes, we have no idea what the significance of feminisation of our profession is on patients. It is currently accepted that exclusively female General Practices care equally well for the teenage sons of single mothers: we need to demonstrate the veracity of that view scientifically rather than blindly wander along our politically correct path that prevents anyone challenging a feminist! Perhaps these two fine academics could collaborate on studies to identify, for example, if single gender General Practice partnerships have different outcomes in gender specific diagnoses such as testicular and cervical cancer. 1. Effects of gender on performance in medicine Jenny Firth-Cozens BMJ 2008;336:731-732 (5 April), doi:10.1136/bmj.39526.359630.BE 2. Domestic violence, sexual assault and stalking: findings from the 2004/05 British Crime Survey, Andrea Finney Home Office Online Report 12/06 http://www.homeoffice.gov.uk/rds/pdfs06/rdsolr1206.pdf Competing interests: As a male, I was unsure which individual article to respond to. Responding to this, the first, constitutes a response to both and suggests no personal support for either position. |
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Phillip J. Colquitt, Technician/RN Independent comment
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......and since medicine can't exist without nursing, it seems odd to be deliberately standing by and allowing the majority of doctors to be women. That may mean a typical hospital ward would be roughly representaive of the population only in terms of patients, while the care givers seemed oddly oestrogen driven. Competing interests: None declared |
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Jan Coles, Senior Lecturer Department of General Practice, Monash University, Melbourne, Australia 3168, Dr Desiree Yap
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The complexity of health service provision was not addressed by McKinstry.1 He quotes simple time based data and the number of referrals as a measures of efficiency, providing no evidence that seeing large numbers of patients in the shortest time possible with the least number of referrals is best way to practice medicine. Nor does he engage in discussing the difficulties associated with defining and measuring time at work.2 We need to move away from these simplistic measures used by McKinstry to construct his workforce argument and investigate patient health outcomes. To do this will require a shift from simple proxy measures to complex modelling and a commitment by interested parties to comprehensive longitudinal studies. Women doctors may engage with patents differently, be more patient centred, empathetic, be more likely to address social issues such as family violence3, engage in patient education and preventive care. Addressing medical problems and social issues is time consuming but are there benefits from this “touchy feely” stuff? We know that patient satisfaction increases, patients are more likely to comply with treatment, may require fewer health services and less likely to litigate 4-7. But what about health service utilisation and costs? Do longer consultations save precious health dollars in the long term because patients attend less frequently? Does their health improve when causes, symptoms and education are all addressed? Do patients do better medically when they are referred electively or early? What is the cost to patients and the medical system when patients are not referred and/or medical error occurs? These are the type of issues we should be exploring in depth and developing an evidence base to improve how we think of efficiency at work. It’s time to move past “time bombs” and implications that women are the problem and put our minds to developing workforce measures that look at healthcare outcomes for patients. 1. McKinstry B. Head to Head: Are there too many female medical graduates? Yes. British Medical Journal 2008;336(5th April):748. 2. Wainer J. Work of female rural doctors. Australian Journal of Rural Health 2004;12:49-53. 3. Taft A, Broom D, Legge D. General practitioner management of intimate partner abuse and the whole family: qualitative study. British Medical Journal 2004;328:618. 4. Gross R, Brammli-Greenberg S, Tabenkin H, Benbassat J. Primary care physician's discussion of emotional distress and patient satisfaction. International Journal of Psychiatry in Medicine 2007;37(3):331-345. 5. Silverman J, Kurtz S, Draper J. Skills for communicating with patients. Oxford: Radcliffe Publishing, 2005. 6. Firth-Cozens J. Effects of gender on performance in medicine. British Medical Journal 2008;336:731-732. 7. Zaharias G, Piterman L, Liddell M. Doctor gender and patient gender interactions in consultation. Academic Medicine 2004;79:148-155. Competing interests: None declared |
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Naghman Bashir, Senior Medical Officer Holy Family Hospital, Rawalpindi. Pakistan
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In Pakistan there has been a definite change in the number of medical school seats taken by girls. Over the last decade the girls have outnumbered boys in medical schools by 3 to 1. No gender bias but in our cultural setup, most of the girls marry and /or do not pursue an active career. Many follow their husbands abroad; some take care of the families exclusively. Thus a lot of workforce is lost to cultural demands. We asked around in our unit 3 years back and found that about 60% of female graduates were not actively working as doctors 3 years after graduation and thus were an enormous burden on the already depleted resources for medical colleges. while women demand equal opportunities in getting admission to medical colleges, they must also realise their responsibilities after graduation. They must pay back to the society what they have taken from already poor society. If the same seats would have been left to boys, more active doctors would be working in the society. Competing interests: None declared |
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Dr. John A.J. MACLEOD, retired island GP Lochmaddy, HS6 5AE
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In 1998, I conducted a "straw" poll of a number of female senior medical students and young graduates. I found several who stated that their aim was to 1) get a degree and 2) catch a better level of husband. They did not intend to follow a career in Medicine. I put this forward at a meeting of the Scottish General Practice Committee as a reason for instituting some control on the number of females admitted to Medical Schools. Today (7th April 2008) the Sydney Morning Herald has an article confirming this theory. The paper quotes research done at Monash University where it was shown that in 2006 as compared to 1996, more women (aged 30-34) with degrees were married than those without a degree. Competing interests: None declared |
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Sylwia V Nilsson, Doctoral student Departement of Law, Umeå university, SE90187 Umeå, Sweden
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The article shows some awareness that the origin of the problems concerning female doctors might be found in the social structure rather than the individual. One of those problems might be based on the idea that only women become/are parents. If fathers would take the same responsibility for their children women wouldn't have the same need for part time work. The same applies to periods later in life, when the children have grown up, but when elderly parents might need some attention. That too is a concern only for female relatives. As long as the male population don't take their responsibility in family life female doctors with families are denied the opportunities male doctors have. That could be the reason why they feel the need to work part time, keep office hours, and can't publish as many articles... Male doctors with families have a wife to take care of their family, female doctors don't. You want to solve a structural problem in society by reducing the number of female doctors? Isn't this just adding a lot of negativity to a group of professionals who already have too work against a lot of prejudice and other obsticles, instead of adressing the real problem - the structure of family responsibilities in society? Competing interests: Swedish female lawyer (+RN) working with health care legislation and gender questions |
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Tomi-Pekka Tuomainen, Professor (acting) University of Kuopio, 70211 Kuopio, Finland
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Gender differences are only partially societal-cultural. Biology - yes, also human biology- has a role, too. Also free will, making choices, need to be accommodated. Some female colleagues may actually want to have more time with their children and parents. Anyhow, unless it is shown that either gender produces conciderably better outcome (let's say, in general practice), a very good starting point is to have balanced gender distribution. Competing interests: None declared |
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clarissa d fabre, full-time GP principal buxted east sussex TN22 4LA
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It is a woman’s right to become a doctor as much as a man's. The key issue is whether a woman is a mother or not. Most women do become mothers. The challenge is to have a structure which maximises a woman’s input while she is having her children. The present system is not optimal. The Medical Women’s Federation, which recently celebrated its 90th anniversary, is actively campaigning to ensure that flexible training and part-time working opportunities are available to all those who request it when a woman doctor’s children are small. This view has been endorsed by the CMO in his 2006 Report 'Opportunity Blocks' (1) There are many years after child-bearing that a woman doctor can make a very full contribution. (Dr) Clarissa Fabre 1. CMO Annual Report 2006 Women in Medicine Opportunity Blocks Competing interests: Vice President Medical Women's Federation |
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J Drinkwater, Foundation Year 1 Doctor Salford Royal NHS Foundation Trust, M6 8HD
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In 2004, as a third year medical student, and one of 60% of female medical students, I was astonished at reading Dame Carol Black’s (1) comments, which were reinforced throughout last weeks BMJ (2, 3). I along with my female colleagues, worked hard to achieve the goals set to get into medical school, and we had achieved these in a system allowing equal competition with men. I was setting out on what I hoped to be an ambitious career practising medicine. Now I read that because of my gender, I am not only going to fail in this ambition, I am also going to ruin the reputation of the profession. Instead of despairing, I carried out research into what both male and female medical students see for their futures in terms of both career and family life (4). The data showed that both male and female medical students were surprisingly similar. Both wanted to have successful careers, and both wanted children. The difference was that women were already aware of the obstacles in achieving this balance. Both men and women stated that it is a woman’s role to take responsibility for child care, and the majority of students were uncertain about paid child care (4). As someone who has grown up with two successful doctors as parents and paid child care, I was sad that the research identified a lack of real women role models. The issue is rarely addressed but is self perpetuating. The age/gender distribution was only briefly touched on in last weeks BMJ article (3), but although 60% of entrants are female, there are still only a few senior female doctors. Many female students recounted their experience of women doctors being “hard nosed”, "unhelpful", and "unapproachable". To be recognised as a good role model, female doctors had to have good careers and talk in glowing colours of their wonderful family life, whereas men only needed to be good at their jobs (4). In addition there was a lack of careers advice, it usually involved – "if you want a family, be a GP, don’t even think about surgery/emergency medicine…" (4). I am now an ambitious female junior doctor. I wish to pursue a career in general practice as this is where my interest lies. However, when asked what career I want, I am immediately written off as just another woman wanting a part time career. I was recently told by a Neurosurgeon that General Practice is not “academic”. However, a career is what the individual makes of it. Some people, both female and male, see medicine as a 9 to 5 job, and some devote their lives to it. My research suggests that this may be heavily influenced by the culture and the expectations inculcated in the training environment (4). A recent article laid the blame for the continuing ‘glass ceiling’ on society’s expectations of women, and proposed that both genders have more choice regarding work-life balance (5). My research suggests that both male and female students would like more options (4). However, current career models allow little choice for either men or women regarding taking time out, or spending more time with family. Moving to a new 48 hour week, will force everyone to do something else with their time. This may mean sitting in board meetings, doing research ‘out of hours’, or spending time with children. The choice should be available to every individual regardless of gender. There is pressure from society on women to do more than an equal amount of child care, but the multitasking this involves should be celebrated. 60% of entrants being female should not be the issue; what is the issue is that they are treated differently from their male counterparts. Society is changing, it’s just that the people currently at the top have not yet realised it, or made adequate arrangements for it. 1. Laurance J. The medical time bomb: too many woman doctors. The Independent. 2 August 2004. 2. Firth-Cozens J. Effects of gender on performance in medicine. BMJ. 2008: 731-732 3. McKinstry B, Dacre J. Are there too many female medical graduates? BMJ. 2008: 748 -749 4. Drinkwater J, Tully MP, Dornan T. The effect of gender on medical students’ aspirations: a qualitative study. Medical Education. 2008: 42: 420-426 5. Reeves R. Work isn't working. New Statesman. 19 March 2008. Competing interests: I am a woman, I am part of the 60% of female medical entrants, I have recently carried out research in the area, I would like children, I intend to have an ambitious career |
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Nandita M deSouza, Reader in Imaging Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey, Member of Medical Women's Federation
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Dr. McKinstry's article usefully highlights the core problem--that although men might be effective at balancing risk and providing a "full- time" service to their NHS employer, they are shirking fundamental societal responsibilities. The task of child-rearing determines the legacy that we leave our society, and caring for elderly relatives and dependants is what makes us a successful, mature community. Women have traditionally shouldered these important roles. It is time to share them equally with men, freeing us up to do those fast turn-over GP clinics, on-call, and academic sessions. Competing interests: None declared |
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Lesley A MacDonald, GP trainer General Medical Practice, Edinburgh EH4 2DA
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In response to Dr McKinstry’s letter I have to say that I feel as if I have been assaulted, and devalued, and I believe it will now be hard for doctors like me to recover from this attack. It will also deflect attention from the main cause of the very real problem, which is that many (or even most), new doctors, regardless of gender, have very different hopes and expectations of what a career in medicine will offer them. I have worked for 25 years as a full-time partner and GP trainer in a deprived area, and I have never stopped doing my share of out of hours (I am currently contracted to do 10 hours per week on top of my practice commitment). In addition I have been a GP appraiser, summative assessment audit assessor, audit facilitator for the trust, associate advisor for the development of practice based learning, served on the GP quality development committee for the LHCC, have been involved in the development of the PEP, led my practice twice through Practice Accreditation, obtained the Certificate in Medical Education, and have been nominated as a fellow of the College. I have had three children and took 16 weeks off work after the birth of each of them. I never took any time off for child care reasons, nor for my children’s illnesses. Until now, when I am recovering from major abdominal surgery, (not gynaecological in nature) I have never had any sick leave. My plan has always been to work until I am 65. So far none of my male partners, male salaried GPs, male locums, or male interviewees have done, nor have had any intention to do, all of this. Admittedly one partner, who reduced his sessional commitment, works elsewhere (outwith the NHS) in the time liberated, but that is scarcely relevant to the NHS commitment. I respect the right of all of these doctors to make these choices.I do not think it means we should have fewer male graduates. When we advertised recently for a new partner (full time) every single applicant, male and female, including married men who had children and non-working wives, asked if we would consider offering fewer sessions. Two years ago we did a straw poll of our then registrar group of 14 (8 men, 6 women) if they were going to look for partnerships and 100% of them said no. Course organisers told me that this pattern was reflected in the bigger group of over 80 bright young men and women. In conclusion, the truth is that I used to agree with Dr McKinstry; I believed that general practice was sitting on a demographic time bomb with the preponderance of women coming through. What changed my mind was the discovery that it was not the just the women graduates who wanted a reduced commitment, but all of the graduates. It made me feel better as a woman but obviously did not make me very hopeful for the future of general practice. I meet many of our future GPs in the out of hours service. They are highly personable, educated, intelligent, and talented. They know what they want to do and it is not what I do. They tell me explicitly "no-one wants to work like that any more", I have met quite a few young men who tell me they want to "do locums for a few years, then find a part time salaried post, perhaps taking a few months off each year in the ski season". I tell them that we always had room for a few eccentrics who wanted that sort of career (indeed we welcomed them), but that these people were completely reliant on a majority who were willing to run the service and provide the practices where they were going to do locums and work part-time. I point out that if they all want to do it the whole system will collapse within a few years. This might please the government, as they rush in with their polyclinics. This might also suit the young doctors who can then choose their hours. I think something very valuable will then be lost forever, but perhaps no-one cares about that (except the patients?) I fail to see how anyone inside or outside the profession can argue with the idea that we should all give time back to the NHS in the country which trained us. And if they cannot or will not give enough time then we need more doctors. I believe that despite my gender I have given as much to the NHS as most people, and will continue to do so. I have probably not given as much as Dr McKinstry, but I would defy him to find any evidence that this is because I am a woman Competing interests: I am a female medical graduate |
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Kiran K Turaga, Surgery Resident Creighton University Medical Center, Gargi Bhagavatula
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The gender distribution in medical specialties need not reflect the population. For instance, look at nursing, dentistry, construction: gender roles are defined in these professions. The choice of medicine or a sub- specialty should be a function of competence, not gender, race etc. It is interesting that despite having >50% medical school graduates as women, less than 20% choose general surgery, and 14% of all surgeons are women in the US. Thus, female medical graduates self select themselves to specialties that meet their needs. We must avoid trying to equalize the distribution, rather, we must provide opportunities and remove barriers to this choice. Competing interests: None declared |
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Antoine Kass-Iliyya, F2 Obs&Gyn University Hospital of North Staffordshire, Stoke on Trent, ST4 6QG
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There are 3 important points I would like to make 1- Maternal Instincts: Nowadays, many women are asking men to take similar responsibilities of raising the kids, but none would ask the kids, what they want and whom they prefer? Talking from my point of view, when I was a child, I surely preferred my mother to look after me, rather than my father, what a child look for is affect, compassion, care, love, and tenderness, many of these gifts are naturally and inherently present in women, in fact that what maternal instinct is all about. The majority of kinder garden and preliminary school teachers are females, this secret bonding between female gender and kids is written in the book of nature and it cannot be changed or substituted… you are asking men to give something they don’t possess, I’m not saying men don’t love their children, they do, but they can’t substitute women even in million years. The same instincts can be found in animals; mothers always support, defend and care for their cubs until they become independent. Asking men to assume the role of mothers or equally share that role is going against nature, and I believe they will fail miserably. 2- Physical/physiological differences: Talking medically, Male dominant specialties are the toughest specialties, and tough specialties require devoted people. In the current extremely competitive world, to be successful in a career like surgery or an academic career, you should be extremely committed, you should be overzealous, hardworking, devoted and you have to show good career progress. Being a female and wanting surgery for example, means that you have no time to get pregnant, at least in the first few years of the specialty, as having frequent career breaks would not help career’s progression, let alone the involvement with children care which is inevitably distracting and hindering many potentials for excellence. By the time a female surgeon becomes a consultant and considers getting married or having children if already married, the crucial physical difference between men and women sets in; We can’t deny the fact that Women age quicker than men, a 35 year old male consultant surgeon, is at his peak and is attractive for many women including younger women, with a huge potential to get married, in the same take, a 35 year old female consultant surgeon is not as attractive, and If she didn’t get married until this age, which is a likely scenario given the nature of her job, then her chances of getting married are less and her physical attractiveness is withering by the day, and even if she already got married she has only few years left to have children safely. Some would argue, that there are very successful female consultant surgeons who were married at an early age, had many kids and led a happy life, I am not saying it’s impossible, it can be achieved, but such examples are exceptional, it’s not common and thinking otherwise is simply not true. 3- Women’s rights defenders Most women who defend the idea of equality, and the competency of women to work in demanding careers, are in fact not a representative voice of the majority of women, they are themselves excellent women and they managed to strike a very difficult balance between their careers and their families, but not all women are exceptional, and asking all women to be the same, or putting women under the illusion that they can do it, is not to the best thing to do. If women want to deny their maternal instincts, if they want to devote themselves to their careers the same way men do, if they don’t care about how years bear on their bodies and looks, if they don’t care about getting married and have kids at an early age, then I have absolutely noting to say, but to me, the first victim of such approach would be women themselves. P.S. I am only talking about women who choose to work in demanding specialties or careers, I have nothing against women who choose to work in family friendly specialties, which I always believe is the best of wisdom. Apologies to all women who find my comments offensive. Competing interests: None declared |
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Beryl de Souza, SpR Plastic Surgery Barts and the London NHS Trust E1 1BB
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Has the question been asked as to why fewer males are applying to study medicine? Is it possible that some of the reasons to consider are that there is no job security, training costs are high (eg exams, self- funding of courses), the work is intense, with pay that does not reflect time spent, and medicine is seen as a professional job and not a career? In the imminent future the European Working Time Directive will ensure that both male and female trainees work a 48hr week. 'Less-than- full-time' working will become the norm from trainee to consultant level and therefore job patterns will change. Women generally only work part time for some of their working lives, when their children are young. This gives a bimodal working pattern with subsequent return to full time employment. There should therefore not be any anxiety as to loss of "woman power" in the NHS but rather innovative ideas for job creation and job-sharing as part of workforce planning. The Medical Women's Federation, which is over 90 years old, strives to encourage and support our medical students and juniors to achieve their career goals. We listen to our members and the problems of trying to combine family and careers and facing barriers. The career choices that women make in medicine after graduating reflect the opportunities available and we continue to lobby for equal opportunities. If it means less than full time training is needed for equal opportunity towards career progression, then this should be available. The results of our study “Making Part-time Work” are to be launched in June and will provide useful data on less than full time working experiences of both male and female doctors. Beryl De Souza
Competing interests: Joint Honorary Secretary Medical Women's Federation |
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Co-Chairs Equal Opportunities Committee, British Medical Association BMA House, Tavistock Square. WC1H 9JP, Professor Bhupinder Sandhu MBBS, MD, FRCP, FRCPCH & Dr Justin Varney MBBS, MSc, MFPH.
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Dr Brian McKinstry (BMJ April 4th 2008 “Are there too many female medical graduates?”) accepts that for many years women have faced unfair discrimination and that he supports their role and the strengths they bring to medicine. However he goes on to suggest that “in the absence of profound change in our society in terms of responsibility for childcare we need to change approaches to recruitment in the interests of equity and future delivery of service.” This suggests a position which would see women discriminated against because of their reproductive capability, a position which is illegal and irresponsible. There have been obvious changes in societal attitudes towards women and the role of women, and as with many cultural shifts the medical arena has been perhaps slower to adopt these changes, but long gone are the days of suffragettes and the concept of the female gender as a second class in terms of autonomy or productivity. It is sad that Dr McKinstry’s arguments seem to reflect a tenuous evidence base recently rehearsed in the Journal of the Royal Society of Medicine (JRSM), instead of arguing for more robust exploration of gender comparisons with transparent methodology and like for like comparisons, he proposes discrimination that could disable the healthcare profession and alienate the majority of the workforce. Childcare is no doubt a significant challenge for the NHS, for all healthcare professional groups. As the proportion of women in medical schools moves to reflect the national demographic (1) the NHS will need to make true the commitments of the 2000 Labour NHS Plan to a flexible, accommodating and productive workforce. It is also worth noting that as the general population grow older, the burden of caring may not be restricted to those with children. We would suggest that although arguments about gender productivity provoke extreme reactions and can prompt a new onslaught of sexist humour, the global evidence base and legislative framework suggest that where women are given equality of opportunity, resource and infrastructure, they achieve at least equal productivity. (2,3,4) The reality is that the NHS has not evolved to meet the needs of the 2008 workforce. The argument should not be about women taking time to support their children, because the evidence base is that men value the opportunity just as much,(5) but rather be about the way the NHS can maximise productivity alongside maximising workforce well being, moral and loyalty. ‘1.2 Our vision is of an NHS where staff are not rushed off their feet and constantly exhausted; where careers are developed not stagnant; where staff are paid properly for good performance; and where childcare is provided in every hospital. Ours is a vision of a renewed public service ethos, a system that values the dedication of staff and believes that trust is still the glue that binds the NHS together.’(6) The 2005 NHS Staff survey found that 4 times as many women experienced bullying or harassment from colleagues compared with men in the survey.(7) This reflection of the experience of women in the NHS is shocking and illustrates the poor interpersonal relationships between men and women in the NHS which can be perpetuated by the mythologies and discrimination promulgated by Dr McKinstry. We hope that his article prompts all of us to consider our own prejudices and practice and lobby for an NHS which is truly a gold standard employer for a diverse, exciting and challenging workforce at all levels. Yours sincerely, Professor Bhupinder Sandhu MBBS, MD, FRCP, FRCPCH & Dr Justin Varney MBBS, MSc, MFPH. Equal Opportunities Committee Co-Chairs British Medical Association 1 The demography of medical schools: a discussion document. BMA. June 2004. P59. 2 A fair deal for women in the workplace – an interim statement. Women & Work Commission. March 2005. 3 Towards A Fairer Future: Implementing the Women and Work Commission recommendations. Department for Communities and Local Government. April 2007. 4 Gender Differences in Agricultural Productivity: a Survey of Empirical Evidence Discussion Paper Quisumbing Agnes R. June 1995. 5 Mather H. Specialist registrar’s plans for working part time as consultants in medical specialities; questionnaire study. BMJ 2001;322:1578-9. 6 The NHS Plan. Secretary of State for Health. July 2000. section 1.2. p17. 7 NHS Staff Survey 2005. Healthcare Commission. Q30d. Competing interests: British Medical Association Equal Opportunities Committee Co-Chairs |
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W Juliane A Groning, GP registrar Preston Grove Surgery Yeovil BA20 2BQ
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What is the reason for the best male applicants to universities to choose other subjects over medicine? Male students would traditionally choose careers which are lucrative, stable, and with a high professional reputation. If the proportion of male to female students is shifting, is the reason not just the doubtless better academic achievements of female students, but also a choice away from medicine? Does it reflect the reduction in job security, lower pay than the private sector and 'doctor bashing' in the media? Commenting on 'efficiency': To see as many patients as possible in a clinic can backfire and lead to a high number of follow-up appointments and reduced patient satisfaction. Having worked for male consultants, some very 'efficient' and others taking more time, I know that a little more time spent at each appointment lead to less follow-up and better patient self-management, surely a desirable outcome (and nothing to do with male/female working patterns). Competing interests: None declared |
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Hannah J Smith, unemployed none
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interesting but rather offensive article... i suspect people like Brian will next be advocating that we also limit or stop older students from studying medicine as they also will have a shorter active working life... i disagree with him. if there's a shortage, let's have more students and train more postgraduates rather than prejudging female applicants who may or may not individually work less. we should wholeheartedly reject any proposal that calls for gender discrimination. a more positive step would be to look at why medical graduates stop working and what can be done to persuade them back to work. Competing interests: None declared |
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Barbara Pierscionek, Acadamic Professor University of Ulster, Dr Patricia Hart
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Dr McKinstry is to be congratulated for making an important observation and cogently presenting the potential consequences of a greater proportion of female medical graduates compared to male. The question that is not answered is why more females than males are admitted to medical schools and the issue that is not addressed is that perhaps the answer lies, at least partly, in the fact that the education system fails more boys than girls. There is a disturbing spread of feminisation across society leading to mistaken beliefs that boys, and the men that they become, are worse at communicating, cannot show empathy and consequently are not as good at caring. This, of course, is all seen from a female perspective with no recognition that a male manner of communicating, showing empathy and care may differ from that of a female but it is no less acceptable. Women are not better at being doctors than men are but with more women in the profession, the talents and skills of male students and eventually male doctors stand the risk of being eroded. As academics and educators in the clinical and medical professions we have seen and heard of excellent male students chided and even insulted by female clinicians for being poor communicators because they do not behave in a certain way that is more characteristic of females. Unlike the female student who can complain of sexist behaviour if a male tutor were imposing his viewpoint on her communication skills, the male who is unfairly treated by a female tutor is unlikely to make such a complaint. The chatty, touchy feely manner may be favoured by some, but not by others. One can only wonder whether the gradual loss of public respect in the medical profession, the increasing input, in medical courses, of sociological topics and the over emphasis on communication skills at the expense of the science of medicine, are not all correlated with a feminisation of the profession. The solution lies in keeping the numbers of male and female students equal and in ensuring that the equality begins years before applications to medical courses are made: by providing schooling that is as fair to boys as it is to girls. Professor Barbara Pierscionek Dr Patricia Hart Competing interests: None declared |
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Pilar Arrizabalaga, Consultant Nephrology Service, Hospital Clinic . I.D.I.B.A.P.S. Barcelona Medical Council.Spain.
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Dear Editor, The proportion of women as students at the medical school and residency programs for medical specialisation has risen dramatically over the three past decades in the developed world. A recent Head to Head under “Are there too many female medical graduates?” was controversial. Brian McKinstry - senior research fellow, Community Health Sciences: General Practice section, University of Edinburgh - said yes (1). He argued women are more likely to choose less pressurized disciplines, work part time, take career breaks, and leave medicine early. Jane Dacre – vice dean, Faculty of Biomedical Sciences, University of London; and academic vice president, Royal College of Physicians, London - replied medicine needs and want to attract the best and brightest people, whatever their sex (2). Whereas women now outnumber men at entry to medical workforce, they are still under-represented in some specialities and in the higher career stages, as it has been noted by Allen in United Kingdom, and Arrizabalaga, Moreno, Merino and Estrach in Spain (http://bmj.bmjjournals.com/cgi/eletters/331/7516/569). McKinstry and his colleagues Colthart, Elliot and Hunter - NHS Education for Scotland – previously have expressed their pessimism about the feminization in medicine (3). It’s unlike to the tradition of the University of Edinburgh, where Sheila Sherlock (SS) (1918-2001) was fortunately accepted in medical school, after she was rejected as student in three universities. SS would hold the first European Women Professor in Medicine. Underlying the debate about feminisation in medicine: what sort of medicine do we want? Because adequate service delivery is a basic requirement of workforce. Women are changing the profession itself. The tendency for women in medicine to provide patient-centred care has interesting implications for the profession. Women are likely to be sensitive not only to patients’ biomedical concerns but also to their emotional concerns. Studies have demonstrated effective communication skills can enhance outcomes of care, including patient adherence to treatment recommendations, biological outcomes in chronic disease, and patient satisfaction. Models of health care delivery at the local level are changing rapidly toward a multidisciplinary team approach to patient care. Studies of leadership style indicate that women empower other team members to develop their potential, act as role models by gaining confidence of colleagues, and take an interest in the personal needs. Some authors point out that the M-shaped distribution of women’s careers has been recognized for a long time: a peak in the early years, a dip in the middle and then the potential for a peak in later years. The careers of women do not fall after childbirth, as many people believed (4), and for that reason, the potential contribution of women in the second half of their careers has not been fully recognized. There is, however, the hope that more women gain positions of power and high rank, and that the institutions will be able to warrant equivalent opportunities to women and men. References 1. Mc Kinstry B. Are there too many female medical graduates? Yes. BMJ 2008; 336: 748. 2. Dacre J. Are there too many female medical graduates? No. BMJ 2008; 336: 749. 3. McKinstry B, Colthart I, Elliot K, Hunter C. Women's contribute less than men to non-clinical care as general practitioners in Scotland. BMJ 2005; 331: 696-97. 4. Allen I. Women doctors and their careers: what now?. BMJ 2005; 331: 569-72. Competing interests: None declared |
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Barbara Pierscionek, Professor University of Ulster, Cromore Road, Coleraine BT52 1SA
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Dr Patricia Hart and I wrote in support of Dr McKinstry (1) and pointed out the misguided arguments, about women being better carers and communicators that are used, mainly by females, to make the case for women being better doctors (2). We did not have to wait too long for the evidence. Pilar Arrizabalaga (3) makes the sort of unjustified statements: “Women are likely to be sensitive not only to patients’ biomedical concerns but also to their emotional concerns” and “Studies of leadership style indicate that women empower other team members to develop their potential, act as role models by gaining confidence of colleagues, and take an interest in the personal needs” that are not backed by any proper scientific analysis and only serve to perpetrate the myth that women are better carers, better communicators and hence better doctors than are men. Yes Pilar, women may be ‘changing the profession itself’ but not necessarily and in all aspects for the better. 1. Mc Kinstry B. Are there too many female medical graduates? Yes. BMJ 2008; 336: 748. 2. Pierscionek B. and Hart P. Feminisation of medicine begins before medical school. Rapid response 11th April 2008 3. Arrizabalaga P. Are there still barriers to women in Medicine? Rapid response 28th April 2008 Competing interests: None declared |
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