Despite achieving the legal right to equal pay and protections against workplace discrimination, there remains several barriers to achieving gender equity in medicine. How do we overcome the remaining hurdles?
1975 was International Women’s Year. It was the figurative moon landing for the women’s movement, a flag at the top of Mount Everest, a significant milestone in our race to the South Pole.
It celebrated the gradual, yet tectonic shifts in society made by women who had fought for equal rights. By 1975, women in Australia had secured the right to vote (although this excluded Indigenous women), the right to be elected to a national parliament, protection from sexual exploitation, the right to control their own reproduction and sexuality, the right to federally-funded child care, women’s refuges, the right to equal pay, and the right to have a drink at a public bar (cheers).
Women had certainly come a long way.
And in the ensuing years, more rights and protections have been established – the criminalisation of rape, for example, as well as greater recognition of women’s rights as human rights. In 1984, the Sex Discrimination Act was enacted, making sexual harassment and sex discrimination against the law. There’s also been an increasing awareness of the barriers and gender inequality faced by Aboriginal and Torres Strait Islander women, older women, ethnic minority women, and women with disabilities.
Forty-three years have passed since that landmark in the women’s equality movement, which begs the question – are we there yet?
Current statistics reveal Australian female graduates are outnumbering men, with almost 45,000 more women completing tertiary qualifications last year than men. This trend is also reflected in medicine, with women making up more than half of medical school graduates.
While educational attainment is high, there is still a lot of progress to be made. Women remain underrepresented at all career stages and there remains a huge imbalance at the top of organisations.
In medicine, only 34% of specialists are women and 9.2% of surgeons. According to Level Medicine, rates of female specialists tend to be higher in less lucrative specialties. The organisation attributes the lack of gender parity to the culture of medicine.
“Female students are avoiding specialties that are not perceived as welcoming to women due to a lack of female role models and their approach to parental leave or part-time training.”
According to Dr Danielle McMullen, general practitioner and Vice President of AMA (NSW) medicine is evolving, albeit slowly.
“There is greater community awareness of women as doctors. I frequently get asked by patients to be referred to a female specialist. So we are being taken seriously, which is great.”
But Dr McMullen says the pace of change has been frustrating, particularly around pay equity.
“There is still a gender pay gap. And in general practice this often boils down to the style of consultation – women in general tend to have longer consultations, which are often less well remunerated.”
The starting salary in full-time employment between males and females in medicine is similar. However, as female doctors progress in their careers they can expect to earn less. 2016 figures revealed a 33.6% pay gap for full-time medical specialists, and a 24.7% pay gap among full-time general practitioners. When taking hours worked into consideration, the annual gross personal earnings for female specialists was, on average, 16.6% less than their male counterparts, and female GPs earned, on average, 25% less than male GPs.
2014-15 BEACH data found female GPs offer better value for the healthcare system. They spent longer in consultations with patients and addressed an average of 1.63 health concerns per encounter, compared to 1.51 for male GPs. The data indicates that regardless of experience, female GPs earn $11 less per hour, on average, than their male counterparts. This works out to almost $21,000 per year, and it is adjusted for the number of hours worked.
Understanding why there is a pay gap is complex and there are many factors that contribute to the discrepancy in pay – the most obvious being females are more likely to take time out or work part-time to care for children or aging parents. Female GPs with dependent children typically earn less than female GPs without dependent children. Meanwhile the inverse is true for men – male GPs with dependent children tend to earn more than male GPs without dependent children.
Dr McMullen adds, “I think the slow pace of change is hard to swallow, and the failure to understand that for gender equality to really get there, we also need to look at the way men work – both in the workplace and at home. We can’t have it all – women, in general, still bear the heavier workload at home.”
Research by the Australian Human Rights Commission reveals 95% of primary parental leave (outside of the public sector) is taken by women, and women spend almost three times as much time taking care of children each day, compared to men. Australian women also account for 68% of primary carers for older people and people with disability.
On average, women spend 64% of their working week performing unpaid care work. They spend almost twice as many hours performing such work each week compared to men.
“So without asking women to be superhuman, how we can also expect them to be kicking all the goals at work? We need to work together with men to redefine how we both work. And I think men want that too,” Dr McMullen says.
Women are more likely to balance paid and unpaid work by working part-time. Why does this matter? Because part-time employees are less likely to progress into senior or management roles. This is a major barrier to women’s career development and earning capacity.
In medicine, women are often dissuaded from pursuing certain specialties because of the inflexibility of training and hours, and the perception that certain careers are incompatible with family life.
Most doctors undergo post-graduate specialist training between the ages of 25-35 – an optimal time to have children.
Dr Ashna Basu says the inflexibility of training weighs particularly heavy on female doctors who are often faced with a choice between delaying their career or starting a family, and in pursuing either road they risk the other.
“From the very start of my medical journey, my female-identifying friends and I have discussed the best time to have children. Before training? During? Risk the ire of our biological clocks and wait until we’re finished? It’s a conversation we’ve had so many times that doesn’t even factor into the decisions of most of my male-identifying friends. I would much rather be happy-go-lucky and carefree, but that luxury doesn’t exist when you know you risk discrimination because your sex bears the responsibility of pregnancy, and employers still view pregnant women as a burden.”
A 2014 report by the Australian Human Rights Commission found that one in two mothers experience discrimination in the workplace at some point during pregnancy, parental leave, or on their return to work.
In 2017, AMA (NSW) called for sanctions against hospitals and training institutions that were asking female doctors about their plans to have children during interviews or ‘informal chats’ with candidates beforehand.
“This is not information an employer needs to be privy to ahead of employing someone and nor should they be seeking it on a formal or informal basis,” said former AMA (NSW) President, Prof Brad Frankum at the time.
After emailing members to condemn the practice, Prof Frankum received dozens of reports from junior and senior female doctors outlining similar stories of discrimination during the interview process.
The best way to deal with gender discrimination is to not accept it. Prof Frankum urged hospitals to foster more supportive environments to encourage women who had experienced such discrimination to speak up without fear that doing so would hinder their careers. He also called for more flexibility in training programs – and a greater pool of trainees – to make it easier for hospitals to fill maternity positions.
Dr Kath Browning Carmo, Senior Staff Specialist Neonatal Intensivist, Grace Centre for Newborn Intensive Care CHW and the Deputy State Director NETS NSW, recalls facing gender discrimination during her medical training whilst pregnant with her first child.
“An aging cardiologist asked me why wasn’t I was going into general practice because clearly I wasn’t serious about my career. He wrote as much on my end of term report. I tore it up and asked another cardiologist to complete my form.”
According to Dr Browning Carmo, there is a little more awareness today of the need for equality – from both men and women in medicine.
“I am in paediatrics, which has traditionally always been a more friendly space. I am also more aware of my own sexism as more and more of my junior male colleagues must also be accommodated to take paternity leave – which, of course, they should.”
Gender equity is as much about men as it is about women.
As Dr Tessa Kennedy, Chair of AMA Council of Doctors-in-Training, explained in her article “Gender Equity – We found the will but have we lost the way,” her partner’s company offers a equitable workforce policy that allows both of them to realise their aim of equal parenting and workforce participation.
“Where I work in NSW, female medical officers can access 14 weeks paid maternity leave, yet men are entitled to just one week of paid paternity leave. If my partner were a doctor, that’s not much of an incentive for him to take on parenting while I get back to my career. In fact the path of least resistance would be for me to continue to stay home beyond 14 weeks if neither of us would get paid to anyway, and if childcare is an issue it’s more likely to be me who returns part time.”
If more women are going to be given the opportunity to take on leadership and senior roles, then men must be more involved in family life and flexible work, and parental leave must become the norm.
Another barrier for female practitioners is the current lack of recognition of interstate service within parental leave arrangements. Accredited trainees are often required to move interstate or to New Zealand. Interstate recognition of parental leave entitlements would no longer see them penalised for complying with training program requirements.
Federal AMA, along with the Australian Salaried Medical Officers Federation, wrote to the COAG Australian Health Ministers’ Advisory Council last May asking that the policy of interstate recognition of long service leave entitlements be extended to parental leave entitlements. COAG indicated that status quo would be maintained. However, Federal AMA will continue to advocate on this issue.
Australia is starting to see a gradual change in positions of authority. A report by the Workplace Gender Equality Agency (WGEA) found women now comprise 39.1% of all managers in Australian workplaces and 43% of appointments to manager positions. A woman holds one in every three key management personnel roles in Australia –the level just below CEO.
Evidence demonstrates a link between increased representation of women in leadership positions and reductions in gender pay gaps.
But there is still a lag in medicine. This imbalance at the top makes it harder for medicine to address cultural barriers that reinforce traditional conservative norms.
In 2016, The Conversation reported fewer than 12.5% of hospitals with more than 1000 employees had a female chief executive, 28% of medical schools had female deans and 33% of state and federal chief medical officers or chief health officers were female.
Colleges and medical associations are looking at the issue. Federal AMA currently has 40% female participation on its Board, but recently committed to establishing targets to ensure greater female representation on its councils and committees.
In 2017, AMA (NSW) added five new Council positions to increase diversity and representation of Council. Four of the five new members added were female. The female representation on AMA (NSW)’s Board currently sits at 33% and our organisation has implemented measures to facilitate female participation on its Council. These include reducing the number of meetings, allowing Councillors to attend meetings via video or telephone conferencing, making the meetings a weekday evening, and limiting events on weekends. These measures were implemented to make it easier for Councillors to meet the commitments required while balancing family and carer responsibilities.
Increasingly, organisations and companies are developing policies to improve female representation in leadership roles and strategies to allow for flexible work. But there is a gap in action. It’s not enough to agree on gender equity, we need to follow through with concrete activities. The WGEA’s Gender Equity Insights Reports highlight the importance of accountability in closing gaps. For example, it found actions to correct pay gaps were three times more effective when results were reported to the executive or Board.
In addition to accountability, a number of organisations are not just setting targets, they are setting gender quotas as a tool to achieve gender diversity at leadership levels.
AMSA supports a target of 50% to be achieved by 2020 of elected leadership positions. “A target is an aspirational commitment that reminds us to keep gender equity in mind when choosing our teams. It has certainly worked within our organisation; our National Executive is currently 60% women,” says AMSA President, Ms Jessica Yang.
Ms Yang says the visibility of women in leadership positions is important to the next generation of doctors.
“A lack of visibility of accomplished women plays a huge part in the motivation for women to pursue leadership opportunities. It is a common experience for women to look up at a table of leaders, see no one who looks like them, and subconsciously, or consciously, write off the prospect of ever sitting at that table. Gender balance is an issue that transcends who holds leadership positions, and should also be considered when choosing, for example, selection panels during interviews, and speakers and workshop facilitators at events.”
AMSA also runs a Mentoring Program for Women which aims to link up accomplished female medical students to mentor women who may want some more guidance, particularly around advocacy and leadership.
“Having support from positive female role models is what inspired my own leadership throughout the years, with previous Presidents like Dr Alex Farrell and Dr Elise Buisson,” Ms Yang says.
Men have just as important a role to play in addressing gender equity as women. Opportunities to address inequality can come in many forms.
Dr Carmo recalls how empowered she felt when her male PhD supervisor, Prof Nick Evans, put her forward to present at a conference overseas.
“He was asked to speak in Italy about my area of expertise. He advised them he didn’t know much about the topic but he knew someone who did and recommended me. He has been great at elevating my career,” Dr Carmo says.
“I think we need more men like that – who admit when they are not the expert and nominate and elevate the women they know who are.”
Dr McMullen says men can address inequity by actively thinking of women they could tap on the shoulder for leadership positions or career opportunities.
“It’s natural to think of the people we spend the most time with, and like an Aussie BBQ, men and women at work sometimes gravitate to opposite corners. So let’s try to meet in the middle.”
And at the end of the day, discrimination – in any form – shouldn’t be tolerated by either gender, says Dr Basu.
“It’s exhausting for female-identifying medical professionals to bear the sole burden of calling out discrimination – be it at an individual or systematic level. It’s draining, and it’s not fun. A true male-identifying ally needs to step up and call out discrimination himself and take some of that weight off our shoulders.”
AMA (NSW) will coordinate with Federal AMA to support its recommendations and goals and push for State-based changes.
While we are further developing our recommendations, AMA (NSW) has highlighted the need for these priority actions: