Gender-balanced medicine will heal many wounds

‘A medical profession that accommodates the needs of both genders equally can only result in benefits for patients’

Dr Emily Winifred Dickinson, a young woman from Co Tyrone, was one of the first women to study medicine in Ireland. In 1896 she was awarded a Fellowship of the Royal College of Surgeons in Ireland, becoming the first woman to be awarded a Fellowship of any of the Colleges of Surgeons in Britain or Ireland.

In 2016 women were still making history in Irish medicine when Prof Mary Horgan, Dean of Medicine in University College Cork and specialist in infectious diseases and internal medicine at Cork University Hospital, was appointed the first female President of the Royal College of Physicians of Ireland (RCPI) in the College's 360-year history.

Prof Horgan, who takes up her role in October this year, said she hoped her tenure as the first female president would inspire others to take up leadership roles in the healthcare system.

Asked why it took 360 years for a woman to be elected president of the RCPI, Prof Horgan said: “There are more women working in medicine than ever, and the numbers have increased significantly over the past few decades. The medical profession has long supported and promoted colleagues based on merit and experience irrespective of gender or specialty, and it was inevitable that a woman would be elected to this role at the Royal College of Physicians of Ireland.

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“It can be daunting for a woman to put herself out there and hope to be supported by her colleagues to be the first in any role. Now that the glass ceiling has been broken, it is easier for others to follow in all areas of medicine,” she added.

According to Prof Horgan, Ireland is fortunate in attracting highly motivated students, both male and female, to its medical schools who ultimately become our GPs, consultants and public health specialists.

“In terms of supporting more women in senior roles in Irish medicine, I think role models and mentors are an essential component of this support system. I hope that I will continue to provide both during my presidency,” she said.

The Irish Medical Council collects detailed data on the make-up of doctors working in Ireland through its Medical Workforce Intelligence Reports.

According to the Council’s latest figures, at the end of 2015, 41 per cent of registered doctors and 56 per cent of those with specialist training were female.

The figures also show that just 30 per cent of hospital consultants were women compared to 80 per cent of community health doctors. This disparity was also evident in specialist areas of medicine, with some specialties having a much higher proportion of men than others.

For example, just 8 per cent of specialists in neurosurgery and 6 per cent of those in trauma and orthopaedic surgery were female.

However in other specialties there was a higher than average proportion of women: public health medicine (71 per cent), psychiatry of learning disability (70 per cent), and genito-urinary medicine (67 per cent).

The report also found that women were more likely than men to work part-time.

Writing in its latest Medical Workforce Intelligence Report (2015), the chief executive of the Medical Council, Mr Bill Prasifka, said, "I found it particularly interesting that although males continue to dominate the medical profession as a whole, since we began collating this data, there have been more Irish female graduates entering the medical profession than their male counterparts. The majority of those on the register between the ages of 30-44 are female; however from 44 years and on the number of females on the register begins to decrease and this definitely poses some questions for the health sector."

In a recent survey of surgical trainees in Ireland across all specialties, 83 per cent reported that having a surgical career or placement had a strong impact on their personal lives, with the majority agreeing that it had a negative effect on issues such as starting a family, personal relationships or purchasing a home.

The survey, which aimed to examine the attitudes of Irish surgical trainees to gender balance in the workplace, was presented at the RCSI 2016 Millin Meeting, which took place in the college late last year.

It further revealed that 44 per cent of women felt that they had missed out on a job opportunity or chance to progress their career due to gender and almost 50 per cent of women stated that their gender affected their fellowship choice. Some 63 per cent of women felt that women had fewer opportunities within surgery.

Ms Ailin Rogers, surgical trainee at Beaumont Hospital in Dublin, who carried out the research, said that while the survey was statistically significant, it was still small and there was a need for more data in this area.

Ms Rogers said for her personally gender had not influenced any aspect of her training to date and she had benefited from a number of very positive role models, both male and female, throughout her career.

She also said she would encourage other women to consider a career in surgery.

“I absolutely love my job and I couldn’t imagine doing anything else and that is something that anyone in my position should be thankful for. It is an extremely rewarding career with so many opportunities.”

Ms Rogers said that while she hadn’t personally experienced anything to suggest a gender imbalance in Irish medicine, there was a perception and data to suggest that were some issues in relation to gender which she argued could also be present in a number of other professions.

She added that there did seem to be a disparity in relation to the number of female graduates who progress to surgical training and then on to consultancy level and this may be that people were leaving the specialty at later stages in their training. She said that this was an area that needed to be examined.

The historical dearth of women in medicine also meant that up until relatively recently there was a lack of senior female role models and mentors for young female trainees.

This has thankfully changed in recent years with the appointment of a number of highly respected female clinicians. These include Dr Rhona Mahony, who was appointed as the first female master of the National Maternity Hospital in Holles Street in Dublin, and consultant neurologist Prof Orla Hardiman, who was the first fully tenured professor of neurology in Ireland (male or female).

As the first female consultant colorectal surgeon in Ireland, Ms Deborah McNamara, consultant surgeon in Beaumont Hospital in Dublin, is another strong role model for female surgical trainees.

Ms McNamara said her training and career as a female consultant surgeon in Ireland had been a very positive experience.

According to Ms McNamara, just fewer than 10 per cent of consultant surgeons in Ireland are female and while women who apply for surgical training here do extremely well, an estimated half of all female medical graduates are not choosing surgery as a career.

The majority of doctors in Ireland are approximately 25 when they graduate and surgical training can take between eight and 10 years. This means that newly qualified surgeons or those approaching the end of their training are in their mid 30s, which for some is a time when they may be considering getting married or starting a family.

It is also traditional for young surgical trainees to spend some time abroad towards the end of their training (known as a Fellowship) to get specialist experience in centres of excellence overseas. This period abroad benefits both the trainee and the Irish health service enormously as they return with specialist experience they would not have received at home.

However this is also the time when travelling abroad can cause the most disruption for the surgical trainee and his or her family.

McNamara said that things could become difficult for both men and women as they approach the end of their training programme and there was a need to provide more flexibility in surgical training.

While there is a HSE flexible training scheme open to trainees, the terms of the programme dictate that each post must be 50 per cent full time. Ms McNamara argued that training in this manner could take a very long time, whereas functioning at 80 per cent would be a better solution for most trainees.

“There are a number of years where trainees can find it tough but if you look at the investment that the state puts into teaching us in medical school and then into our training over a number of years, it seems a false economy to not have some way to let people have a bit of slack in their mid-career if they do have family commitments,” she said.

“Our systems aren’t very well set up for part-time working at consultant level, especially in surgery. If we were better at that, that would work both for retiring doctors as well as doctors at the beginning of their career, because there are lots of doctors who are at retirement age who might be quite happy to work one or two days a week and at a time when we can’t recruit doctors, it seems a waste,” she added.

According to Ms McNamara, we currently don’t have any data about what happens to doctors who complete higher surgical training in Ireland. Therefore we don’t know if fully trained male and female surgeons are equally likely to be appointed to consultant grades.

However a new working group on gender diversity in surgery has recently been established by the RCSI and, as chair, Ms McNamara said the group was planning to request that this data was systematically collected.

The RCSI gender diversity group will provide recommendations on how the RCSI Surgical Affairs Department can work to address gender diversity in surgical training and promote professional development of female medical students, surgical trainees and surgeons.

The group met for the first time in December and is expected to deliver its recommendations within six months.

The Medical Council’s 2015 report found that 77 per cent of female graduates of Irish medical schools under the age of 35 were registered in general practice.

Dr Sinead Cronin is a newly qualified GP working in Dublin. After her internship, Dr Cronin applied to train in surgery, emergency medicine and general practice and was offered all three, which she said made her decision even more difficult. Ultimately she chose to train as a GP and loved every minute of it; she is also extremely happy with her choice of career in general practice.

However she said that the flexibility offered by a career in general practice, such as the opportunities to work part time, etc, were a factor in her decision and she believes that lifestyle is a factor for a lot of female medical graduates when choosing a career in medicine in Ireland.

“It [general practice] offers loads as a career . . . the flexibility is a big thing in comparison to some other specialties . . . subconsciously or not, it does factor into a lot of women’s decision. They may not ever say that to you but I think it would be very naive to say that it doesn’t,” Dr Cronin said.

A study published last month in the journal JAMA Internal Medicine (published online December 19th, 2016) suggested that elderly patients under the care of female doctors fared better than those who were looked after by male clinicians.

While it would be wrong to suggest that women are better doctors than men, a medical profession that accommodates the needs of both genders equally can only result in benefits for patients.

According to Ms McNamara, “I always find it difficult when one reads about surgeons and women, it is always about the trouble of being a surgeon and a woman. No one ever talks about [how] women bring great things to surgery”.

“I think it is important that we have high quality consultants and that we retain the quality of the service we provide and I think that service could be provided by men or women. I think patients deserve to have a choice as to who looks after them and I think that a lot of our hospitals can’t meet the preferences of patients because of the pattern of staff that they have.”

Ms McNamara said she would encourage anyone to consider surgery, which she described as “a fantastic career”.

“A lot of the things that would make surgery more accessible for women will actually make surgery a better career for men too,” she said