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ASMS researcher unpicks medical culture’s impacts on women

8 November 2019 New Zealand Doctor - Virginia McMillan

Research released today is highlighting that a medical career pressures New Zealand women in ways not experienced by men, affecting their wellbeing, advancement and choice of specialty.

A gathering at Parliament this morning presents Association of Salaried Medical Specialists’ interviews and analysis on why medical women are at greater risk of burnout than men.

Having reported that 71 per cent of surveyed medical women aged 30 to 40 were likely to be experiencing burnout, ASMS director of policy and research Charlotte Chambers interviewed 14 women about their lives and work as senior doctors in DHBs.

Key points from the resulting paper, ‘Making up for being female’, include that women experience:

  • limits on their opportunities
  • extra mental load because medicine assumes primacy over doctors’ lives and has low tolerance for personal or domestic circumstances, and
  • subtle inequities in interactions with colleagues and patients.

Treated differently

A surgeon said nurses kept failing to supply the equipment she specified for theatre – a problem not faced by men and fixed only after she had tried untold pleasant reminders, then finally insisted aggressively.

Another doctor said in an interview: “[Nurses] definitely say stuff to us that they wouldn’t say to guys. [They] question your judgement.”

Belonging and being seen

Dr Chambers quotes doctors who sense that, as women, they don’t belong in the profession.

They tend towards lower-prestige specialties, which interviewees said include palliative care and paediatrics, and towards part–time work, where they are less visible and have less chance of being promoted.

Dr Chambers says societal norms still place women as children’s main caregivers, and they often run households even when children aren’t involved. So the research does not just relate to women with children, although she was saddened by accounts of mothers trying to do it all but feeling like bad doctors and bad mothers.

One doctor struggled to get time away from patients so she could express breast milk for her new baby; another took a work phone call every second day when on maternity leave.

Improvements for both sexes

Working part time led to women internalising guilt at not pulling their weight. They face a “juggling act” that appears not to apply to male doctors.

When young men starting their careers want to play a larger part in their children’s lives, rostering and time expectations hinder this for them as well.

Cultural and structural changes are needed; more flexible arrangements would benefit women and men, Dr Chambers says.

Long hours and burnout

ASMS’ earlier research on burnout shows long hours correlate with burnout risk, so she advocates schedules that enable work–life balance and self–care.

New Zealand competes for doctors internationally and can’t compete on salary, but could provide workplaces that attract doctors and prevent them leaving, she says.

Dr Chambers hopes her work will spark discussion and debate, especially in DHBs and colleges.

It’s likely staffing and rostering for a better workplace will require more people on medical teams, but she believes this isn’t insurmountable.

'Making up for being female'
ASMS research publication by Charlotte Chambers, published today

‘Feminisation’ a loaded word

She also wants an end to pejorative use of the expression “feminisation of the medical workforce”.

Research suggests this implies women lower the standing of medicine but ignores the context of a long tradition of a pro-male medical environment with huge time demands. The job has to be able to be done by people “other than a man who has a wife” – the approach of past generations.

The interviewees were talented, intelligent, hard-working and insightful about their situations, Dr Chambers says.

Early findings were presented at last November’s ASMS annual conference, and the final paper is being launched by associate health minister and minister for women Julie Anne Genter at Parliament this morning.

ASMS president Murray Barclay will be MC and Sarah Dalton, who replaces Ian Powell as executive director from 1 January, 2020, will give closing comments.

Up to 50 guests are expected, including representatives from the RNZCGP, NZMA and Ministry of Health.

Snapshots from the launch

Dr Chambers: “Overwhelmingly [from this research], micro inequities really do matter; collectively they add up…women have to work that little bit harder to be accepted as legitimate medical professionals, even if they don’t acknowledge it themselves…Medicine continues to be a profession that is old-fashioned and archaically structured.”

Ms Genter: “We are not going to achieve the outcomes we want from old ways of doing things…To address [gender inequity], we have to acknowledge it exists and start sorting out some structural changes.”

Charlotte Chambers and Julie Anne Genter
ASMS director of policy and research Charlotte Chambers with associate health minister and minister for women Julie Anne Genter
Murray Barclay

“These issues do need to be solved if we are to have healthy doctors.”

Murray Barclay
ASMS president Murray Barclay
Sarah Dalton

“Five thousand doctors and medical students have joined the Women in Medicine Facebook group. Many of their comments are positive but some, to say the least, are sub-optimal…ASMS wants to help eliminate some of the double standards described [in the report].”

Sarah Dalton
ASMS incoming executive director Sarah Dalton
Samantha Murton

“In a word, ‘awesome’. It’s about time this came out. It is totally my lived experience…I have felt you have to do a whole lot more as women to be perceived as the same as your male colleague. If you want to work at the same level and you have children, the juggling completely does your head in. That juggling needs to be more shared.

“The college needs to do more work to explain the pay gap [revealed in general practice workforce surveys]…and look at what support we can put in.”

Samantha Murton
RNZCGP president Sam Murton
Deborah Powell

“[This report] is not before time. Resident doctors feel more strongly about this than senior medical officers because they’re up against it. We had to strike to keep the safer hours we achieved [in negotiations] last time. We are working with members with [employment] grievances because they have been told to resign when they say they want to work part time.”

Deborah Powell
Resident Doctors’ Association chief executive Deborah Powell
Juliet Rumball-Smith

“It’s fantastic to see this research. We appreciate the support of ASMS in exploring this important issue.”

Wahine Connect mentoring network trust chair Juliet Rumball-Smith