Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Yes but
- Peter A West (4 April 2008)
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Gender and ability to practice medicine
- Carl J Reynolds (4 April 2008)
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Should we cap the number of women entering medical school?
- Susan J. Ward (5 April 2008)
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Feminisation of the medical profession....
- Kathryn McCarthy (5 April 2008)
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Re: Should we cap the number of women entering medical school?
- Rosalind M. Duhs (5 April 2008)
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Back to the kitchen sink then?
- Martha Scott (5 April 2008)
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Preliminary study on increasing feminine matriculation in a developing country
- Alberto E D'Ottavio, Larisa I. Carrera (5 April 2008)
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Why Is This News?
- Sacha C Haworth (7 April 2008)
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Are there too many female Drs?
- Helen J Miller (7 April 2008)
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Another Crisis!
- Nancy Blake (9 April 2008)
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Is this really the 21st century?
- Iris P. Gonzalez, M.D. (9 April 2008)
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Too many men or too many women
- Maria Bauer (9 April 2008)
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Far play for women doctors and their families
- Morris Greenberg (9 April 2008)
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The personal is professional
- Finola C Lynch (10 April 2008)
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Too many women in medicine?
- GEORGE Y. CALDWELL, SINGAPORE 259858 (10 April 2008)
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'Are there ever enough women?'
- Kirsty E Zealley (11 April 2008)
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Let the job market self-regulate
- Eleni T. Petridou, Georgios Antonopoulos, Giagkos Lavranos, Maria Mpinou, Evi Germeni, Giannis Matsoukis and Theodoros Sergentanis (12 April 2008)
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Aren't we missing the point?
- Julie A Teague (23 June 2008)
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Peter A West, Senior Research Associate, York Health Economics Consortium YHEC University of York York YO10 5NH
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Yes there may be too few women in senior medical positions but overall it does not appear that this article really addresses the main thrust of the article it is responding to. It includes the suggestion that while more women are training in medicine, the fact that they work less means that numbers in practice are more equal. This could of course be used to justify ever larger proportions of women medical students if the working life of women doctors were to get shorter and shorter! What about the return on the expensive investment in medical training? And why is it assumed that medicine wants and needs the most brilliant minds. Surely it wants and needs minds that can adapt well to the work of medicine, including its stimulating and demanding elements and its more routine elements. The most brilliant can also be the most frustrated in many professions. And yes, on-site creches would probably help to keep more women doctors working full time. But this is as true for women in all forms of employment. Hospital creches would need to provide for all the staff, in my view, and the costs and benefits would need to be considered before the NHS took on a major role in child care. Competing interests: None declared |
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Carl J Reynolds, Medical Student Royal Free and University College Medical School, WC1E 6BT
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The author appears to claim that female Doctors might achieve better patient outcomes than do male Doctors. The scope of the meta-analysis (1) referenced in support of this claim is limited to the primary care setting. Further, it is important to distinguish measured patient outcomes from actual patient outcome since the two may not be the same. The complexity of the medical interaction makes it difficult to capture the true, overall, outcome for the patient through the measurement of patient outcomes. For this reason the validity of applying such measurments to compare the overall ability of male and female Doctors is questionable. 1. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA 2002;288:756-64.[Abstract/Free Full Text] Competing interests: I am a male final year Medical student |
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Susan J. Ward, Consultnat Gynaecologist Kings Mill, Mansfield
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The Medical Women's Federation has been representing women doctors and their patients for over 90 years. When it was founded in 1917, it was very difficult for women to get into medical school, and their subsequent careers were also fraught with problems. Although the situation regarding access to medical training has now been dramatically reversed, there are still many difficulties in the way of female doctors who wish to combine childbearing with a medical career. This explains the comment made by Jane Dacre on radio 4 this morning about attrition - how the women who graduate from medical school are less likely to progress in their careers than their male counterparts. We have heard people describing women wanting to have children and a career as "Having their cake and eating it" but as Cherie Blair once famously said, we think of it as a juggling act. Women are getting their places at medical school on merit. Are people really suggesting that well qualified, clever and motivated women should not have access to this worthwhile and rewarding career? Surely it is the job of all of us to help them overcome the problems they face rather than just planning to reduce the numbers of women facing the problem. The MWF and many of the representative bodies in medicine, such as the colleges, have been having discussions with the Chief Medical Officer and the Department of Health to make plans to cope with the rise in the population of women doctors and would like to point out that we prefer to look upon the situation as a challenge rather than a problem. Competing interests: President of Medical Women's Federation |
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Kathryn McCarthy, Specialist registrar, General Surgery Wessex Deanery
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The 'feminisation' of the medical profession is an increasingly debated topic in medicine and also the press. Carol Black, president of the Royal College of Physicians, made the front page when she voiced her concern that there would be no future professors of cardiology. Ever since the beginning of the profession there has been a predominance of men. Infact, it has taken us female doctors thousands of years to progress up the ladder. I find it incredible, therefore, that the first sign of an increase of women over men should spark such a furore. Are we not allowed a few thousand years grace? The author (Mr McKinstry) must be the only person who is concerned about future staffing levels in these troubling times of unemployment and the MMC. One possible solution to the over-production of trainees, particularly in surgery, would be to offer them all 50% job shares. This may go some way to improving flexibility in the profession. Competing interests: None declared |
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Rosalind M. Duhs, Senior Teaching Fellow Centre for the Advancement of Learning and Teaching, University College London, WC1E 7HB
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Jane Dacre's reaction to Brian McKinstry's views is much needed and appreciated. Since my return to England after ten years in Stockholm, I have been disappointed that progress has been comparatively slow in supporting women in their careers in the UK. The resultant loss of talent is regrettable. There are many women who are unable to work as much as they would like. Sweden is a good model, as a culture of men also being responsible for looking after their children is emerging there. This has been gradually built up through the provision of excellent affordable childcare and an expectation that women with young children will continue with their careers and work flexibly. The result is the highest birth-rate in western Europe, tempering the aging of the population. Despite (or perhaps partly because of) this flexibility, healthcare provision in Sweden is of an extremely high standard. Competing interests: None declared |
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Martha Scott, SpR Respiratory medicine Poole Hospital, Longfleet Rd, Poole, Dorset. BH15 2JB
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Splendid, I am delighted that my XX status means that apparently I am less productive (1), more (2) or less (3) likely to retire earlier. That ‘in the absence of a profound change in our society in terms of responsibility for child care, we need to take a balanced approach to recruitment’(4). Sorry, am I missing something here? Roughly 50% of our society is female – I think that a profound change in society sounds like a damn good idea – and I would call it ‘enabling a level playing field – finally’ ‘Balanced approach to recruitment’ pardon? Discrimination on the basis of gender more like. Perhaps as well as excellent grades a fertility assessment at application to medical school – if you are a ‘breeder’ back in the box? Productivity – brilliant, conveyer belt medicine – what about outcomes? I have done far too many outpatients where either you are left wondering what an earth the patient is doing there - as does the patient. Or being too pushed for time to be able to get to the bottom of what is going on/investigations not back/done and having to rebook to feel that number of outpatients seen is a desperately reliable tool in judging quality – surely I am not alone in believing that quality is better than quantity? How we can even muse on gender differences in productivity given inherent bias in coding, crudity of data collection and exclusion of anyone who is not full time or maximum part time1. Frankly, I am livid. MMC, political masters, morale issues, unemployment, working time directive these are all having an enormous impact on our ability as doctors to function and provide the best quality health care by impacting on training, work patterns and hence continuity of care - and what have we focused on – ‘too many female graduates’ Flexibility, thinking outside the box, adaptability are key skills for any doctor – so here’s a thought – how about looking at new ways of utilizing a highly skilled work force, leading the way in reducing the inequalities in OUR society and sending out a firm message to society at large that discrimination in any shape or form on the basis of gender, sexuality and race is unacceptable. Dr Martha Scott. SpR Medicine. References: 1: Bloor K, et al. Gender and variation in activity rates of hospital consultants. J R Soc Med 2008; 101:27-33 2:McKinstry B, et al. The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practioners BC health serv Res 2006;6:56 3: Batchelor AJ. Senior women physicians: the question of retirement. N Y State J Med 1990; 90:292-4 4: Mckinstry B, Are there too many female medical graduates? Yes. BMJ 2008; 336:748 Competing interests: None declared |
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Alberto E D'Ottavio, Professor and Researcher Rosario Medical School and Research Council, Rosario National University, Argentina, Larisa I. Carrera
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During 2005, we examined reasons of potential relevance concerning the progressive increase of feminine matriculation registered in an Argentinean medical school since the percentage of female matriculation exceeded 60 % since 1986 onwards. We guessed that other reasons that population and economic ones were underlying in this augment. Then, a poll applied to 130 feminine and 75 masculine students, among 809 admitted ones was qualitatively combined with an interview to 16 feminine and 10 masculine participants chosen from the same sample following Strauss and Corbin’s procedures. Then, we found that women (82 %) firstly thought of Medicine at the age of 15±1 years and decided for it when aged of 16±1 years (85% women). A similar short deliberative period also occurred in men. Most participants (93.5 % of both sexes) perceived Medicine as their only self-satisfying career, referring no previous university studies. Influence from close persons and mass media (Women: 39 %; Men: 52 %) was referred. Reasons for choosing Medicine showed significant differences between women (Attraction for Biology 53 %; Social role of Medicine 43 %) and men (Social role of Medicine 42 %; Independent profession 30 %) (p = 0.008 and < 0.007, respectively). Qualitatively, women felt capable of facing Medicine and its challenges and of reaching any hierarchic level in it. In addition, Medicine was believed to offer access to several functions, provided autonomy and possibilities for promoting human aspects and personal values. Finally, being Medicine man-tailored, women envisaged it as a challenge to revert such status. Furthermore, they felt that her role as future mothers (considered relevant by them) could be perfectly well-matched with her role as future physicians. To our humble knowledge, further studies are needed in developed and developing countries prior to discuss if there are too many female medical graduates or not. Particularly, if we consider that the proportion of women reaching the top ranks remains relatively low and that the pool of women available for leadership positions in academic medicine is still small. References Strauss A and Corbin J (1998) Basics of qualitative research. Techniques and Procedures for developing Grounded Theory. 2nd ed. Sage Publications, London, UK Competing interests: None declared |
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Sacha C Haworth, FY1 Surgery Inverclyde Royal Hospital
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The debate that there are “too many women” in medicine and that this in turn is bad for the profession is indeed disheartening. I feel I should point that many women in the NHS have successfully balanced family life against long, often unsociable hours. No one seems to complain that a mostly female workforce is bad for nursing! British society burdens women with the combined pressure of employment and family life. Despite the gains made by the feminist movement, men are allowed only a fraction of the parental leave allocated to women after the birth of a child, sending the message that raising an infant is clearly a woman’s responsibility and for no valid, logical reason. The problem is not that there are too many women, but that women are faced with archaic burdens that need to be shared. Competing interests: None declared |
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Helen J Miller, Full-time GP Partner Tain and District Medical Group, Scotsburn Road,Tain,IV19 1PR
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Having read an article in the BMJ (dated 5/4/8) on the feminisation of the medical profession, I must take issue with one of Dr McKinstry's comments. He wrote 'empathy and communication skills are important but so are efficiency and the ability to live with risk.' Is he implying that female Drs, are, by-and-large, inefficient and unable to live with risk ? Instead of presenting a sensible and cogent argument for balancing up the medical profession he has come across as arrogant and out-of-touch with the reality of day-to-day general practice. He is mistaken in his belief that a female Dr who consults more slowly than another Dr, male or female, sees fewer patients. She (or indeed he) actually has a shorter tea- break/lunch-break/administration time. Competing interests: None declared |
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Nancy Blake, Private UKCP Accredited Neurolinguistic Psychotherapist 64 Ella Street, Hull, HU5 3AY
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This sounds like the concerns raised when it began to appear that boys were more intelligent than girls. As long as the intellectual superiority of boys was taken as read, there wasn't a problem. As soon as it seemed that this was reversed, an educational panic ensued. As long as the medical profession is dominated in numbers and in hierarchical superiority by men, everything is fine. If it seems that women might be taking over in numbers (though not yet in terms of professional status), it becomes a crisis. Competing interests: None declared |
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Iris P. Gonzalez, M.D., Director Student Health Services Washburn University Topeka KS USA
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I am flabbergasted that anybody in this day and age might think that there are too many women entering medicine. Are there too many men entering nursing or teaching? What does it matter what gender of human is performing a job if they do it ably? I began my medical training 21 years ago, in the US. Even that recently, the role of the physician was more strictly defined than it is now: physicians elicited a history, performed a physical exam, arrived at a diagnosis and prescribed treatment for it. I remember watching a female pulmonologist at work at that time, and thinking to myself that she was sure acting like a man; she was personable and very smart, but there was little warmth in the interactions, and no give-and-take. Back then, to be a successful woman physician, particularly in academia, you had to be "tougher" than the men. Things are different now - the physician-patient relationship is on average less patriarchal and less unequal, and I like to think that this is a consequence of the increasing numbers of women entering the field. Female physician are less authoritarian than men; they see themselves more as highly informed facilitators of the medical process; they develop more collaborative relationships with their patients, which result in more complete information sharing by the patient, better patient education, a plan of care more acceptable to the patient, and better outcomes. The time I invest in educating patients about their condition improves their self-care abilities and well-being; I certainly note that more of my patients come to me stating that they took effective first line care measures (e.g. nasal irrigation at onset of a cold or sinus symptoms), but that these had failed and they thought it might be time for an antibiotic. Incidentally, another great bugaboo of medicine has been "sharing;" telling patients anything about oneself has been considered anathema. I can tell you from experience that limited disclosure can help patients feel that they are understood, which is an important part of the therapeutic relationship. The "therapeutic relationship" (a "safe" place for patients to air their concerns and receive responsive advice) is another concept unheard of in the "bad ol' days" of, "Me Doctor/God, you patient, do what I say." Look at the April 3rd BMJ article on the components of the placebo effect: "assessment and observation, a therapeutic ritual (placebo treatment), and a supportive patient-practitioner relationship" - make the assessment and observation component accepting and comprehensive, remove the placebo part of the prescription and you have an effective physician-patient relationship! Although I cannot argue that the changes in medicine enumerated above have been due solely to its increasingly feminine face (certainly the US' Family Medicine specialty has encouraged evolution of a healthier physician-patient relationship), as a female physician I want to claim credit for the hard work I have done exploring my professional role and re -defining it in a way that is more comfortable for me and my patients, and more effective to boot. I challenge the medical establishments in both the UK and the US to work to eliminate even the faintest air of controversy surrounding the changing demographics of medical students and practicing physicians. Do not look at me and see a "female physician;" I am a physician, and a damn good one, because I listen to and respect my patients, and take care to act in their best interest. There are more pressing aspects of medicine - such as the trend toward running more and more patients through 5-minute office visits in an assembly line atmosphere - that need to be addressed instead. Listen to the women; they will help you fix the situation. Competing interests: None declared |
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Maria Bauer, Industry D-40223 Düsseldorf
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that is the question to be discussed. I didn't think that such a discussion would be possible nowadays, seriously. It should be an April fool but I'm afraid that it's not. Competing interests: None declared |
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Morris Greenberg, Retired 74 North End Road NW11 7SY
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Sacha C Haworth's comment on: Jane Dacre. Are there too many female medical graduates? BMJ 2008; 336: 749 BMJ 2008; 336: 749, included the statement: " I feel I should point that many women in the NHS have successfully balanced family life against long often unsociable hours." Anecdotal evidence confirms Dr Haworth's assertion that medical work often involves long, unsocial hours; unsocial in the sense that they are often unpredictable and interfere with regular sleep and leisure. With the best laid plans for children (and even for spouses), family life remains unpredictable and sleep and leisure are disturbed. The problem of reconciling career with family is a complex one, and like all complex problems is not susceptible to a simple solution (eg Paternal participation and job sharing). We all know of Stakhanovite Professors X, Y, Z et al who worked on close to the time of delivery and resumed promptly afterwards, and received well deserved glittering professional prizes. They started work early each day, attended meetings late at night, and travelled extensively. This will have left a limited amount of time for family, giving a special meaning to "balanced": holding them up as examples of what is open to other women is as unkind as it is irrelevant. Once accept for professional women that but for the extreme exceptions, reconciling work and family is particularly difficult, then the Department of Health and the NHS management must revolutionize manpower calculations, postgraduate training, and job profiling, to reconcile the reasonable career expectations of women doctors, the needs of their families, and the needs of Society. Competing interests: None declared |
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Finola C Lynch, FY1 James Paget University Hospitals NHS Foundation Trust, Lowestoft Road, Great Yarmouth, NR31 6LA
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Imagine your brilliant daughter is training to be a doctor. She has a string of perfect scores in her school exams, she loves her degree and has found her vocation in one of the hospital specialities. Then she chooses to downsize her career ambitions because she knows that at some point in the future (and at this point in her life she can't say when) she would like to have a family. However her perception of hospital medicine is that it's inflexible and unforgiving towards family life. Conversations with undergraduate female students often circled around this theme and I began to wonder if there was a trend. So as part of my undergraduate training I did a research project and reached the sad conclusion that women are choosing between "personal commitments and professional power"(1) even before they qualify as doctors. The entire medical student population (years 1-5) at the Institute of Health, University of East Anglia, was given a questionnaire based on the British Medical Association's Cohort Study of 1995 Medical Graduates. From a 47% response rate (262/619) hospital-based specialities were the most popular overall (60%) with the remainder split roughly 50:50 between general practice or being undecided. There was no significant difference based on gender or stage of training. However in the hospital specialities significant gender differences emerged in male preference for Surgery and Radiology and female preference for Obstetrics and Gynaecology. Undecided students and students who changed their minds about their career aspirations during their training were more likely to be female. They were also more likely to consider part -time working at some point in their career in both early (years 1-3) and later (years 4-5) stages of their training. A small focus group met to unpick the questionnaire answers. What emerged was that personal circumstances such as having a family had a greater influence over the career aspirations of undergraduate females. Male undergraduates tended not to anticipate the career impact of such circumstances. This may explain why more females than males considered part-time working and were more undecided about their career aspirations compared to males. These findings suggest that to make best use of women doctors in the National Health Service (NHS), all specialities need to develop posts which allow less than full-time working. This should become easier for workforce planners as the recent swell in undergraduate recruitment starts to hit the wards. Brian McKinstry is right. For years women have been unfairly discriminated against in medicine. However, their rising numbers do not suggest that the glass ceiling has lifted. Barriers to the success a woman might seek are still built into workforce planning and career structures. In fact they are so endemic, that undergraduate females are already anticipating their implications. Finola Lynch FY1 doctor, East of England deanery f.lynch@doctors.org.uk 1 Showalter E. Improving the position of women in medicine. BMJ 1999;318:71-2 Competing interests: I am a member of the MWF |
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GEORGE Y. CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33, SINGAPORE 259858
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Of course it is immaterial whether man or woman becomes a doctor. The work is surely the same and if either can do it adequately then the more the merrier. BUT when a girl absents herself from work on account of her sex, for whatever reason then she has become an unreliable asset. WHEN she does not want to do night-calls or see, for example, syphilitic seamen and hands the cases over to her male colleagues then she is no longer part of the team. The ladies can't just pick and choose. The best of them do not. What has become a problem is that so many students, both male and female, obtain their medical qualification and then do not practise medicine much, or at all. They sit in the back row and write articles from no or little experience. At least they should experience some years in General Practice before they form any worthwhile opinion Now if the ladies will study and take those prizes and qualify, then aim to work every year of their lives as the men seem to do, then the question does not arise that "too many girls" are qualifying. It is when, it is supposed, that those girls only take up Medicine as a "meams to an end", to find a medical husband perhaps or one in a certain position in society, and then cease to practise, then it has all been a waste of time and perhaps public money. She ceases to be a doctor, and becomes just a title with a medical opinion with little or no experience of the practice of medicine Competing interests: None declared |
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Kirsty E Zealley, GP partner Eastfield Medical Centre,Penicuik, EH26 9LX
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As a 4th generation working female doctor I read with great interest the head to head article 'Are there too many female graduates?'. I too have an anxiety in relation to work force planning with the predominantly female medical school graduates currently being produced. I agree with the points made by both Brian and Jane! Society - and I suspect biology - is unlikely to change the fact that woman will continue to carry the burden of caring for children and elderly relatives for the foreseeable future. As a result I feel we need to acknowledge that woman will often work less than full-time for some or all of their careers. Therefore, we need to accept that we need to train relatively more women than men to ensure that the ratio of doctors working reflects society. Well motivated and well educated women doctors are an asset to the NHS and creating opportunities that can retain their service commitment is essential to avoid wasting huge resources spent on their training. I feel frustrated and saddened by some female doctors who can give the impression that the NHS owes them a living and a good career - when they seem unable to see that that may involve some flexibility on their own part. Let's hope that flexibility on all sides can be developed to ensure that a well balanced service can be offered, while accepting that society needs women doctors to be far more than just that. Competing interests: None declared |
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Eleni T. Petridou, MD, Professor of Preventive Medicine & Epidemiology Medical School, National and Kapodistrian University of Athens, Goudi, 117 25, Greece, Georgios Antonopoulos, Giagkos Lavranos, Maria Mpinou, Evi Germeni, Giannis Matsoukis and Theodoros Sergentanis
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Nowadays, female outnumber male medical students in most EU countries; nevertheless, equal gender distribution alone does not guarantee gender equality. For example, when it comes to specialty selection or promotion to higher posts, women still do not seem to enjoy the same opportunities as men. Indeed, in their subsequent education, female doctors tend to choose specific specialties, namely paediatrics, anesthesiology, dermatology and general practice, whereas there are far more men holding leading positions. Admittance to medical education should remain a competitive process regardless of sex or national origin, using objective criteria for choice of students and medical trainees. Antagonism is an inherent element in the function of contemporary societies and successful candidates have to prove themselves daily as scientists and clinicians, rather than blame sociodemographic variants. With regard to future employment opportunities, we should realise that the job market is a free market, governed by the forces of supply and demand. Once it deviates too much from the optimum configuration, the market forces will automatically tend to correct it. Therefore, any concerns about women crowding certain specialties while other posts remaining relatively understaffed are unfounded since eventually the increased competition and unemployment in the most sought-after specialties will scare applicants away; at the same time, demand for doctors in less preferred specialties will raise wages, generate applicants’ interest and help restore balance. Establishing state controls and putting gender caps on the job market will only strip it of its self- regulating power and inhibit it from adapting to the ever changing needs of healthcare. On the other hand, apart from purely technocratic issues, one may not overlook the human side of the physicians’ personal life. It would be a fallacy to deny the importance of interpersonal relationships fostered in the work environment. Indeed, physicians tend to marry colleagues; this is well known in the literature and has been described as a mechanism of subconscious spousal support [1, 2]. Let’s envisage the dramatic scenario: in a totally feminized context, what kind of interpersonal relationships may be expected among physicians-colleagues? The question lacks a definitive answer, as no systematic studies have explored the impact of the male-to-female ratio upon professional well-being, self-perception, creativity and role-model behaviours in medical settings. With this in mind can we argue that, despite the free and competitive nature of our society, we should impose gender ratio rules upon this job sector? The answer to this question should be negative, because unless a detrimental effect to physicians’ well being from gender imbalance in their workplace can be adequately demonstrated, the null hypothesis should remain that there is no such effect. After all, there are many other job sectors where there is gender ratio imbalance without any harmful effects to the employees and without any calls for gender balancing rules. After our inter-unit debate among four male and two female physicians as well as a female psychologist we concluded: while it cannot be denied that men are becoming a minority in medical schools, this realization per se should not be in any way alarming. There is currently no reason to suspect that this gender imbalance will lead to worse healthcare or damage physicians’ emotional stability. The argument that certain specialties might become understaffed is valid but the answer should be to allow freedom of choice to the job market so as to self-regulate to the respective demand. We feel that trying to control this sector at any point – medical school admission, specialty placement – is very complex, and surely not the pertinent way to address the issue. 1. Woodward CA. When a physician marries a physician: effect of physician-physician marriages on professional activities. Can Fam Physician. 2005 Jun;51:850-1. 2. Østerlie W, Forsmo S, Ringdal K, Schei B, Aasland OG. [Do physicians experience spousal support in their medical career?] Tidsskr Nor Laegeforen. 2003 Aug 28;123(16):2296-9. Competing interests: None declared |
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Julie A Teague, General Surgical Trainee Australia, 3011
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Why are we punishing women for being the people traditionally lumped with caring for the kids/ parents (even the inlaws)/ other family duties? Aren't we missing the point? Doesn't the change need to be joint responsibilities over these things by men and women. Then both sexes can compete in the workplace? Why do women need to keep proving that they are superwomen, why don't the boys just come to the party and do their share of the not so rewarding things so we can all play nicely together? Competing interests: None declared |
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