Women’s contribution to general practice: Medusa or Mother Teresa?

Women’s presence in medicine has been good for patient care. Studies from Western countries about gender differences in the consultation have produced similar findings — women have an inclusive and democratic style of communication13 that helps foster “collaborative relationships” with patients.12 Women tend to be “information giving”, use a more participatory decision-making model14 and appear less motivated by financial rewards.15 They deal with more complaints, are more patient-centred in their approach, and provide more preventive health care.2,16 These attributes, which could be grouped or labelled as consistent with the Mother Teresa effect, are valued by patients, appear to produce good patient outcomes,17 and have helped shift medical teaching away from a doctor-centred agenda to a patient-centred one.18

On the other hand, in relation to health care delivery, women’s work patterns are seen by some to limit patients’ access to medical services as well as being a contributory cause of workforce shortages. Although acknowledging that “empathy and communication are important”,1 quantitative studies also demonstrate that women work about 13.8 hours less per week than men, tend to work part-time, have longer consultations, and provide less institutional care, emergency services or procedural services.10

However, simply assuming that quantitative studies are evidence of female doctors’ inefficiency or “inability to live with risk”,1 or are a consequence of female doctors preferred working styles7 may confuse cause and effect. Numbers merely describe gendered work patterns — they do not and cannot explain them. Seeking such an explanation may help clarify solutions for some of our workforce problems. Attributing the cause to “women’s behaviour” and in doing so ignoring any other possible factors could reflect an underlying attitude related to the Medusa effect.

The importance of these other factors, such as the patient’s gender, the sex match of the doctor–patient duo or the patient’s prior health status,5,19 was highlighted in an Australian study by Britt and colleagues, who established that some of the associations attributed to gendered work styles disappeared after controlling for the influence of age, experience, other practitioners’ characteristics, and patient mix.20 Similarly, a cross-sectional European study into consultation length found that 55% of the variance was due to factors at the patient level and that “the age and sex of the doctor had no impact on the duration of the consultation”.21

The missing ingredient in contemporary discussions of the effect of women in medicine is the role of sex socialisation, a powerful force for both women and men. The traditions of Western medicine have been forged in a male-centric work model. In this model, vocational commitment is demonstrated by long hours of work and dedication to the profession.18 This could be seen as the male version of the Mother Teresa effect, except that it is predicated on a personal life that is provided by a full-time “invisible” other. That invisible other is traditionally female.

It would seem that little has changed. Many female medical students still see their gender as a disadvantage for their careers and expect that they will be required to sacrifice their professional lives to have a personal life, even if they are in a dual career relationship.22 This persistence of “gendered schemas” within the medical profession means that “men are consistently over-rated and women under-rated” in relation to competence and performance.23 Invisible barriers such as the classic glass ceiling24,25 — or other hidden forms of the Medusa effect — may often stymie women’s attempts at assertiveness or leadership.

Overcoming the constraints of such a “discriminatory environment”18 may be having an adverse effect on female doctors’ health and wellbeing,26 especially if the effects of gendered behavioural expectations are not given a place at the “workforce patterns” discussion table.

In any debate that draws on quantitative data, women are likely to “fall foul” for biological reasons. In a male-centric environment, periods of peak career building coincide with the time of establishing a family. Both are time hungry, and gendered socialising still sees women expected to take the prime responsibility for both children and domestic requirements.27 Gjerberg, from the Norway Work Research Institute, has pointed out that any discussion of medical workforce patterns that does not factor this expectation in ignores the fact that, while women work shorter hours in paid work, compared with their male colleagues, they work longer hours in total.28

The medical profession

Women are here to stay, and we believe that trying to dance to the Henry Higgins refrain of “why can’t a woman be more like a man?” will not help us find workable and practical solutions to help shape the profession’s future. Women now account for about 37% of the Australian general practice workforce overall and half the workforce among general practitioners younger than 45 years. These trends appear set to continue, as two-thirds of all GP registrars younger than 35 years are female.29

As the medical workforce races toward a gender balance, to what extent is the female perspective influencing major decision making within the profession? Evidence suggests this is limited, as gender still appears to have a filtering effect in terms of leadership roles, choice of specialty, and academic advancement for women within the profession.30