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Editorials

Improving the position of women in medicine

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7176.71 (Published 09 January 1999) Cite this as: BMJ 1999;318:71

Will not be achieved by focusing only on the problems of women

  1. Elaine Showalter, Professor of English (eshowalter{at}compuserve.com)
  1. Princeton University, NJ, USA

    Papers p 91

    Along with other Scandinavian countries, Norway is one of the world's most progressive societies in terms of sex equality: dual career families are the norm, and official policy has favoured women in the workplace. Yet, even here, women doctors have not competed equally with men to achieve leadership in their profession. On p 91 Kvæner et al show that despite high sex ratios, liberal maternity leave policies, creche facilities, and funds for daycare, women doctors in 1997are still not taking leadership positions in hospital medicine, academic medicine, public health, or private health care. In the 1990s half of Norwegian medical students have been female, but the new generation of female physicians is no more likely to be in leadership positions than the older ones. Do women simply lack ambition? Is equity in medical leadership an impossible goal? What do women doctors want?

    Kvæner et al show that women continue to cluster in less prestigious, lower paid specialties and “report less interest in academic careers and leadership” than men. They conclude that women are more likely to be leaders in specialties where they make up more than 25% of the total and in those like public health with regular working hours that fit in with family responsibilities. These data suggest that women doctors choose personal commitments at the expense of professional power; possibly even more flexibility in part time work would help them balance their lives and careers and move into more positions of influence. In the mean time progress seems to have reached a temporary plateau.

    Yet asking what women doctors want may be the wrong question. Women doctors want the same things other women and other doctors want—challenging work and fulfilling personal lives. Part of the current impasse may still come from traditional female conflicts between career and family. Even on a popular television program like ER, where many female physicians are shown in positions of authority as surgeons, chief residents, and hospital executives, none have husbands, let alone children.

    Unfortunately, one sided social change at the institutional level, such as setting up childcare facilities or slowing down the career clock for mothers, doesn't automatically translate into change at the personal level. If male partners in the dual career marriage still expect to put in long hours, to network, and to participate in informal power systems women will be disadvantaged. Moreover, the very structure of medical training creates a mystique of stamina, fierce dedication, and stoic endurance, so that deviation from the norm, however licensed, spells weakness rather than leadership potential.

    Prominent women in medicine also point to the hierarchical system of medicine and the subtle and overt resistance to female authority. In her book, Walking Out on the Boys, Frances K Conley, professor of neurosurgery at Stanford and acting chief of staff of the Palo Alto Veterans Health Care System, discusses the sex discrimination she encountered in academic medicine.2 In medical school in the United States, she notes, “the message heard by women was that only a certain few disciplines were open to us, and …we should not expect a built-in support system.” Without “prohibitive written policies,” women were steered into the low prestige specialties. Conley believes that “medicine's rigidly controlled academic culture …precludes equal opportunity for all students. Women are still viewed as …infinitely more suited to a career in primary care than in a surgical or medical speciality.”

    The statistics on leadership and influence in medicine are no different from those in other professions. The picture would look the same if we considered women as deans or chancellors of universities, presidents of corporations, political candidates, or film directors. Research and testimony from the professions in general make it clear that sex equality cannot be achieved solely by a focus, however earnest, on the problems of women. The greater challenge is also to change the attitudes of men as well, and to transform public, internalised assumptions that link professional leadership to long hours, sacrifice of personal interests, and stereotypes of managerial style. Women have already overcome many obstacles and accommodated themselves to traditional structures in order to enter a medical profession that long excluded them. If they are to achieve leadership, the profession, as well as the women, will have to change.

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