Women Physicians: The Second Shift

According to the Canadian Medical Association, 64% of practicing family physicians are women under the age of 35. This is a welcome statistic and a clear indication of the change in attitudes towards women in medicine. This increase has been steady since the 1960s, with gender parity in Canadian medical schools reached in 1995.

Source: Women are Changing the Face of Medicine, but are Underrepresented in high-level positions CBC Health March 2011

The intersection of women, work and family is a crucial one in 21st century society. More women are in the paid workforce than ever before, which is surely a good sign for women’s economic equality. However, women’s reproductive work, their childbearing, and the regenerative work that women do, the cooking, cleaning, caring for family members, continues to sit solidly on women’s shoulders.

Attitudes are changing. Male partners are more aware of the challenges that their female partners experience, if only because we talk so much about them. The discourse around women and their “second shift” centres around the contributions of male partners (could be more), workplace accommodations (difficult to negotiate) and the policy decisions of government around childcare and part-time work.

Women working in professional fields face an added challenge of negotiating workplace systems that were built and sustained by traditional gender and class-based stereotypes, such as medicine, law, engineering, where the wife of a professional worked in the home to support her husband’s career. These workplaces have not been friendly to the entrance of women. However, that’s becoming less of the norm with every generation as more women continue to work after marriage and while raising their children. Their labour force participation may vary as their circumstances allow, moving from full-time to part-time back to full-time again when children grown. Flexibility is the key in the career plans of many women.

For women in medicine, the rise in numbers has not necessarily translated into a more women-friendly practice of medicine. Long shifts, call duty, scheduling, are practices borne from an era where male doctors designed the day; early morning grand rounds, meetings that stretch into the dinner hour, CME events that last late in the evening, weekend conferences.

Can the day be designed differently, can the work be managed collaboratively, can the schedule be more consistent? Can the remuneration be more equitable?

Not only do gendered social expectations remain strong, but women genuinely want to be there for their children. The tension women feel when they are unable to fulfill this role can be difficult for some to manage. Physician burnout, for men and women, is at an all-time high. The suicide rate for women physicians is twice that of the general female population. The system needs to change before it eats everyone up.

What can be done?

Canadian Medical Association Past-President Dr Granger Avery was in Ottawa in early February and hosted a roundtable discussion exploring “what a progressive, values-based vision for medicine might look like”. It was a welcome opportunity to speak to how medicine can be more receptive to women in medicine and I was happy to share with Dr. Avery and others the issues that women physicians tell us are important to them.

  • Childcare. Not surprisingly, this is a top consideration for women in medicine. On-site childcare, with flexible hours to accommodate schedules. Access to emergency childcare is crucial.
  • Breastfeeding space. It is a shame of our healthcare system that dedicated breastfeeding space and secure storage for pumped milk is not a standard fixture in every hospital in Canada.
  • Administrative Reform. This would benefit everyone, not just women. However, women feel particularly affected by administrative tasks as they directly cut into time spent with family.
  • Alternative Funding Plans. Remuneration plans that accurately reflect the work of health care, including compensation for administrative work and educational contributions.
  • Practice Sharing. Collaborative care in community practice to accommodate part-time clinicians with young families.
  • Reduced professional fees for part-time physicians
  • Media campaign – to alter the public’s perception of “entitled” doctors

March on Parliament Hill, September 2018 to protest unfair tax changes

Women bring change. We need to embrace the change and make it work for everyone. Medicine is in a crisis right now. Burnout threatens physician well-being. Change is inevitable and much needed. Listening to women and what they need can help create a more humane practice of medicine for both women and men, which, of course, is the cornerstone of good patient care.

It’s long past time to review how the health system fails those who work within it by considering what changes would help women physicians be both mothers and doctors. Workplaces – hospitals, clinics - could be more family friendly, not just for mothers in medicine, but for fathers too.

The FMWC advocates in support of women physicians and women’s health. Join us, add your voice to ours, in pushing for the changes that will transform medicine for the 21st century.

Let’s keep the conversation going. How can the system change to be more women-friendly, more family-friendly, and ultimately, more humane overall?

Beverly Johnson
Federation of Medical Women of Canada