I recently attended a conference and heard a presentation delivered to female surgeons which addressed the subject of mentors, sponsors and gender inequity in medicine.
These were the facts presented:
- Female mentors help women feel better
- Male mentors are more valuable for career progression
- Sponsors don’t just give advice, but “become personally invested in their protégé’s career success, take risks to champion them for recognition and advancement, and actively embed them in powerful networks.” (Kang and Kaplan, 2019)
- Among NIH grant recipients (2006-9), those with sponsors were significantly more likely to be successful in 2014. Men were more likely to report receiving sponsorship (Patton et al. 2017, JAMA Internal Medicine)
Analysis of self-reported experiences of sponsorship by gender showed that men with male mentors did best, then men with female mentors, then women with male mentors, and women with female mentors fared least well. (Patton et al. 2017, JAMA Internal Medicine)
Women have had gender parity in Australian medical schools for decades; however, they represent only 28% of medical deans and 12.5% of hospital chief executive officers, a recent article outlined.
Women accounted for 50 per cent of all medical graduates, yet just 12 per cent of all surgeons in 2016, and just 4 per cent of orthopaedic surgeons, national data shows.
So knowing all this, how can we deal with the gender-based inequalities in medicine and particularly in surgery?
This is not just a problem that pertains to surgery, but is across the board in all areas of society.
I recently heard on the radio the very same problems being discussed on the ABC Law Report when it came to inclusiveness and gender diversity.
Older white males control much of our society, at all levels. This is a fact which we can either just accept and carry on with, or call into question, for it does not serve all of us to have it be this way, as the state of our health care system, and indeed our world, shows. Being part of an old boy’s club is great if you are an old boy, but we are not all old boys in this world and we all deserve to be treated with equal care and respect, and to have a say in how we shape the society of which we are all an equal part, no matter what our gender or cultural background.
Finding solutions or dealing with the root cause
The problem is that we tend to focus on finding superficial solutions to the problem, rather than dealing with the root cause.
Quotas for female trainees to redress the current imbalances in surgical training and in female representation at more senior levels may be a great idea in principle, but in practice they are resented by both men and women and used as an excuse to demean all women, including those who ‘made it’ on their own merit.
Using a ‘de-biased’ selection process where the name and gender of the trainee is blind or redacted on the job application may get them into the training programme, but it will not stop the systematic discrimination, harassment and abuse that many of us are subject to during our training.
Dealing with individuals who are particularly notorious for these behaviours is required action, but the problem is not just an individual one, it is a system failure that has allowed the culture of male-dominated misogyny to thrive.
Of course there are many great men within our profession who do not endorse this behaviour, who treat women with respect as their equals, but the outdated attitudes are still far too prevalent.
How do we change this?
How do we restore the understanding that we are all innately equal, no matter what our gender, colour, race, culture, religion or nationality?
We as doctors, of all people, who have seen under the skin and realised that we are all the same inside, should know that we are inherently equal and treat each other accordingly.
We should in fact be world leaders in this way, in showing equal care and respect and common decency to all people, no matter what they may look like or how they may behave on the outside.
Let’s start with our trainees
And treating our trainees with this respect, no matter whether they are ‘like us’ or not, would be a great place to start.
It may be comfortable having trainees who are ‘like us’, who look the same, dress the same, go to the same school, university, club etc., but the world needs a medical workforce who can relate to everyone, not just white upper-middle-class professional males, and the sooner we open our hearts, minds and training programmes to all, irrespective of outer appearances, the richer our profession will be.
Medicine is not a war; it is the art and science of healing. We do not need to train warriors; we need to train people who are loving, caring, decent, and respectful of all, as well as being great at what they do.
We can only train them to be like this by treating them like this during their training; by offering reasonable working conditions, adequate leave, job-sharing or part-time work if they want to raise a family during their training, and all the other conditions that other professions assume as their right.
Why do we think doctors have to hurt themselves to become doctors when we are supposed to be in the business of helping people to heal?
We do not need to be hurt by the training programme and the people in it to such a degree that we feel we have to hurt the next generation in return. We do not need to suffer to succeed, to become a great doctor, and we do not need to make other people suffer so that they can do the same. In the current system, if you are not willing to suffer, to put medical training first and everything else a distant last, and you want to be treated with respect, appreciation, have a family and time to rest and play, you are seen as not having what it takes to succeed.
But doctors are not special super-human beings; we are people too, with all the needs, desires, frailties and great love that other people have. Staying connected with our own humanity in fact makes us a better doctor, for the more we care for ourselves, the more we are able to genuinely care for the health and wellbeing of our fellow human beings.
By all means let us deal with the inequalities in medicine when it comes to gender and other differences, but let’s do it by dealing with the problem at its root, and restore our understanding that in essence, we are all equal, no matter what our outer form. Let’s treat everyone as if they are our family, our mothers, fathers, sons, daughters, sisters and brothers, for in fact they are.
1. Working toward gender diversity and inclusion in medicine: myths and solutions.
Lancet. 2019 Feb 9;393(10171):579-586. doi: 10.1016/S0140-6736(18)33138-6.
2. Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants
JAMA Intern Med. 2017;177(4):580-582. doi:10.1001/jamainternmed.2016.9391
- Gender inequity in medicine and medical leadership
Allison Hempenstall, Jillian Tomlinson and Marie M Bismark
Med J Aust 2019; 211 (10): 475-475.e1. || doi: 10.5694/mja2.50388
Published online: 18 November 2019
4. ‘Hidden curriculum’ keeping best and brightest from becoming surgeons
By Kate Aubusson
May 9, 2018 The Sydney Morning Herald