Thoughts from a Panel Discussion

It was an honour to be asked to participate in a panel discussion at the Royal College of Physicians in Ireland to commemorate the 100th anniversary of the first female Fellow of that esteemed establishment. Dr Mary Hearn from Cork was a gynaecologist and philanthropist, who completed her MD in 1922 and became a Fellow of the College on 18th October 1924.

Following on from hearing the inspiring stories of my fellow panellists’ experiences as female leaders in their respective fields, there was ian invitation for questions and comments from the audience. This drew out diverse and astute perspectives from women with lived experiences of being a female in healthcare in Ireland.

The issue of conflict of interest arose, both in relation to the provision of reproductive healthcare (which the questioner felt was of particular pertinence to female providers of abortion services) and with regard to the divestment by educational organisations from sources of funding which would be deemed to be inappropriate or unethical. This is a developing area of difficulty for all organisations who accept funding from third parties, particularly those like ours which operate on a charitable basis. How do we know that the money we accept is “clean”? How do we provide high-quality educational resources without seeking funding from the kinds of for-profit entities that are keen to give it?

 It is a conundrum; a little like Groucho Marx’s musing that he would “refuse to join any club that would have me as a member," if a commercial entity is very keen to spend their money to access a particular group of professionals, one has to question their motives. Corporate social responsibility (CSR) has become immensely fashionable, and the concepts of green-washing, pink-washing, and even blue-washing are all around us. With a female-focussed organisation, the draw for companies is very clear – they get to show how wonderfully concerned they are about the wellbeing of women, while quietly persisting with huge gender pay gaps and pathetic childcare provision for their employees. Worse again, they may be perpetuating body-shaming practices in order to sell yet more overpriced products which support the notion that a woman’s social value is primarily based on her physical appearance. An editorial in Health Promotion International in 2023 calls this out quite clearly: “While harmful corporations may claim that they are socially responsible in supporting and empowering women, it is important that we do not legitimize the role of these organizations as partners, collaborators, funders or decision-makers.” 

WiMIN does not accept funding from pharmaceutical companies, as the evidence for their undue influence over prescribers and resultant negative outcomes for patients has been clearly demonstrated in multiple studies. We endeavour at all times to partner only with organisations and companies who we feel match our core values and who have demonstrated genuine good intent when it comes to gender equity principles. We support female-founded enterprises, and those whose CSR record is genuine and grounded, rather than solely for show.

 The next question posed by an audience member was based on her observations at a recent academic conference; why is it that female presenters will spend hours refining and honing their slides, diligently editing and practising their speech, and generally sweating buckets about the delivery of their work in a coherent and cogent package for the benefit of the audience, when (it would appear, allegedly, based on observational data only) that some male presenters simply hop up on the stage and blurt out whatever they like about the slides that someone else prepared for them? I am paraphrasing here a little; the learned Fellow obviously said all of this in a much more measured way. It reminded me of Sarah Hagi’s phrase,  "God, give me the confidence of a mediocre white dude".

Another woman commented on the difficulties of trainees in relation to the very thorny issue of childcare. While this is a problem for parents in any profession, it is particularly tricky for doctors who are unceremoniously hoofed around the country at regular intervals to “optimise their training experience”, with little to no regard for the upheaval this brings to family life. Seeking out new childcare options every six to twelve months is more or less impossible, and results in huge commuting times or the reliance on wider family supports, if they are available. In the average heterosexual couple, the woman will work an additional 16 hours per week at home, on top of her paid employment, while the man does 6 hours of unpaid domestic labour. Unfortunately, the European Working Time Directive does not take these additional hours into consideration for any gender. Add this to the mental load involved in arranging drop-offs and pick-offs, organising playdates, remembering to take the chicken out of the freezer and swapping the purple leotard for the black one because today is Acro Dance, not Dance Acro. These are significant external barriers on a woman’s ability to focus entirely on her career and professional advancement, and yet we are mostly embarrassed to even mention them.

There was a question about whether medical students are being supported to consider the impact of their gender on their future careers, and I am glad to say that WiMIN has a significant number of student members and our conference bursaries are quickly snapped up each year. The contributions of students to the conversations at our events are always insightful and provocative, and the opportunity for inter-grade interaction is one of the key benefits of attending a WiMIN conference.

A mother of a 19-year-old daughter said she was happy that things are so much better for the younger generation than they were in “our time”. I didn’t have the heart to debunk this soothing myth, but perhaps a browse through some of the resources on our website might lead us to see that with a global increase in violence against women and girls, a significant rise in online misogyny, and the fact that the no country is meeting the Sustainable Development Goals for gender equity, it is very hard to be optimistic at the moment.

A very esteemed and wise colleague pointed out that at the end of the day, the one thing that truly matters in medicine is the wellbeing of the patient. This should supersede considerations around the difficulties faced by any doctor in their training or career, and our main focus should always be on delivering the best outcomes for the people we serve. It is very interesting to note, however, that a growing body of evidence being collated worldwide indicates that the gender of your doctor has a statistically significant impact on your healthcare experience, including reduced surgical complications, readmissions and even mortality. So if we truly care about providing the best quality of care to all patients we should be loudly discussing the reasons why, despite the additional workload and unconscious biases that persist for women, we are still providing a better experience for all of our patients.