Quo Vadis Gender Politics in FP?

Peter AC Hutten-Czapsk - 14 September 2007

The article raises important issues about female gender equality that are long overdue. One has to wonder, however, if recommendations to empower female gender physicians are as important now as they would have been a few decades back. Current medical school admissions and FP residencies appear to be as predominantly female as they were predominantly male two generations ago. New academic faculty are already reflecting this. The authors, all eminent academic female role models themselves, are advocating ("redressing of identified imbalance") that to achieve equity they, and other female academics, need better access to opportunity than their male counterparts. This raises a moral conflict between equality and equity, that I find generally and, of course, as a junior male faculty member, personally troubling, and inadequately explored in the paper. Whatever the merits of the argument, and I on balance agree with them, perhaps the authors should have mentioned their conflict of interest in advocating it.

Re: Quo Vadis Gender Politics in FP?

Barbara Lent, Associate Dean, Equity and Gender Issues, and Faculty Health Schulich School of Medicine - 25 October 2007

Dr. Hutten-Czapski questions whether efforts to empower female physicians are as important today as they would have been a few decades back, now that there are more women entering family medicine than men. In our view, ensuring gender equity is every bit as important today as ever before. This has been affirmed by numerous international bodies, including Wonca, the international face of family medicine. There are significant structural impediments which continue to discourage and restrict women’s full participation in civil society in both Canada and everywhere else. In addition, Canadian and international research continues to confirm that this discrimination interferes with how well women physicians can and do provide health care in their communities. The CFPC gender equity initiatives that we outline in our paper are key to our remedying these imbalances in family medicine in Canada. It is no coincidence that senior women physicians like us (who have all experienced, withstood and overcome many of these impediments) are advocating for the “redressing of identified imbalance”. We still experience marginalization and even retribution by virtue of our gender, but are perhaps more seasoned and less vulnerable than junior women faculty to the subtle and less-than-subtle disparagement that occurs when women tackle gender issues. Our advocacy raises no moral (or any other conflict) between equality and equity. To assert that members of a disadvantaged group have a “conflict of interest” in advocating the elimination of inequities, because that group and thus they themselves might therefore benefit, is specious. It is far truer that gender equity is threatening to individual male physicians because to this day, the status quo represents enhanced opportunities for male physicians’ advancement especially at leadership levels. The elimination of gender inequities will not only “level the playing field” for men and women physicians; it will enhance the profession as a whole. Barbara Lent May Cohen Sheila

Reflections of a junior medical woman

Nili Kaplan-Myrth, medical student University of Ottawa - 4 November 2007

Dr. Hutten-Czapski's response to the article on promoting gender equity by Drs Lent, Cohen, Dunn and Levitt makes the assumption that gender equity exists because we have medical school classes that are predominantly female. He also questions the validity of senior medical women speaking on behalf of junior medical women.

As a junior medical woman, soon to graduate from a medical class of more than 60% women, allow me to reflect:

In our medical school orientation week four years ago, the medical students a year ahead of us put on a video in which female medical students were dressed up as nurses in short skirts while the male medical students made sexual advances... A worrisome introduction to the culture of medicine, would you not agree?

Our medical school curriculum was lacking in content on women's health. Even with the existence of amazing tools to study health and illness through a gender lens, such as the Gender and Health Collaborative Curriculum Project (http://www.genderandhealth.ca), we only discussed women in the context of reproductive health... When a cardiologist was asked why a particular study focussed on men rather than on women, he responded, "Probably has something to do with the estrogen factor." Surely there is more to women than their reproductive body parts and hormones!

Women with children in medical school and residency still face numerous challenges, not least of which is the expectation that our work in medicine should take priority over all other aspects of our lives. Ontario residents and physicians can now enjoy 17 weeks of parental leave. Is this enough? What happens to our careers when we step out? Why are there so few women in senior faculty positions? Are mentoring, community involvement and advocacy work -- the kinds of things women physicians are wont to do -- given as much weight, by those on promotions committees, as scientific research and long hours at the office?

Imagine my disdain as I sat at a faculty-student retreat one day and listened to a senior physician say to the person next to him, "We have too many women in medical school." His unfortunate attitude is not uncommon. We have even seen it in public media. The term, "feminization of medicine," is used pejoratively because medicine is built on a patriarchal tradition. But, as we know from the fantastic recent study done by the QMA, we would all benefit from a shift in our model of practice. Feminization is, indeed, a step in the right direction.

We are clearly still a long way from gender equity in health. There are many young people in my class who are unaware of the challenges that lay ahead of them. It is only if the young women and men work together with the senior women and men that we can create positive change. If we can convince our faculties of medicine and our clinical departments and our medical organizations to adopt the 10 Steps to Gender Equity in Health, we'll be much closer to that goal.

Link to the Canadian Family Physician Website