The recent Women in Medicine in Ireland Network (WiMIN) inaugural conference in Dublin was a great success, attracting over 100 female doctors and medical students from all over the country.

The idea to establish WiMIN came to me in December 2017, on a whim. I am a big fan of Twitter and spend far too much time exploring and perusing the opinions and recommendations of others there!

The Medical Women’s Federation (MWF) in the UK delivered an ‘Advent Calendar’ of daily tweets that caught my eye, acknowledging the contribution of various women to the history of medicine. Looking into the MWF and its background, I learned of its two main aims: to promote the personal and professional development of women in medicine, and to improve the health of women and their families in society. That sounded like a pretty sound premise for an organisation. 

When I asked if others would be interested in an Irish organisation, the response was overwhelmingly positive. Having set up a website, email address and created a logo, I carried out a survey to ask what we should do first. The response was to hold a Dublin meeting. I booked the hotel and off we went.

I set myself a target of reaching 900 members by the end of 2018, as that would represent 10% of the total number of women working in medicine in Ireland. 

I began to research the available data on gender equality in medicine. The IMO Position Paper on Women in Medicine¹ provided some uncomfortable truths. It revealed that 18% of NCHDs had been subject to sexual harassment in the previous two years – 11.5% of male NCHDs and 21.4% of female NCHDs. The rates were less for consultants and GPs, which implies that the hierarchical structure of medical training may be facilitating a situation where harassment of juniors is somehow culturally facilitated. 

Male consultants and GPs did experience gender-based bullying and harassment, but to a lesser degree than their female colleagues. It is important to remember that any strategies or policies that are implemented to reduce workplace bullying and harassment should apply to both genders and the aim should be to eliminate such incidents for all workers. 

Of note, a significant proportion of the discriminatory experiences of female NCHDs originated from patients (33% for bullying, 48% for gender-based harassment). This is indicative of the wider societal problem of a tendency for gender-based nastiness to be seen as somehow acceptable (“ah sure I was only joking, love!”)

I also read the PROGRESS report,² published by the RCSI in July 2017. This was the final report of the Gender Diversity in Surgery Working Group, chaired by Prof Debbie McNamara. It looked specifically at the ongoing gender disparity in surgery, despite increasing numbers of women at undergraduate level, with just 34% of surgical trainees being female, and < 7% of consultant surgeons. 

Only 17.5% of clinical professors in Ireland are female, with a significantly smaller proportion among surgeons. This once again highlights the “glass ceiling” effect, where women can enter the profession on an equal footing, or in even higher numbers than men – 58% of new entrants to Irish medical schools in 2015/16 were female³ – but as their career progresses they do not maintain their distribution among the higher echelons. 

The first Women in Surgery meeting was held in Dublin in July 2018, with a number of career initiatives taking place around the country. The RCSI has just been granted the Athena Swan Bronze award, which recognises its commitment to advancing gender equality. 

It was interesting to look at the Medical Council’s most recent Medical Workforce Intelligence Report (2015). This breaks down the country’s registered medical practitioners according to various demographics, including gender, age, specialty, type of work and geographical location. 

Community health and public health have the highest proportion of female doctors, with hospital consultants having the lowest. Forty-six per cent of all GPs are female, but this increases to 78% for those GPs who are under the age of 35 and who graduated from Irish medical schools. 

There has been discussion of the feminisation of general practice. Any time I have heard this phrase being used, it has tended to be in a derogatory sense. I have heard women GPs being described as ‘cherry-pickers’; choosing their work practices to suit themselves (or probably more accurately, to suit their families). 

The concept of a ‘portfolio GP’, who works in a number of different fields rather than devoting nine sessions per week to their own practice, has also been somewhat derided in some quarters of the general practice hierarchy. However, it is my understanding that currently very few GPs, male or female, have nine full sessions of clinical contact per week, as the realisation dawns that to do so is simply a one-way ticket to “Burnoutsville”. 

Male GPs are probably somewhat uncomfortable with describing themselves as part-time and will instead clarify how their working week is made up of various different clinical and administrative or academic commitments. Across all specialties, 80% of female doctors and 89% of male doctors work full-time. Broken down by age group, it is among the doctors aged 55-64 that we see the biggest difference in work practice, with 30% of female doctors in this age group working part-time versus 11% of male doctors. 

It may well be that more male doctors would like to work less than full-time, but without the culture or encouragement to do so, they may feel obligated to continue with full-time work. Male GPs are also missing out on the opportunity to take extended periods of leave, in the same way that women can with maternity leave. 

And yes, I know motherhood is a hard job, but it is important to reflect on the benefits that time away from the practice can give you and to realise that this is simply not an option for male GPs. The PROGRESS report was notable for addressing the needs of trainees of either gender who are parents, recognising that both mums and dads would like to work in an environment that is more accommodating to their needs.

The HSE’s Strategy for Doctors’ Health and Wellbeing 2018-2021⁴ (yes, such a document exists!) aims to: “ensure that doctors in Ireland can continue to be physically and emotionally well throughout their working life”, and has recommended standards for each grade of doctor – medical students, NCHDs, GPs and consultants. It mentions support services, line managers, occupational health services and counselling. 

However, the section for GPs is conspicuously more vague and ill-defined, with references to ‘employer’ (where relevant) and ‘named GPs’ who can be contacted in case of need. Of course, it is clear to us that because most of us in general practice are self-employed, it falls to us to implement our own strategies and targets with regard to wellbeing in our workplaces. 

At the WiMIN conference, Prof Aine Carroll (UCD) spoke about the various reports, giving an excellent overview of the current state of play with regard to gender issues in medicine in Ireland today. Ms Siobhan Patten, HSE HR lead for equality, diversity and inclusion told us that the current pension pay gap for female doctors in Ireland is of the order of €10,000. 

Dr Fiona Kiernan (RCSI) spoke about the wider economic effects of gender disparity in healthcare, reminding us that men and women have different experiences and outcomes when they interact with health services and this has implications for planning and strategy development. Dr Colman Noctor delivered a very entertaining but deeply relevant talk entitled ‘Keeping the plates spinning’, addressing the constant demands on our lives to be perfect.

A panel discussion focused on the challenges and rewards that a medical career offers. There was a huge amount of enthusiasm in the room and many suggestions were made for future progress of the organisation.

This is not a ‘Them and Us’ scenario; it is not about increasing gender equality by somehow diminishing our male colleagues. It is about recognising that the evidence is there that despite over 100 years of women doctors, the environment in which they work remains inequitable.

For more information visit www.wimin.ie

References

1. IMO Position Paper on Women in Medicine. September 2017. Available at https://www.imo.ie/policy-international-affair/documents/IMO-Position-Paper-on-Women-in-Medicine-Final.pdf

2. PROGRESS: Promoting Gender Equality in Surgery. RCSI 2017. Available at http://rcsi.ie/files/newsevents/docs/20170707051740_Gender-Diversity-in-Surgery-Re.pdf

3. HEA Higher education factsheet: Medicine 2017 http://hea.ie/assets/uploads/2017/04/HEA-Medicine-Factsheet-2017.pdf

4. HSE Strategy for Doctors’ Health and Wellbeing 2018-2021. Available at https://www.hse.ie/eng/staff/workplace-health-and-wellbeing-unit/spotlight/doctor-hw-strategy-200418.pdf