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 The Medical Women’s Federation sees barriers for women doctors and for good health – which should we fight about? - By Jessica Sinyor

Writing in 1895, the pioneering British-American physician Elizabeth Blackwell describes the moment that sparked her interest in becoming a doctor. A female friend, suffering from “a painful disease [of a] delicate nature”, tells Blackwell that, “if I could have been treated by a lady doctor, my worst sufferings would have been spared me” (1). This observation demonstrates the intimate relationship between a medical profession that reflects the population it serves and the health of that population. Blackwell’s friend’s conviction that access to a “lady doctor” would have improved her care highlights the false dichotomy this essay title proposes: that the fight for good health can be isolated from dismantling the barriers faced by women in medicine. First, I will show how excluding women from the medical profession leads to poorer outcomes for patients. I will then argue that the question we should ask is not “which” issue to address but rather how we can tackle the obstacles that curb the potential of women doctors, thereby undermining the medical workforce and harming good health.


Homogeneity in individuals comprising a healthcare service can be hazardous. A medical profession in which people of similar age, gender and ethnicity profiles dominate may result in a normative approach that views certain patients as the “default” with poorer outcomes for those not represented among researchers or clinical practitioners (2). This is exemplified by the designation of Acute Coronary Syndrome symptoms experienced more frequently by women as “atypical”, a classification which may lead to symptoms being overlooked, leading to dangerous delays in management (3, 4). A diverse, representative and equitable medical workforce has been shown to be better equipped to achieve good outcomes for patients (5). For example, equitable access to care is central to a universal healthcare service. Patients often show a preference for same-gender doctors, which may accommodate cultural needs and enhance patient comfort (6). Furthermore, patients may receive more time from female general practitioners and women doctors may demonstrate more patient-centred communication (7, 8). The importance of women doctors to good patient health therefore necessitates that we advocate for gender equality.

Surely, then, there is much to celebrate in the news that 62% of the 2022/23 UK medical student intake was female (9)? However, although women dominate the medical pipeline, they remain underrepresented in leadership and certain specialties, most notably surgery (5, 10). Women represent only 38% of consultants – a higher figure than my personal experience might have led me to expect, given that by my third year of studying medicine I am yet to be supervised by a female consultant (5). Gender parity across the entire medical hierarchy is central to workforce planning: attracting female medical applicants expands the potential talent pool, while retaining highly trained women doctors is
essential to a sustainable healthcare service.

There remains, therefore, much to fight about. How can we dismantle the barriers that prevent women doctors from maximising their potential, and in doing so achieve better health for patients? The following recommendations aim to improve the recruitment, retention and advancement of women doctors:

  1. Medical school lays the foundations for future practice, so it vital that women at the beginning of their careers have access to role models and mentors (11). By interacting
    with women doctors occupying leadership positions, female medical students may gain confidence that there is a place for them on Trust boards and in academic medicine too.
  2. Access to less than full-time training (LTFT), which can make a medical career more compatible with caring responsibilities, must be improved. LTFT trainees report difficulty arranging flexible working, an issue which particularly affects women because they remain responsible for the lion’s share of childcare (12, 13). Parenthood should not preclude certain specialties or seniority. Trust-based LTFT advisers would bolster the retention of women doctors.

As we move away from the sexual bias, gender stereotyping and harassment that have dogged women in medicine, these two recommendations will serve a culture change in which women doctors can thrive (14, 15). This change, defined by the “compassionate leadership” for which the brilliant late Dame Clare Marx advocated, involves colleagues approaching patients and each other with respect, empathy and a collaborative spirit (16). Furthermore, this culture change must be intersectional and tackle the particular challenges faced by women of colour and trans doctors, including damaging professional hyperscrutiny and barriers to education (17, 18). Finally, progress for women in medicine does not occur in a vacuum abstracted from wider social changes. Gender inequality has very real negative outcomes for health (19). If the medical profession wishes to promote health on a population scale, it must begin by addressing its own gender inequities. As this essay has argued, to fight for the good health of our patients, we must also fight the good fight for ourselves.


References:
1. Blackwell E. Pioneer Work in Opening the Medical Profession to Women London: Longmans, Green & Co.; 1895 1895.
2. Plaisime MV, Jipguep-Akhtar M-C, Belcher HME. ‘White People are the default’: A qualitative analysis of medical trainees' perceptions of cultural competency, medical culture, and racial bias. SSM - Qualitative Research in Health. 2023;4:100312.
3. Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Pepine CJ, Long T. Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med.
2007;167(22):2405-13.
4. Joseph NM, Ramamoorthy L, Satheesh S. Atypical Manifestations of Women Presenting with Myocardial Infarction at Tertiary Health Care Center: An Analytical Study. J Midlife Health. 2021;12(3):219-24.
5. Hemmings N, Buckingham H, Oung C, Palmer W. Attracting, supporting and retaining a diverse NHS workforce. NHS Employers; 2021.
6. Dagostini CM, Bicca YA, Ramos MB, Busnello S, Gionedis MC, Contini N, Falavigna A. Patients' preferences regarding physicians' gender: a clinical center cross-sectional study. Sao Paulo Med J. 2022;140(1):134-43.
7. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a metaanalytic review. JAMA. 2002;288(6):756-64.
8. Dahrouge S, Seale E, Hogg W, Russell G, Younger J, Muggah E, et al. A Comprehensive Assessment of Family Physician Gender and Quality of Care: A Cross-Sectional Analysis in Ontario, Canada. Med Care. 2016;54(3):277-86.
9. General Medical Council. The state of medical education and practice in the UK: Workforce report. 2023 2023.
10. Penfold R, Knight K, Al-Hadithy N, Magee L, McLachlan G. Women speakers in healthcare: speaking up for balanced gender representation. Future Healthc J. 2019;6(3):167-71.
11. Boylan J, Dacre J, Gordon H. Addressing women's under-representation in medical leadership. Lancet. 2019;393(10171):e14.
12. Harries RL, Gokani VJ, Smitham P, Fitzgerald JE, councils of Association of Surgeons in T, British Orthopaedic Trainees A. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6(4):e010136.
13. Walthery P, Chung H. Sharing of childcare and wellbeing outcomes: an empirical analysis. UK Cabinet Office,; 2021.
14. Choo EK, Byington CL, Johnson NL, Jagsi R. From #MeToo to #TimesUp in health care: can a culture of accountability end inequity and harassment? Lancet. 2019;393(10171):499-502.
15. Coe IR, Wiley R, Bekker LG. Organisational best practices towards gender equality in science and medicine. Lancet. 2019;393(10171):587-93.
16. Marx C. A message from Dame Clare Marx – Stepping down as Chair of the GMC: General Medical Council,; 2021 [Available from: https://www.gmc-uk.org/news/news-archive/a-messagefrom-dame-clare-marx---stepping-down-as-chair-of-the-gmc.
17. Restar AJ, Operario D. The missing trans women of science, medicine, and global health. Lancet. 2019;393(10171):506-8.
18. Bajaj SS, Tu L, Stanford FC. Superhuman, but never enough: Black women in medicine. Lancet. 2021;398(10309):1398-9.
19. Veas C, Crispi F, Cuadrado C. Association between gender inequality and population-level health outcomes: Panel data analysis of organization for Economic Co-operation and Development (OECD) countries. EClinicalMedicine. 2021;39:101051. 

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