There are more doctors that are women, but gender equity remains elusive

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There are more female physicians in Canada than at any point in history – and almost 47 per cent of family doctors and 37.5 per cent of specialists are women.

Female surgeons in Ontario earn 24 per cent less than their male counterparts even though, in theory, they are paid the same fee-for-service rates.

Almost 40 per cent of female physicians in the United States go part-time or leave medicine altogether within six years of completing their training.

Those three tidbits of information drawn from research published in recent weeks serve as a sobering reminder that gender equity is a long way from reality in medicine.

While gender equality is close numerically, female physicians still get walloped by disparities in status, pay, academic advancement, recognition of achievements and expectations outside of work.

The research on gender disparity in surgeons’ pay, published in the medical journal JAMA Surgery, is particularly fascinating because, on the surface, female and male surgeons are paid exactly the same rates for surgery, but when the researchers scratched below the surface, they found sexism was ingrained in work practices.

The study showed female and male surgeons took the same amount of time to do the same type of surgery – challenging the stereotype/assumption that women work more slowly.

But male surgeons in eight specialties made significantly more money – $300.86 an hour on average, compared with $214.59 an hour for female surgeons – because they do surgeries that pay higher rates and, in some cases, refuse referrals for lesser-paying procedures.

Even more insidious is that procedures aimed specifically at women, such as gynecological exams, are poorly remunerated; not only are female physicians devalued, so are female patients.

Add to that that female doctors tend to gravitate – or, more precisely, they’re nudged – toward less-lucrative specialties such as pediatrics and family medicine while men still dominate in the big-money specialties such as ophthalmology and radiology.

One of the most touchy issues in medicine is relativity – how much doctors in various specialties are paid.

Why, for example, do eye doctors bill far more than family doctors? (And, before the howls of protest rise up, yes, there is more overhead in an eye clinic, but that doesn’t explain everything.)

When the Toronto Star published a list of Ontario’s top 100 billing doctors, it was noteworthy that, among the 194 physicians on the list since 2011, only nine have been women.

Relativity, among other things, is a gender issue.

But billing and income are only one aspect of this discussion.

Women are being drawn to medicine in record numbers – a 21-per-cent increase in the past five years alone, but they are still not routinely working their way into the upper echelons of the profession.

In its more than 150-year history, there have only been eight women at the helm of the Canadian Medical Association.

Retention of front-line doctors is also a major problem.

U.S. research, published in JAMA Network Open, found that a staggering number of female physicians scale-back their practice or leave medicine altogether in the early years of their careers.

After six years, 22.6 per cent of female MDs were working part-time, compared with 3.6 per cent of men; among those with children, it was 30.6 per cent women and 4.6 per cent men.

While we are seeing the steady feminization of medicine, policies and practices are not keeping pace.

Medical studies can take up to a decade and, by that time, women who are going to have children need to have their children.

But many physicians – especially women in their child-bearing years – find it close to impossible to achieve work-family balance. Burnout is commonplace in an often unforgiving work environment.

Maternity (and paternity) leaves are relatively new in the medical field, and far from universal. Medical students and residents with children feel openly discriminated against. Doctors who are in private practice essentially have to shut down the business if they take time off for child-rearing.

Re-entry after parental leave can be difficult and costly.

While gender roles are changing, women still bear the bulk of the burden of “non-work” activities: The U.S. study shows that male physicians work seven more hours and spend 12 fewer hours on parenting and domestic tasks than their female counterparts.

The common theme of all this research is that until we better support women in their roles as mothers and physicians, gender equality in medicine will remain elusive and too much of the money and effort we put into training doctors will be lost because we refuse to acknowledge that medicine is no longer a boy’s club.

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