The proportion of female medical graduates is rising. Women comprised 32% of the workforce in 2004, and current Australian medical student intake is approximately equal in terms of gender.2 This is a far cry from only a few decades ago; in 1970 only 8% of practising physicians and 13% of medical students in the USA were women.3 However women remain under?represented in leadership positions in medicine. For example, there are few women in paediatric academic and community leadership positions in the USA despite women comprising 63% of practitioners taking the board exam.4 A Norwegian study has shown that men still have a higher probability of obtaining any leadership position in medicine.5 This study also showed that the proportion of female practitioners in a hospital specialty is a determinant of the number of women in leadership roles in that specialty. This has implications for specialties where women are still vastly under?represented, such as surgery.
In Australia in 1996, only 8.9% of surgical trainees were women, compared to 40.2% of psychiatry trainees, 36.3% of internal medicine trainees and 33% of obstetric and gynaecology trainees.6 There may be many reasons why so few women have leadership roles in medicine. In some cases, this may be a matter of choice, with women making career decisions that give priority to emotional and family commitments as opposed to power and influence in the workplace; in other cases this may be a result of discrimination and a ‘glass ceiling’ effect, especially in areas where women make up the minority.7 With regards to the former, the reality is that women are still more likely than men to hold a caring role in the household, and that leadership positions tend to involve longer hours and more commitment at work. This may not be feasible when trying to juggle relationships, marriage and children. Conversely, Olga Jonasson, a surgeon in the USA, considers discrimination to be a major factor in many instances: “the pervasive, unspoken, usually unconscious sexism that still prevails in surgery is a disease that has not yet been cured”.8 Jonasson also mentions the lack of mentorship opportunities for women which are vastly important for encouraging leadership participation. A study looking at junior women doctors’ views of surgery mentioned the importance of a female consultant role model to encourage young doctors to consider surgery as a specialty.9 As mentioned previously, women are more likely to become leaders in fields where there is a higher proportion of female practitioners.
I am a final year medical student, soon to be entering the medical workforce as an intern. I have held many leadership positions in the past, and aspire to continue doing so as a doctor in the future. However, I am interested in the more surgical fields of medicine, such as surgery and anaesthetics, which are still seen as male?dominated specialties with workloads not conducive to family life. Simply trying to work in this area without having to give up my hopes of a life outside of medicine, and one day a family, is daunting enough in itself without factoring in the prospect of taking on a leadership role as well. I believe most female medical students and junior doctors dread the thought of juggling work, relationships and lifestyle and have questioned whether they will one day need to choose between career and family.Further study and academic or clinical leadership positions seem out of reach for many who want to have a family as well. General practice and other specialties which offer flexible working hours may become attractive options, and often more ambitious aspirations are dismissed almost as a matter of course because they seem unattainable. My personal opinion is that the importance of having female mentors in senior positions is invaluable, if only as proof that these dreams can in fact be achieved. I have already been inspired by women who have taught me at medical school, and I hope to be able to find mentors to guide and encourage me as I progress through my training. As well as the informal mentor relationships that may develop as a result of having more women in leadership positions, a multifaceted approach is needed if the growing number of female doctors is to be supported. This could include structured mentorship programs, regular networking events, leadership skills training, and institutional change to allow more flexible work arrangements such as job sharing and part?time positions. It is unlikely that an increase in women in medical leadership positions will arise without proactive intervention from the medical community. I believe that as women we have much to offer our patients and the medical profession, and that by having more women in leadership to represent the growing number of women in practice, medicine can only go from strength to strength.
Medical Women and Leadershipr was written by Miss Verity Sutton (VIC) in October 2008 as part of her AFMW Leadership Scholarship.
References
1 http://en.wikipedia.org/wiki/Leadership
2 Joyce C, Stoelwinder J, McNeil J & Piterman L (2007). Riding the wave: current and emerging trends in graduates from Australian university medical schools. MJA; 186 (6): 309?312. Accessed from: http://www.mja.com.au/public/issues/186_06_190307/joy11334_fm.html on 4 Oct 2008
3 Paik J (2000). The Feminization of Medicine. JAMA; 283 (5): 666. Accessed from: http://jama.amaassn. org.ezproxy.lib.unimelb.edu.au/content/vol283/issue5/msindex.dtl on 4 Oct 2008
4 Graham E, Wallace C & Stapleton F (2007). Developing Women Leaders in Medicine at the Grass Roots Level: Evolution from Skills Training to Institutional Change. J Pediatr; 151: 1?2. Accessed from: http://www.sciencedirect.com.ezproxy.lib.unimelb.edu.au/science on 4 Oct 2008
5 Kværner K, Aasland O & Botten G (1999). Female medical leadership: cross sectional study. BMJ 1999; 318: 91?94. Accessed from: http://bmj.com/cgi/content/full/318/7176/91 on 4 Oct 2008
6 Australian Medical Workforce Advisory Committee, Australian Institute of Health and Welfare (1996). Female Participation in the Australian Medical Workforce. Accessed from http://www.nhwt.gov.au/documents/Publications/1996/Female%20participation%20in%20the%20Australian%20medical%20workforce.pdf on 4 Oct 2008
7 Kværner K, Aasland O & Botten G op cit.
8 Jonasson O (2002). Leaders in American surgery: Where are the women? Surgery; 131 (6): 672?675. Accessed from: http://www.sciencedirect.com.ezproxy.lib.unimelb.edu.au/science on 4 Oct 2008
9 Williams C & Cantillon P (2000). A surgical career? The views of junior women doctors. Medical Education 34: 602?607. Accessed from: http://web.ebscohost.com.ezproxy.lib.unimelb.edu.au on 4 Oct 2008
