Think sexism in medicine is unique to Japan? Think again

https://www.theguardian.com/commentisfree/2018/aug/13/think-sexism-in-medicine-is-unique-to-japan-think-again Van Badham I’d love to insist sexism is localised to Tokyo medical school. But women are devalued in medicine across the west @vanbadham Mon 13 Aug 2018 02.49 BST Last modified on Mon 13 Aug 2018 04.35 BST Team of surgeons operating on patient in hospital ‘Britain and Australia are both producing more female graduates of medicine than male, but report profound wage gaps between the genders.’ A nasty scandal exposed last week at one of Japan’s most prestigious medical schools should provoke global questions about enduring sexism and the profession of medicine. Tokyo Medical University has admitted that its examiners manipulated the scores of its entrance tests – specifically to police and restrict the inclusion of women in its courses. They did this by reducing the scores of all first-stage applicants by 20% and then adding “at least” 20 points to the scores of most male applicants. Their reason? “The school wanted fewer female doctors, since it anticipated they would shorten or halt their careers after having children,” reported the Guardian. “I suspect that there was a lack of sensitivity to the rules of modern society, in which women should not be treated differently because of their gender,” explained a contrite director. 'Betrayed': victims of Tokyo medical school scandal speak out Read more An investigation discovered the manipulations had been occurring since 2006. Thousands of women were denied entry to medical training as a result. “Studies show female doctors who have passed the national medical exam has plateaued at around 30% for more than 20 years,” reported Canada’s broadcasting corporation, despite Japan’s gender parity in rates of university education, “leading some experts to suspect that other medical schools also discriminate against women.” I’d love to insist this sexism is aberrant, uncommon, localised to one institution. But I would be wrong. Anyone tempted towards indulging some Anglophonic western smugness by the outrageous events in Japan is in profound error. At least the sexism at Tokyo Medical University is overt. But overt or covert, active or passive, behaviours that devalue women within the high-status profession of medicine is, alas, a shared cultural concern. The question “Why are there still so few female doctors?” for example, was explored in an article about professional discrimination in the United States in only January this year. There, women have entered medical fields at the same proportion to men for 20 years, yet experience burnout at double the rate. They’re subject to patient harassment at seven times the rate of their male colleagues, have a gender pay gap that’s widening, and in academic medicine are represented within only 15% of department chairs and 16% of medical school deans. American female doctors commit suicide at the rate of between 2.5 and four times that of the general population. And these aren’t unusual afflictions. Britain and Australia are both producing more female graduates of medicine than male, but report similarly profound wage gaps between the genders. In Australia, “the annual gross personal earnings for female specialists was on average 16.6% less than their male counterparts, and female GPs earned on average 25% less than male GPs”, according to research group Level Medicine, while comprising only 34% of specialists and 9.2% of surgeons. In Britain, the gender pay gap between consultants stands at 12%, with four times as many male consultants receiving pay bonuses as women do. Sign up for Guardian Today Australian edition: the stories you need to read, in one handy email Read more It was in 1993 that an influential qualitative study in Canada reported 76% of female doctors were subjected to patient harassment. Last year 60% of female doctors in Ireland reported harassment of the same kind. In the same report from the Irish Medical Organisation, a third reported sexual harassment from a colleague. A further 28% reported experiences of gender-based bullying. Again, earlier this year, when the New Zealand Herald reported one in 10 junior doctors had witnessed or experienced workplace sexual harassment it was within the context of claiming there was a culture of “sexual intimidation and cover-ups” in the hospital system there where the majority of female victims were “scared to speak up” about harassment by their male colleagues. “I don’t think we’re coming close to establishing how big of an issue this is,” said one female doctor, the Herald reporting: “Female staff thought putting up with a certain amount of sexual harassment was part and parcel of being a female doctor.” Similar sentiments ignited debate about sexual harassment in Australian medicine three years ago. Sydney-based vascular surgeon Gabrielle McMullin lamented that career progression for local female doctors often obliged them to comply with a harasser’s demands for sex, given the professional blacklisting that she’d so often seen result from lodging complaints. “The complainant becomes a scapegoat and the perpetrator ascends the ranks,” agreed Ranjana Srivastava, the medical columnist for this publication, speaking of her female colleagues’ shared experience. In light of the Tokyo revelations, it’s interesting to revisit the latter article for its claim, “The most competitive training colleges can behave like a cartel – their selection processes are opaque and favours are bestowed on a chosen few by a chosen few.” The evidence suggests systems of professional discrimination are ingrained and habitual, and, of course, the culture of disadvantage does not affect women alone. And the ramifications have impacts far beyond a few hospitals or communities. Why does America still have so few female doctors? Elisabeth Poorman Read more The restriction of leadership to a self-selecting “chosen few” that defaults to traditional privileges compromises any profession’s capacity to provide equal outcomes. Medicine’s history of gender bias against women yet saturates our understanding of the body, perpetuates gendered lags in treatment of shared diseases, restricts access to specialised services, discriminates in research priorities and for 20 years has been shown – again and again and again and again and again – to minimise and marginalise the treatment of women’s physical pain. Speaking about a national endometriosis strategy, Australia’s health minister was obliged to admit “women have not felt comfortable seeking help” for the painful disease, “they have been made to feel ashamed, or their pain or their circumstances have been dismissed”. When the example – be it from Japan, the United States, Britain, Australia or anywhere else – is a professional disregard for the women within its own ranks, are such symptoms of systemic malaise really that surprising?