Response: Women in general practice, Women in intensive care medicine.

An article in the Age published recently has revealed that for the first time, women in general practice slightly outnumber men. While this of course is a wonderful thing - having access to both male and female GPs in equal numbers - I couldn’t help but be disappointed by the overall flavour of the article and how the media continues to portray working women. Despite this, there are many lessons which intensive care physicians can learn from our GP colleagues.

First of all, well done to the RACGP and the general practices involved for providing a working and training environment in which a diverse pool of trainees can flourish. Other colleges should take note of how it can be done. Second of all, this is in no way intended to discount or criticise the achievements of the women and men who prioritise work-life balance as a key element in their career decision making. Certainly, I chose intensive care medicine partly because I knew that shift work would complement my husband’s 9-5 work schedule when it came to helping to look after our kids and my increasingly elderly parents. Feminism is about choice.

However, this article seems to perpetuate gender stereotypes, that women seek work-life balance in order to fulfil roles as parents and primary caregivers That men are left in hospitalist and academic roles, in academia. That the “gruelling” physicians exams and careers in surgery and intensive care are left to men, without exploring the societal factors which drive these choices. That women who seek work-life balance only do so because of their desire to have children, without consideration that some women (and men) choose not to do so.

The author did the very real issue that women are largely still shouldering the majority of domestic unpaid work (both mental and physical), but failed to mention why this is concerning. Of course there will be female trainees who will choose to undertake this role, but there are many others who are left with little choice. Across industries, women are still basing key career decisions on the fact that they must also “[raise] children or look after elderly relatives,” more so than men. This is blatantly unfair because in many instances, the choice to do so is taken away from women. This is not exclusive to medicine, of course, with the resignation of Kate Ellis, former Labour MP, due to lack of flexibility in the workplace serving as an example. We need to start moving the conversation away from just accepting that women are to take on the domestic labour and child raising duties and to start moving toward more equitable division of this work – or, at least an opportunity for negotiation with our partners. If a trainee so desires to take on this domestic workload, then that is his or her rightful choice. A recent conversation with a female junior registrar, considering intensive care training springs to mind – “I just assumed that I would be the one working part-time,” she said “I never thought to discuss with my husband that there might be another way.”

On a separate note, I am disappointed by the way in which the article paints General Practice as almost academically substandard to other medical specialties – the sort of specialty appropriate for women - despite the breadth of knowledge that is required to handle anything that comes through the door, without the hospital armada ready to back you up. It failed to mention that GPs also must undertake gruelling exams, for example (but managed to point out that it wasn’t exactly “sexy.”).

Despite its shortcomings, the article highlights some very important issues within medicine. For example, the rigidity and lack of flexibility in hospital-based training . Lack of part-time training, poor cover for sick leave, meetings scheduled in an inflexible manner are all familiar to us working within the hospital system. The article paints this as a gendered issue – but should it be? Doesn't everyone want to be in control of their training and hours? More women are seeking flexible working hours,but I can take a reasonable punt that many men seek medical careers with increased flexibility also. If men are to be expected to contribute to their households, if they too have other commitments and interests, than they also need a flexible workplace.

But looking at the bigger picture, we need to stop considering ‘workplace flexibility’ as a women’s issue. This simply perpetuates unfair expectations and allows it to be relegated to the backwaters (where women’s issues go to die).

Instead, we need to start discussing work-life balance issues with our female AND male trainees. We need to start asking the question: how can we make intensive care medicine a sustainable career choice for a diversity of talented doctors? Talented doctors who may have parenting or caring or family responsibilities?

The article also discusses the fact that “women who experienced gender discrimination may be driven away from traditionally male-dominated medical specialties.” This is apparently to the gain of general practice, but what does this say about our specialty? One could argue that this is why WIN, actually exists but we must continue to look inward as to why our female advanced trainee numbers remain relatively low. This bad press can only serve as a deterrent (bad press, which, is unfortunately accurate in its reporting of bullying and harassment and most recently, fatigue and burnout. We must continue to address the systematic issues within ICM which contribute to gender discrimination so that more women are attracted into this wonderful specialty. We need to show our potential trainees, both female and male, that a rewarding career in ICM is possible, with or without children, with or without the added responsibility of domestic unpaid labour by addressing not only our gendered issues within our units but by ridding ourselves, as a society at large, of the gendered assumptions of what a family, what an intensivist, what a working parent should and should not look like. We should learn from the scores of general practices who have clearly made flexibility in their workplace a priority, for the benefit of all.

My vision is to one day see this article re-written, this time featuring a female Intensive Care trainee, having just cracked the 50% mark, proud of her chosen specialty, as I am.


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