Now that the HPAT has been reported to be an undoubted failure in broadening entry into medical undergraduate training, what next? Educators believed the Leaving Cert was creating an unfair and costly grind industry, and an over-feminised medical postgraduate environment. Instead, HPAT created a multi-million-HPAT-grind industry, adding to the already over-burdened parent of the prospective medical student. Why can’t medical schools offer affirmative action instead, to students who can’t afford private schools? If you want to balance gender, social class or race, you take affirmative action. Dedicate places to students who have gone to a sink school, for example. Award extra places for students whose parents were refugees. Give affirmative action to women in medicine.  

“Hang on a minute,” I hear you say. “Wimmen? Gimme a break. Aren’t most medical students already women?” And the answer is that yes they are. We outnumber men in medical schools two to one, and we outnumber men after graduation. We get better exam results, HPAT and all. But we drop out of our careers, and we work less. At the top of the career ladder, in the medical end posts, we have dwindled and, where it really matters, in medical leadership, men completely dominate medicine.  

Career paths and road blocks 

The problem is not school leaving: the problem is intrinsic to the career path of medicine and the attitudes, biases and beliefs of the men and women who work in it. Women don’t achieve success in medicine in a way that reflects our numbers at entry level: at every level female doctors earn less than their male counterparts. We fail to achieve leadership in technical specialties like surgery and obstetrics, and are much more likely to settle for part-time work, in low-paid specialties like general practice and public health, and we avoid high-end jobs. Women opt out at every level because we perceive barriers to family life, to love, to relationships, and to personal goals, and we can’t see a way of breaking through these barriers. We give up, before we’ve even made a start.

No male doctor ever worries, on graduation, that his dreams of marrying or having children might prevent him from studying surgery or psychiatry. No male surgeon puts off having children until his part-time post has been secured. Men don’t hesitate to jump when an opportunity arises. Women choose to hold back all the time because we don’t have a strong, gender-oriented affirmative bias, pushing us through, making it easier for us to succeed. 

This has to change, but the problem won’t be solved at the undergraduate end, it needs to be solved at the postgraduate level, by women themselves standing up for other women in medicine and becoming champions for other female doctors. US Secretary of State Madeleine Albright said, on the subject of women leaders in politics: “They say there aren’t enough qualified women. Well, that’s the biggest piece of bullshit I’ve ever heard.” She then went on to say that: “There’s a special place in hell for women who won’t help other women.” 

Women succeed more at studying medicine but they find it much more difficult to succeed at being a doctor. This isn’t because they will always want to put the school round before the ward round, but because there is no affirmative system in postgraduate medicine that allows, or encourages, them to do both. I don’t know a single postgraduate teaching hospital with an overnight crèche. I don’t know a single postgraduate mentoring scheme targeting female doctors to break into high-tech careers. I don’t know a single postgraduate training course aimed specifically at helping women to break through gender barriers and doing what Sheryl Sandberg, COO of Facebook, has gently termed “leaning in”. 

The ‘F’ word

Training part-time allows women to spend more time with their kids; but it holds their careers back by up to two decades. Career resilience is a huge dilemma for women, and I feel that women in the medical representative organisations have always failed to take on the ‘F’ word, for fear of appearing whiney or weak. But this has to change. Feminism isn’t a weakness for any organisation, it’s an almighty strength. 

And so before we get to that special place in hell, what are senior medical women going to do for other women who want to succeed too? The problems for career retention for women in medicine didn’t go away with the HPAT. They became more difficult. Women from successful families, and women who have married wealth, aren’t necessarily role models, especially if they can afford not to work full-time or choose to drop their careers early in the comfort of their inherited or married wealth. Worst of all, powerful women in medicine can often fail to recognise the struggle for other women, feel threatened, even try to hinder their achievements.  

Women in business are getting better at organising to support other women; so are women in the arts, and even in politics. Women in science and medicine need more than ever to find their own role models now. We need to find, and nurture, our own Sheryl Sandberg, our own Hillary Clinton, and our own Madeleine Albright too.