Wins for nurses not seen for women resident doctors

Female trainees report higher levels of discrimination and bullying than their male colleagues, particularly in more male-dominated surgical specialties

Working in New Zealand’s health system right now is a tough gig, as Te Whatu Ora reported in its workforce plan that in July.

The plan outlines serious shortages across the board, shortages that are, unfortunately, most likely worse than reported and, thankfully, are finally being addressed.

Working in our health system as a resident doctor is especially hard. Our hours keep going up as more and more of the responsibility for keeping the hospital doors open falls on us.

Meanwhile, pay has fallen behind to the point where, with the great news that the nursing multi-employer collective agreements and pay equity negotiations have been settled, resident doctors’ hourly rates are now lower than nurses’.

The hard-fought and hard-won battle for pay equity has been one of the few recent bright points for women in our healthcare system. Unfortunately, few similar gains are being made for women resident doctors. That needs to change if the profession is to have a decent and diverse future in Aotearoa New Zealand.

Women have made up the majority of new doctors for the best part of a decade. Just under 60 per cent of house officers and just over 51 per cent of registrars are women, and the proportion of women in these resident medical officer (RMO) roles has been trending up since 1980.

The research on women in RMO roles speaks for itself. There is good evidence that the number of women trainees choosing surgical specialties is strongly related to the number of women in the surgical faculties but, in many specialties, there are still very few female role models.

Despite the number of women in medicine growing steadily year on year, the proportion of women in leadership roles is disproportionately low. The glass ceiling is fracturing at best.

Survey after survey of trainees has found female trainees report higher levels of discrimination and bullying than their male colleagues, particularly in more male-dominated surgical specialties. Respondents note experiences including sexist comments, gender stereotyping and the pressure for women to fit in to the “boy’s club”.

Unsurprisingly women are two and a half times more likely to leave surgical training within Australasia than men are.

The solutions are well traversed. One of the big ones is building flexibility into training.

Career advice all too often morphs into family planning advice, while I personally have been fortunate to have an unusually supportive specialty college, other colleagues have been told “do not get pregnant if you want to make it [as a surgeon]”, and I have seen discrimination against colleagues who get pregnant while they are training.

Women working as resident doctors are often left feeling that they are caught in a race between their biological clock and their training schedule. This shouldn’t still be a thing in 2023.

The second and third clear solutions are ensuring there are more women in leadership and more women in role model positions. This is proven to encourage more women into specialties and to see themselves as future leaders. An absence of women in these roles and specialties has a dissuading effect, as does the frankly sexist description of leading women as “token” – something we still hear far too much of.

In the face of future workforce shortages, it seems alienating more than half of your potential specialists on the basis of their gender might not be such a smart move.

Finally, advocacy needs to be built into the system.

Much of the discrimination women in medicine face is the result of a societal unconscious bias. That's not unique to medicine, but we should be actively reminding ourselves of it and seeking to counter it.

Gender is among the most influential status characteristics because of its effect on performance expectations, evaluation and perception of females in leadership roles. Gender stereotypes are part of societal norms and affect what we expect from others, how we perceive and evaluate them and how we behave towards them.

When evaluating people for leadership positions, evaluators tend to hold women to higher standards than men and thus underestimate women’s potential and overestimate men’s potential. This is rarely done consciously, but because of that it is also not often recognised unless it is described and checked.

We need to make sure that we keep talking about gender discrimination so that we keep recognising it and making sure it is addressed.

There may yet be light at the end of the tunnel. I may be optimistic, but it seems (on good days) that the gender biases that exist in our society are being recognised more broadly and that the importance of addressing them is also becoming more and more widely accepted.

And then there is the blunt pressure of workforce shortages. We expect the urgent need to attract and retain resident doctors to lead to better pay and conditions in our upcoming September negotiations as it has for other health workers.

Given the majority of resident doctors are women, Te Whatu Ora’s retention plans absolutely must include addressing the disparity women face in medicine. It is hard enough to want to stay in Aotearoa New Zealand as a doctor without also facing additional pressure because of our gender. That’s a reality the profession and the Government can’t turn from.

Christina Matthews is president of Specialty Trainees of New Zealand and a Surgical Education and Training 3 trainee in ear, nose and throat surgery