Volume 166 - Issue 1
Women and men and the medical workforce in Australia
Author: Carolyn Quadrio
Med J Aust 1997; 166 (1): 7.
Published online: 6 January 1997
Published online: 6 January 1997
Medical women and men are struggling with the problems of outdated work structures and geographic maldistribution
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The influx of women into all areas of paid professional work has
brought about a cultural revolution, one that challenges the
traditionally invisible personal life of the worker. "He" is no
longer regarded, implicitly, as a sexless, childless, work-driven
automaton. Except perhaps in medicine, where expectations persist
that "dedicated" doctors will be infinitely available to their
patients and immune to fatigue. Consequently, exhausted and
demoralised young doctors -- both men and women -- are retreating from
oppressive hospital posts. 5
Changes are needed, including the provision of options -- available
to both men and women -- such as job-sharing and permanent part-time
work. 3
The challenge in the future may be to match the community's needs with
working patterns for health professionals that are closer to
reasonable working patterns in the general community. For all
doctors to work around 40 hours per week (and why shouldn't we?) would
require an increase in the medical workforce of about 15%.
3 But Government policy is
moving in the opposite direction (e.g., the restrictions on provider
numbers aimed at limiting new graduates from private medical
practice). Indeed, a two-tiered system may be evolving, with a
predominantly young and female "cottage industry" 5 of general practitioners --
supplemented by (chiefly female) paramedicals -- functioning as
"gate-keepers", 2 referring
patients to the male-dominated, high-technology (high-prestige,
high-income) medical specialties.
Mostly, the findings of the various reports available come as no
surprise and accord very much with my personal experience of women in
medicine and psychiatry. 8
One notable exception is the data on retirement. Based on the 1991
Census figures of the Australian Bureau of Statistics, it appears
that, beyond the age of 65, half of male doctors continue to work,
compared with a quarter of female doctors. 2 For me (born in 1943), these figures
were counterintuitive, and a quick "straw poll" of my peers brought
forth responses similar to mine. No-one in good health was thinking of
retiring. The only sense I can make of these data is that they refer to an
earlier generation (born in or before 1926 [i.e., those aged 65 or over
in 1991]) that differs from subsequent generations. These
early-retiring older women are likely to have had a more traditional
type of marriage, an older husband and more children. They may feel
obliged to retire when their (older) husbands do, rather than (as my
peers seem to) regard the postchild phase of life as a new opportunity
for increased career activity. My guess would be that the retirement
age for later cohorts of older women will not differ so dramatically
from that of their male peers, given the economic imperative for two
incomes, as well as the rising divorce rates, which will result in more
women doctors who are sole parents.
Women have made huge efforts to accommodate work structures that were
designed for male workers with invisible domestic support. Male
doctors are beginning to make lifestyle changes too, perhaps to
accommodate family needs. Work structures must be redesigned to
accommodate these changes. The result will be a medical workforce
that is more expensive, but less exhausted. Without this
redesigning, a two-tiered and gender-stratified system of general
practitioners and specialists may develop.
However, neither of these scenarios deals with what most reports
identify as the single most resistant medical workforce problem:
geographic maldistribution. 2,3,9
The poor supply of doctors outside metropolitan areas is a
major political issue. While even fewer women doctors than men may be
willing to accept a rural placement (with women comprising only 12.7%
of rural general practitioners, compared with 27% of metropolitan
general practitioners 3 ),
the issues involved are common to both. Neither women nor men are keen
to work the longer hours of rural practice, where they must offer more
complex medical services and practise without the support of
colleagues, but where, as general practitioners, they gain no more
overall remuneration than they would in the city.
The professional needs of spouses pose another problem with rural
placements. Both women and men may have spouses to consider, and this
problem seems to impact more upon women doctors than on their male
counterparts -- accommodating to spousal career needs is reported to
be a significant restraint for women. 4 "Conscription" is not a pleasant
word, and neither women nor men practitioners are likely to welcome
moves in that direction, but the new policy of regulating provider
numbers, if successfully implemented, seems likely to usher in just
such a system.
The desirability, indeed the necessity, for doctors to be granted the
same privileges as those that exist in the workforce as a whole should
not be construed as a gender issue. A 40-hour week and
reasonable allowances for family needs and obligations are the
entitlements of all workers -- they do not reflect the
"special needs" of women doctors.
Carolyn Quadrio
Recent Australian medical workforce data indicate dramatic changes
in the structure and culture of medicine in this country. Women now
comprise some 47% of general practitioners under 35 years of age;
1 men are working fewer hours
and retiring earlier; 2 and
the proportion of women doctors in the medical workforce is forecast
to increase by 12% from the present level by the year 2025. 3 Reports, such as that of the (then)
Department of Human Services and Health, 4 usually emphasise the particular
needs of women doctors, including family responsibilities, child
care and spousal career needs. Such conclusions imply that women
alone have family responsibilities and ignore the reality that men,
too, are making adjustments in these areas.
Women have made
huge efforts to accommodate work structures that were
designed for male workers with
invisible domestic support Women comprise only 12% of all private specialists. 1 They are best represented in
dermatology (29%), psychiatry (24%), radiology (19%), pathology
(17%) and anaesthetics (16%). 1
(Figures vary somewhat according to source [e.g., those of the
Australian Institute of Health and Welfare are slightly different].
6 ) These career choices may
reflect the attraction of more flexible working hours in these
specialties, but they may also reflect structural constraints, such
as resistance to women doctors in other fields, rather than female
predilections. The fact that surgery remains 96% male, 1 while anaesthetics has a relatively
high female representation, suggests that Colleges play a
significant role in facilitating (or impeding) the participation of
women. Both surgery and anaesthetics are more technical than
relational -- perhaps one training program is more "woman-friendly"
than the other? The same question might be asked about training in
obstetrics and gynaecology. Women represent only 11% of this
specialty in Australia, 3
whereas they comprise 70% in France. 7 Structural impediments to the
progress of women, such as the lack of part-time or job-sharing posts
and inadequate mentorship of women trainees, must also be
significant in hospitals and in academic institutions; in both these
arenas the increasing influx of women (35% of all hospital doctors and
50% of all medical undergraduates) is not reflected in a
corresponding "upward mobility".
Visiting Fellow, School of Psychiatry,
University of New South Wales, Sydney, NSW.