Cindy Towns, 25, is the President of the Otago University Medical Students Association. We’d heard stories of male med students hurling body parts at their female counterparts in days gone by, so we asked her to tell us what it’s like for young women studying medicine now.
When I was asked to write this article on the position of women in medicine I was initially filled with a tentative optimism. I thought of all my female classmates, the openness with which we conduct ourselves in lecture and tutorials, the ease with which we collaborate and indeed compete with our male peers. On the surface at least, the Old Boys Network in medicine seems to have faded, the future seems rosy, the opportunities endless. But although our predecessors were subject to a prejudice and discrimination of the kind that we will never see, we must still temper this optimism with caution as we consider the progress of women in a field still dominated by men.
Women have a long and rich history in medicine and health. From physicians and surgeons in the Middle Ages to practitioners and nurses in religious orders1, women have been involved at all levels of healing. On the rural farm, prevailing in the Western World in the eighteenth and nineteenth century, almost all females practised domestic medicine2. However, when medicine began to be an officially recognised, formal and institutionalised practice, women began to be excluded. A lack of knowledge in the basic sciences and explicit rejection from university education meant that women could not train to be doctors nor be licensed to practice.
However, some pioneering women, perhaps spurred on by the early suffragists, persevered and demanded to take their place alongside men in medical schools and hospitals. Study for females in these early days was difficult and often fraught with more than just academic stress. Emily Seideberg, the University of Otago's first female medical student (entering in 1891), had to write for special permission to undertake study from the University Council and the Hospital Trustees. Her training was often punctuated with ill-feeling from her male classmates who on one occasion found it necessary to throw pieces of human flesh at her from a neighbouring dissection table3. Such conduct definitely would not be tolerated today, by either students or Faculty.
A century after Emily Seideberg, Margaret Cruickshank and other notable early women doctors, the medical community is still looking at the question of parity. Many in the field still often ask whether female doctors enjoy true equality with their male colleagues. First impressions would seem to suggest that they do. When I look around at my medical class, I am greeted with an equal number of men and women, equally as enthusiastic, equally as capable and equally convinced of their right to study medicine. Data from the Otago School would seem to further evidence this claim as female and male numbers have been roughly balanced for at least the last decade. Although this was perhaps a slow levelling, it is a stable one. A quick dip into the literature reveals similar trends internationally as medical schools, at least in the western world, graduate equal numbers of men and women.
However, the same literature suggests imbalances of a different kind. In 1987, Dr Barbara Heslop from the Otago Medical School, painted a pretty dim picture for female medical graduates4. She claimed that despite an equal number of men and women completing the course, women were still underrepresented in almost all the specialities, especially surgery. Similar concerns have been put forward, over 10 years later, by Philippa Poole working from Auckland Hospital5. Again she highlights the paucity of women reaching the top echelons, her research showing that women comprise only 25% of adult physician training and only 10% of surgical trainees. These concerns are consistent with those voiced in other countries and such disparity is also reflected in salaries. One recent study from the United States indicates that women on average earn 14% less than their male counterparts whilst an Australian study shows that the mean difference in income between male and female doctors is A$20 000 per year 6, 7.
The question remains then as to why such an inequality exists. If medicine as a field is truly an equal employer, if women are entering at the same rate as men, if opportunities exist for both sexes then why are women such a rarity at the specialist and academic teaching levels? To those intimately involved the answers are obvious and unfortunately common. Postgraduate (specialist) training is often simply not compatible with women wanting to have children. Training for these positions is full-time and strenuous. It appears that it is often too difficult for a woman to have children and be a continuous and integral part of their lives, whilst training or working as a specialist. When looking at the timeline of a medical degree in New Zealand, it is easy to see why. An MB ChB is a six year degree in this country which puts most students at 23 or 24 years old upon completion. At Otago University, over 20% of medical entrants have already completed a degree and will therefore be finishing the MB ChB program at 26 or older. Medical graduates usually then complete two years as a house surgeon before undergoing postgraduate training. Fitting a family into such a hectic schedule is a daunting prospect for a young woman and as Poole (2000) notes, if training is interrupted for parental leave, re-entry can be difficult, especially if still breast-feeding or experiencing sleep deprivation. With student loans increasing the strain and financial burden on all students, the ability to combine work and family with a medical speciality is looking increasingly difficult.
So would our predecessors be pleased with our progress,? Although we're no longer dodging strewn body parts like the young Emily Seideberg, it appears as though plenty of work is still to be done to achieve equality with men. But things are not all gloomy. We should be proud that women are entering and graduating Medicine in equal numbers as men. We should encourage young women into a field that is challenging and rewarding as well as demanding. Initiatives are being put forward with regard to flexible training programs, job sharing and mentoring and the hope is that these will aid in encouraging women to enter specialist training.
References