WOMEN IN MEDICINE

A good friend of mine went to the annual general meeting and national conference for the Federation of Medical Women of Canada (FMWC) this past fall. When she returned, she was excited to fill me in about all the wonderful speakers she had seen. Listening to her talk, I realized that I didn't know very much about the FMWC. Recently, she had sent me their winter newsletter( https://fmwc.ca/newsletters/). It is filled with information from their annual meeting and the causes that are of interest to female physicians in Canada. It made me stop and think about why I hadn't paid much attention to the FMWC before.

When I was in medical school, I had a group of women that I became close to. They were my study partners, my confidantes and my counselors all wrapped up in one. At the time, it was announced that the year ahead of us was the first time that 50% of the medical class was female. In my naivete, I remember thinking at the time, “That's interesting”, and then promptly forgetting about it. It didn't seem that big a deal to me. Looking at the Canadian statistics, it was in the late 1990's that the number of female applicants to medical school began to equal the number of male applicants. By the early 2000's, female applicants had surpassed male applicants. So, things must be great for female physicians, right? Well, not exactly. Looking a little closer, data from the CMA shows that only 41% of active physicians are female. Certain specialties are still male-dominated. As of 2015, 7.9% of cardiac surgeons and 9.9% of neurosurgeons in Canada were female. And a recent study published in JAMA Internal Medicine states that male doctors can expect to earn an average of 8% more than their female counterparts, even when factors such as age, experience, specialty and published papers are taken into account. In hindsight, many of my female friends from medical school ultimately ended up picking residency programs that would be considered “female friendly”, such as family medicine and pediatrics. I don't think any of them picked a surgical specialty, outside of obstetrics/gynecology. One of my friends in medical school had a child and she made the decision to only apply to specialties that she felt would be conducive to raising a family. I was the oddball then (and some would argue, still) by picking anesthesiology. At the time, I didn't think of it as a male-dominated specialty. During my elective rotations, I worked with many female anesthesiologists who were supportive and encouraging of my interest in their field. However, when I entered my residency program, my first year female colleague and I were the only women in the program, and the first women they had in the program for a number of years. In 2006, the Canadian Journal of Anesthesia looked at gender patterns amongst Canadian anesthesiologists. The ratio of practicing female:male anesthesiologists increased from 0.29:1 in 1998 to 0.34:1 in 2005. This ratio was highest in the youngest age grouping (under age 45) and lowest in the oldest (greater than 64). Looking around my workplace suggests that this gap is becoming even lower, although it is by no means equal. So what does any of this mean? For a long time, I had been operating under the assumption that men and women were the same. This kind of obliviousness has obviously helped me in many respects, since many times I didn't even consider that there may be obstacles in my way. But men and women aren't the same ( I can hear many of you saying, “Well, duh.”) We are equal, but different. Many of my doctor friends are moms and wives. There is a lot of pressure to maintain a life-work balance. My husband is a stay-at-home dad. He once told me that if he worked the number of hours that I did, he couldn't see himself spending as much time with the kids as I did. Why is this? Is there some hormonal or biological reason? Is it because of an unspoken societal expectation that moms are to be more involved in taking care of the children and home? Is it because of mom guilt? Whatever the reason, I see many of my female colleagues struggling with this, and it may explain why more women work part-time or choose specialties that don't demand a high degree of after-hours work. Sadly, it is for this reason that some specialties may lose talented women. Perhaps this is also why burnout is reported to occur 1.6 times more often in female doctors according to a study in the Journal of General Internal Medicine. Burnout in female doctors is usually caused by an inability to balance work and home life, as well as a lack of control over workplace schedule. Sound familiar? Also, as my previous post discussed, the #Metoomedicine movement suggests that many female physicians, particularly trainees, also have to deal with sexual harassment as part of their work environment.

As much as one may hope that the experiences of female physicians are the same as their male counterparts, I think we can all agree that they are not. And that is why groups like the FMWC are important. It provides a place where women can share their experiences, especially women who may be in specialties where they don't have many female colleagues who they can confide to. It is comforting to be able to discuss a situation with someone and have them say, “ I've been there too!” We can also use our influence to try and change the medical culture, so that a female trainee doesn't feel she has to choose between having a family and having the career she desires. We can try to impact policy that affects women's health. As Dr. Lipi Roy stated in The Journey of Women in Medicine, “Challenges to progress will persist. How we respond to them will define us-just as they had for our predecessors.” Let's hope we can rise to the challenge.