Have I gone mad?

[ailbhe]

Rise in women doctors 'worrying' (Note scare quotes.)

Comments

[sidheag.livejournal.com]

It's a silly headline, but OTOH, it's not obvious what a better one would have been. "Rise in women doctors requires planning for"? Longer and not as catchy...

It is true that if the people entering medical school, on average, work a lower proportion of a working than the ones who used to enter medical school a decade ago did, then it's costing more overall to train our doctors than it used to. That cost has to be planned for and paid.

It is true that if boys on average mature later than girls in certain ways, and interview procedures look for maturity in those ways, then a naive interpretation of the interview results may not get the people who will be best for the profession in the long run.

Isn't it?

[the0lady.livejournal.com]

Er, no. If you start adjusting the bar for certain groups based on the exact circumstances in which they excel against their peers, then when does it stop? Is it fair to girls in the first place, to artificially change the screening process so that they lose their competitive edge?

Better childcare is not something that only affects the medical profession. It's a national crisis, with women being on the sharp end of inadequacy both as earners and parents - but with the whole of society paying the indirect price. This particular catch-22 needs to be resolved before th British economy can move to the next level, not out of any charitable impulse towards women doctors.

[sidheag.livejournal.com]

Depends what the screening process is for. If you think, as I do, that it's for working out which people will make the best doctors, over their careers, then it seems rational to take into account anything you need to get that result. In practice, I think it can't be done without falling foul of sex-discrimination legislation, and that's probably a good thing overall, but I think this is a case of allowing some bad judgements to be made for the greater good. If you doubt that this is a bad judgement, imagine an extreme case: imagine that 99% of 18yo women "interviewed" mature enough to be doctors, and 99% of 18yo men didn't, but that there was evidence that there was no significant difference between 25yo men and women in that respect. Would you think it reasonable to recruit only women, because of how they interviewed at 18? I would conclude that the interview procedure was somehow flawed!

Better childcare: yes, it's very important. However, I doubt that it actually has much to do with why so many women doctors work part-time. These people are very well-paid: well enough paid that they can buy whatever childcare they want, now. The ones I know who work part time do so because they can: they can earn enough money to be comfortable in less than a full-time job. So they choose to do that, because they prefer it. (And so would I, but my job isn't that well paid, so I work full time. Double my salary, and I'd go part time too.) Improving the provision of childcare wouldn't make any difference at all to that. Altering society so that men and women are equally likely to want to work part-time if they can afford to do so would make more male GPs work part-time too, but that's another matter. And neither of these things (providing more childcare, and changing society) is going to happen fast enough that it makes any sense for anyone to wait for it, instead of planning for what's happening now.

NB I am NOT saying that we should take a male student who's likely to be a less good doctor than a female student because he's less likely to work part-time! That would be discrimination.

[the0lady.livejournal.com]

I disagree with your definition of the screening/interview process. The way higher education actually works is by looking for people who'll make the best medical *students*. The screening process makes no predictions about who'd make the better doctors, and the article doesn't address that (except to say that male doctors cost more in malpractice suits, but that may just be because there are more of them in high-risk consultant roles), so I can't speak to data I don't have.

Similarly, I can't really address your personal experience in terms of women doctors you know who work part time. Looking at what junior hospital doctors make, how many hours they work and what the cost of living is against the cost of private childcare in, say, greater London, it doesn't look good.

But you haven't addressed the issue of achieving equality by taking away a non-descriminatory competitive advantage. Would you get behind, say, making all men in their 30's take a 5-year career break because that's what a lot of women do? Would you consider it discriminatory? Why? Or, why more discriminatory than the existing situation, where women are the ones who work part time and take career breaks to take care of the kids?

[sidheag.livejournal.com]

The way higher education actually works is by looking for people who'll make the best medical *students*.
What's your basis for saying this? Are you directly involved in the process? I teach in a university, though not in a medical school, and I was told by someone who is involved in the process that they are looking for people who will make good doctors. (Of course, there is a serious "and how do they know if they're succeeding" question, but we were talking about the aim.)

The people who are working part-time that I know are all GPs, and a full-time GP earns on average around 100K pounds these days.

But you haven't addressed the issue of achieving equality by taking away a non-descriminatory competitive advantage.
I think that's the wrong way to frame it, when there's nothing canonical about the competition. I mean, there's nothing that's valuable in itself in being good at medical school interviews. What's valuable is being a good doctor, and the interview is only valuable in as far as it can make predictions about that. So if there is evidence that it's making women look better than men, in a way which isn't because women will actually be better doctors, then the interview procedure should be changed.

Let me be explicit and say: if, on the other hand, the evidence is that women are doing better at interview because they actually make better doctors, then I think the interview procedure should stay as it is - it's doing its job. In that case, people who think it's a problem should be asking questions like "how can we educate boys to be more empathetic?" or whatever the issue is, not changing the interview.

Would you get behind, say, making all men in their 30's take a 5-year career break because that's what a lot of women do? Would you consider it discriminatory? Why? Or, why more discriminatory than the existing situation, where women are the ones who work part time and take career breaks to take care of the kids?
I'm not trying to be awkward, but I don't understand what you think the connection is between these proposals and the proposal to have different expectations of what 18yos will say in interview, depending on their gender.

[the0lady.livejournal.com]

Re childcare, as I said, it's difficult for me to engage with examples that come from your personal experience. I'm not making an argument from authority here, but an argument from externally verfiable facts. Whatever the income level of the specific part time female doctors of your acquaintance, I think my rough back-of-the-napkin math stands; and we're only talking affordability - we haven't even begun to discuss availability!

Having said that, if it's absolutely essential for the validity of my opinion that I have some personal experience of the matter, I did use to work for the local NHS PST and, as part of my job, saw a fair few ads for GP positions in the area - not sure where you live, but in Swindon we're looking at something more like £50-60K, which makes £1K a month for full time day care possible, but still more expensive than earning less and paying less.

This again is only addressing what to my mind is the least important aspect of this question, which is cost. Availability, _quality_, and social acceptability of childcare are hugely important here, and none of those can be addresed outside of the context of tackling institutionalised sexism head-on.

It may seem as if I'm being unduly stubborn on this subject, and I apologise to Ailbhe for highjacking her journal. But I really do see childcare and early education as one of the major crises facing the west today, not "just" a feminist issue; and the social attitudes to this question are so medieval that people - educated, clever LJ users who are on my friends list - can say with a straight face that asking for better childcare provision is "dumping your kids onto the state", and mean it.

Now, to just briefly address your last point. I can see why you should be confused, my example was a bit random. But we (women and men both) are constantly bombarded by arguments that go something like "blah inequality is unavoidable because of blah natural differnce between men and women", with the second "blah" being something reproductive, like pregnancy or breastfeeding. And that basic and handy argument makes the basis of a lot of apology for inequality, e.g. "the pay gap is a result of women taking career breaks to rear children, which is down to the fact that they're the ones who get pregnant and breasfeed".

Well, yeah, pregnancy "just is"; but boys maturing later than girls "just is" too. So either we should be prepared to discuss equal parenting leave and shared child rearing seriously, or shut up about the "inequality" of holding university interviews at the age where people usually go to university.

[sidheag.livejournal.com]

Oh, average salaries are verifiable of course; if you'll accept the BMA's figures, while they were asking for more: in 2006, at
http://news.bbc.co.uk/1/hi/uk_politics/4920692.stm
Hamish Meldrum, lead GP negotiator for the British Medical Association, told the BBC average GP earnings were a bit below £100,000 a year.
Don't know whether Swindon GPs are especially badly off or what! (If your experience is a few years back now, that'll account for it: GP salaries went up a lot with the new contracts.)

I was appealing to personal (second-hand) experience re (1) motivation for GPs working part-time; (2) aims of medical schools admission interviews. I don't have any verifiable source for either of those, or I'd have offered them, but FWIW you haven't offered any either. I did briefly google for the latter, thinking I might find a helpful web page, but didn't quickly. The first would need a survey, and I don't know whether one's been done.

We are completely in agreement that childcare and early education are not just feminist issues.

For the rest, I think it's "two wrongs don't make a right". I do agree that people not wanting to address the inequalities caused by the fact that it's women who get pregnant, etc., is pervasive and bad. I don't think sanctioning another kind of injustice - making it hard for late-maturing but ultimately very capable boys to be doctors - is helpful, though. We should be fighting for justice, not for women :-)

[the0lady.livejournal.com]

I respectfully submit to the BMA's data, and indeed do so happily since we seem to be in agreement that pay levels are a minor cavil in the wider and more serious field of childcare controversy. =)

To the points about interviews, the purpose thereof: I couldn't come up with anything better than "I work at a university" either, except I don't. My information comes from a pretty idiosyncratic source. Where I come for university places are a more competitive business than they are here, and people put a lot of effort into getting themselves prepared for the competition ahead. So naturally a whole "prep" industry has sprung up around the various psychometric tests and interviews and portfolios that people need for various courses, and one of the first things they drum into their students is "you don't need to be good at X to get into the course of your choice - you need to be good at getting into course X". Cynical, but it works.

I can accept that university interviewers have the avowed and even sincere _aim_ of weeding out the potential bad doctors; but I honestly struggle to envisage a realistic way for a panel of academics to determine at 18 (or 19, or 20) who'll be a good practitioner at 35.

As for fighting for justice, I don't subscribe to all that post-"Backlash" lads mags stuff - or as it is often camouflaged in more enlightened circles, so-called "humanism". Any "injustices" done to men as a result of feminist advances are usually a) relative rather than absolute and b) statistically negligible. I've got a 6% rape conviction ratio to worry about - the tiny percentage of middle class lads who may possibly fail to get into the small number of toffy unis that still hold interview panels, all because they can't keep a straight face at 18, is frankly acceptable collateral damage. Perfect is the enemy of good enough, and I'd rather see an acceptable level of justice for women before worrying about perfect equity for all.

[the0lady.livejournal.com]

I got really curious about the whole admissions thing, so asked my friend who'se an Associate Dean at UWE to help me find some references online. We didn't find anything specifically relating to medical schools, bt here are a few examples:

From "Policy Statement on Equality and Diversity and Code of Practice on Equal Opportunities for Students", University of Essex, p1.5:

"Criteria for admission must relate to a student's estimated potential to succeed academically on a course."

The rest can be found at http://www.essex.ac.uk/academic/docs/regs/equalop.shtm.

Also, from the "Admissions to Higher Education: Fair Admissions to Higher Education: Recommendations for Good Practice", a Steering Group Review headed by one Professor Charles Schwartz at the behest of Charles Clarke during his tenure as Secretary of State for Education and Skills:

"Principle 2: A fair admissions system should enable institutions to select students who are able to complete the course as judged by their achievements and their potential"

This one's a PDF so I don't have a link, but you get the general drift.

[sidheag.livejournal.com]

This is certainly true for courses in general (it's true of the one I recruit for, for example). I've been told that medical school admission is different. For example, they place a great emphasis on how the student handles ethical questions, although ethics is much less prominent in the course than it is in the interview. Although of course there *is* ethics in medical courses, someone who finds ethics difficult will still probably do just fine as a medical student. The reason for emphasising it in medical school interviews is because it's considered important for judging who will be a good doctor. But I have nothing verifiable to point to for this, it's all out of conversations.

[micheinnz.livejournal.com]

The way it's done at the university I work for is this:

The first year of Health Sciences (Medicine, Pharmacy, Dentistry, Physiotherapy, MedLab Science, a couple of other specialties) is all open entry.

The kids are worked hard -- they study biology, human anatomy, biochemistry, some physics I think, a bunch of useful stuff. They also do the UMAT test, which is designed to make sure that people going into the healthcare professions are actually able to relate to other human beings, rather than being callous robots.

At the end of that first year of study they apply for Med, Dent or whatever it is that they want to pursue as a career. Entry to the programmes is based on a combination of their marks (did I mention these kids are worked hard?) and their UMAT results.

So by the time they get into Med School, Dental School etc they're nineteen, got some study habits, got a better idea of who they are and what they want to do.

They still work stupid, dangerous hours as junior doctors (and I can't help wondering whether some of the hand-wringing about the number of women in the profession is the number of juniors suddenly standing up and saying "I'm not working a 48-hour shift"), but there's lobbying for that to change.

[sidheag.livejournal.com]

Junior doctors' hours here have been [edit: are being, I see we are about to implement the EU directive, whereas I thought we'd done it already] improved lately - thank goodness. Still not a fun way to get trained, but not quite as dangerous as it was.

Doing the human-being test a bit later and after some study sounds like a very sensible system!

[the0lady.livejournal.com]

Did you read all the way to the bottom? Where that dude is suggesting changing the interview process to "get more men", because girls do better at interviews right now?

So, there isn't really a problem yet, and already tehy're talking about moving the goalposts to making it easier for blokes; but affirmative actions is baaaaaad, man. Just bad.

[random-c.livejournal.com]

This is just... *boggle*
I bet he's the sort who nags his male staff to take a fraction of the patertity leave they're entitled to, as well.

[ruthi.livejournal.com]

'A separate piece in the British Medical Journal pointed out costs associated with poor performance, litigation, re-education, and rehabilitation were consistently higher for male doctors' -
But this is 18 paragraphs down. Male doctors consistently cost more, perform less well, but this is somehow not 'worrying'.
(I hope the researchers adjusted for actual numbers and ratios of male to female doctors)

[shreena.livejournal.com]

I completely misread this. I thought you'd posted an article about how women doctors worry too much.

[the0lady.livejournal.com]

That's exactly what I thought too... =)

[porcinea.livejournal.com]

They're not scare quotes -- they indicate a direct quote from the interviewed subject.

Thank goddess, because otherwise the paper would be saying that the rise in women doctors is worrying, rather than reporting that some idiot said that etc.

[calieber.livejournal.com]

My girlfriend mentioned she'd never had a doctor she found physically attractive and asked if I'd ever felt that way about nurses (I have a lot of recent experience, I spent about a tenth of 2007 in some hospital bed or other). Not many, at least a third not being my type on heterosomes alone, but ask me about some of the doctors.

[elissaann.livejournal.com]

I don't get why part-time doctors are a problem. My intuition is that two part-time doctors could do as good a job as one full-time doctor, and I can think of a lot of advantages to that situation.

[thereyougothen.livejournal.com]

absolutely. ok, it costs twice as much to train two part time doctors, but the training is a one off cost. once that's paid for, we have a larger, more flexible pool of doctors. win win, it seems to me.
and who cares if they are all female?

[da-pol.livejournal.com]

Continuity of care is a significant issue, especially if you're dealing with patients with chronic conditions who have to bring the GP up to speed in the 7-10 minute consulting slot as opposed to having a GP with domain knowledge which allows them to maintain a single course.

Differences of approach, opinion and manner can be detrimental in long term treatment.

These are all soft things - there's no hard "2 is worse than 1" - for the majority of patients it will make no difference as most people see the doctor once or twice a year, but for chronic patients it could be a serious issue.

[ailbhe]

I get continuity of care for my ongoing issues, and my doctor is jobsharing. I get continuity of care for my parental concerns, and my health visitor is part-time. I got fantastic continuity of care from my midwife, last pregnancy,and she was part-time too. It does mean sometimes waiting for an appointment with the person you want to see, but for ongoing issues, that's perfectly normal; only a certain proportion of the appointment slots are bookable ahead of time anyway. I sometimes book my next appointment during the one I'm having.

In general, the part-time GPs seem less inclined to rush me out the door than the full-time ones, but this could be just because the female GPs are less inclined to rush me out the door than the male ones; there are no part-time male GPs at my surgery. I've learned to book an appointment for myself and a child at the same time if I want to see one of the male GPs; that way we can spill over into each others' time and get at least one of us properly dealt with.

[thereyougothen.livejournal.com]

i have one chronic and one acute medical condition and i have no problem with continuity of care. my GP is part time, as are all but one of the GPs in our practice. i know the days my GP works, and the only time i don't see her is when she's on holiday, or if i need an emergency appointment.
there are 4 doctors in the practice, but information sharing is a big part of their ethos, and i've never had a problem with needing to repeat huge chunks of my life. it's not a serious issue in my experience.

[ailbhe]

Yeah, when My GP went on maternity leave I was upset, because I hate repeating chunks of information, but I discovered that she had actually DONE that FOR me ahead of time, so it wasn't an issue. She has also written a lovely summary for my notes, so whoever I see can get to grips with the situation quickly.

[elissaann.livejournal.com]

I go to an office with 2 doctors. When I make the appointment, I make it with a specific doctor. Why would it be different because the doctors are part-time?

[the0lady.livejournal.com]

I have a minor chronic condition, and a practice where all the - male - doctors are part time. Zero impact as far as I can see.

What really changed my quality of life was when they got rid of the bow-tie wearing cretin who insisted on perscribing me barbituates instead of anti-depressants. Cause, like, suicide is such a minor risk compared to the potential side effects of Seroxat. Fucktard.

[ailbhe]

Suicide IS a potential side effect of Seroxat! But yes, appropriate prescription is very important.

(Or maybe was, since they no longer prescribe it to under-18s).

[the0lady.livejournal.com]

Put it this way: I had been on Seroxat for about 10 months at that point, and was still alive. He made me go cold turkey and gave me 24 sleeping pills to do it with.

I wasn't under 18, but dude, srsly!

[ailbhe]

That would be incredible if it weren't so believable. I'm slack-jawed and openmouthed.

Srsly, indeed.

(I was given Seroxat at 16; the next time I felt so near to death, I was suffering undiagnosed, unmedicated PND/PTSD beat combo. I stopped taking Seroxat and was declared non-compliant. Good times. Thank heavens for my mother.)

[micheinnz.livejournal.com]

Less burnout, for a start.

[rmc28]

Excuse me while I explode in rage at all the unfair assumptions in that article.

Thank you. Normal service will now resume.

[browngirl.livejournal.com]

I really don't think you're the one who's crazy.
Also, grrr. Just... grrr.

[adrian-turtle.livejournal.com]

I think there are considerable problems with the social structures that equate "professions with more women" and "lower status professions." When there are only a few women in a profession, each of them might face any number of nasty barriers, but the profession as a whole has the status of a masculine profession, and they get to borrow that. When there are "enough" women doing something, it gradually transforms into "women's work," and everyone doing it loses status. It happened with high school teaching in the last century. It happened with nursing after the US Civil War. In my lifetime, it's already happened with gynecology and pediatrics.

It's all worrying. But excluding women doesn't make it any less worrying.

[ailbhe]

I'm sure I remember someone on my friends list saying it's happening in the legal profession too.

[the0lady.livejournal.com]

Oh wow, I'm so glad I'm not the only one that's noticed that!

It's also happened to clerical work - "secretary" used to be a respectable middle class (male) job title, but has become so devalued that it's had to be replaced with "PA" or "admin".

To my mind the thinking goes something like "it's too hard for women to do" --> "women are doing it therefore it can't be that hard" --> "it's easy enough for women to do so it must be an unchallenging occupation" --> "it's an unchallenging occupation that requires few skills, so it doesn't need paying as highly as other occupations".

By the time you get to te last step of the reasoning, gender has been taken out of the loop and the situation has become a "just is" - so it's easy to claim that women "bring it on themselves" with regard to the pay gap when they "choose" low-paying occupations such as teaching, nursing etc.

[rosefox]

A male gynecologist recently told me that gynecology is despised by surgeons and that the pay is very low compared to other medical professions. "I go to conferences and the surgeons are all, oh, don't get up, it's just a gynecologist," he said. "My brother's cat needed a C-section, and the vet got paid more to do a C-section than I get paid to do one on a human patient!"

Then his office billed me $600 for an exam that my insurance was supposed to cover 100%, and it took several irate phone calls to get it all sorted out, so I don't feel terribly much sympathy for him specifically, but I can well believe that the profession is increasingly deprecated as more women become OB/GYNs.

[hitchhiker.livejournal.com]

interesting! i'd never consciously thought about that, but you're absolutely right

[aquaeri.livejournal.com]

I'm not a (medical) doctor, but I'm a woman about to leave vaguely medical-related research. I can well imagine that fewer women doctors are involved in research. That's not a problem with the women, honestly.

[hitchhiker.livejournal.com]

i thought those were more disassociation quotes than scare quotes - as in "look, we're just telling you what he said, don't shoot us"