Who’s feminising medicine?
Rising numbers of female doctors are not to blame for problems of leadership and commitment in the medical profession.
At seven o’clock on Thursday morning, after a weary night in Accident & Emergency in a large district general hospital in Devon, the sister in charge came through to let us know that she’d had a call: an ambulance was on its way with a young man who had been found trapped in a car driven into a hedge, unconscious, with his arm horribly broken. This generated what is called a ‘trauma call’ – the relevant hospital specialists from orthopaedics, surgery and anaesthetics were called to the department to await the arrival of the ambulance.
The patient certainly was in a bad way – the first step was to intubate him, which was carried out by the female anaesthetic registrar. The female A&E registrar looked a little uncomfortable in her lead apron, emblazoned with the words ‘trauma team leader’, but she remained calm and in control throughout. Female nurses busied themselves lifting the patient and cutting off his clothes. The female orthopaedic doctor looked carefully at his deformed, swollen arm, checking for pulses and temperature.
I have been at quite a few trauma calls since qualifying as a doctor, and this was one of the quietest and most efficient; there was no shouting of orders or raised voices, even though we had a very sick patient on our hands. Even 10 years ago, this all-female scenario would have been odd. Now it is not unusual – and that’s a good thing, I believe.
In an interview with the UK Independent on 2 August 2004, Professor Carol Black, an eminent dermatologist and president of the Royal College of Physicians, said there may be a downside to the rising numbers of women in medicine. Women now make up over 60 per cent of medical students. Black talked of the ‘feminisation’ of medicine, arguing that such a process could undermine the status of the medical profession in society.
Women doctors, she said, are less prepared to sacrifice life outside work to take on the enormous commitments required to lead the medical profession. They are happier than male colleagues to stay in lower status jobs, and less interested in the kind of extra-curricular activities – research, leading professional organisations, chairing committees and so on – that ensure the continuation of the profession.
Her arguments have a resonance. The old idea of medicine as an all-consuming passion, to which an individual might dedicate his or her life, is seen as unhealthy these days. However, I think it is wrong to see this purely as a gender issue. There has been a ‘feminisation’ of medicine, certainly – but the new attitudes are equally pervasive among male doctors.
I have seen many talented female colleagues on junior surgical training schemes opt out of surgery to become general practitioners. Some of them regret turning their back on a specialty they love, but are keen to achieve a ‘work-life balance’. However, many male colleagues seem to go the same way – they may be more likely to stay in hospital medicine but often they will opt for easier careers, such as in radiology or anaesthetics. Even for those who stay in surgery, the tough specialties of general and vascular surgery have become less attractive, whereas urology or ENT, seen as easier options, are growing in popularity.
There are no easy solutions to these problems. Professor Black is right to point out that it is difficult, if not impossible, to combine a conventional family life with a high-profile career as a doctor. And of course, dedicating your life to your job is even harder for women, due to the realities of family life and child-rearing.
But traditionally, some women have persevered and made it through to the top ranks of the profession, inspiring others to follow in their tracks. Perhaps the problem is not that female doctors are bringing the medical profession down, but that those at the top of medicine have failed to persuade the rest of us that making sacrifices is worthwhile.
Professor Black’s thoughts seem profoundly pessimistic in this regard. It is true that the medical profession commands less respect than it did in the past – but we need our leaders to think up imaginative ways to address the problems of public mistrust and internal self-doubt, rather than simply suggesting that we turn the clock back.
Dr Liz Frayn is a surgical trainee in southwest England.
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