In 2015, vascular surgeon Dr Gabrielle McMullin unleashed a storm of controversy when she said in an ABC interview that female trainees approached for sex by senior colleagues should “comply with the request” if they wanted a career. When a female surgical trainee complains about sexual harassment, she said, “you can be sure they will never be appointed to a major hospital”.
The outcry over her comments sparked a mini “MeToo” moment in Australian medicine and led to the commissioning of a damning report into sexual harassment from Royal Australasian College of Surgeons (RACS). The report contained multiple reports of female doctors expected to provide sexual favours in return for tutorship, along with outrageous stories of discrimination, including one female surgeon who was told she would only be considered for a job if she “got her tubes tied”.
The report recommended a mandatory training module for surgeons, Operating With Respect. But according to the RACS’s own figures, by late last year only 60% of surgeons had completed the course, with the figure dropping to only about half of surgeons in NSW.
Three years on, has anything changed? Perhaps not, at least not in surgery, according to a new study presented this month at the RACS Congress in Sydney. The study is authored by Sarah McLain, a final year medical student, who says there remains a “hidden curriculum” holding women back in surgery. Although women now make up well over 50% of medical graduates, only 12% of surgeons are female, with just 4% of orthopaedic surgeons are women.
Unlike the male students, female med students interested in pursuing a career in surgery are routinely asked how old they are, whether they are married and whether they are planning to have children.
“Being a woman means you might have children and you are therefore perceived as being less committed. You’re told surgery is hard or competitive, with the insinuation that you’re not competitive enough,” she told Fairfax Media.
Her study found a lack of women in leadership roles in medical schools, with only 20% of deans and 5% of heads of surgery at medical schools.
“You can’t underestimate the importance of positive female faculty surgical role models,” Ms McLain said.
Of course, gender discrimination and disparities are by no means limited to surgery. Female doctors are considerably less likely to become specialists than men, and even when they do, they earn substantially less than their male peers. The pay gap between full-time male and female medical specialists stands at 33.6%, with a 24.7% gap between male and female GPs.
Around 63% of graduates from Australian medical schools were women in 2015, and at the beginning of their career their earnings don’t differ from their male colleagues. But as their career progress, a gap appears and then continues to widen. A report from Level Medicine says the reasons for this are complex and include more women in lower paid specialities, less success in negotiating remuneration, and more women taking time off to raise a family.
But these factors do not explain away all of the disparity in earnings, the report says. Around a quarter to half of the pay gap cannot be attributed to hours worked, career interruptions or to employment type, it notes. The rest of it is more to do with systemic discrimination, which includes lack of leadership on pay equity from the colleges, discrimination against women in the more highly paid specialties such as surgery, a lack of female leadership roles and a lack of flexible training and working.
But sexual harassment and pay disparity are not the only issues facing women in medicine. There is good evidence that female doctors are more likely to be affected by burnout than their male colleagues. One theory is that this is due to societal expectations for women to show more empathy than men. In a highly stressful, life-or-death environment like medicine, this can quickly translate into compassion fatigue and put an intolerable stress on female doctors’ mental health. A disturbing study found that while the suicide rate of male doctors was about 40% higher than that of men in the general population, the rate for female doctors was 130% higher than in other women.
Clearly, there is much more to be done before the medical profession can be truly said to be female-friendly.