A FEW YEARS ago, Sarah Fitzgibbon began speaking to women she had qualified as a doctor with in 2000. There was a roughly equal gender balance in her course in college, but it struck her that the men in their year had enjoyed more career progression since graduating.

“You would expect, after all these years, that the women and men would have achieved equally in the sense of being professors, being clinical directors, being in leadership roles,” she says. “It became apparent that that wasn’t the case.”

It was on the back of such conversations that Fitzgibbon founded the Women in Medicine in Ireland Network, which supports and promotes female doctors and medical students. The Cork-based GP points out the majority of students in medical undergraduate courses are now female. “More and more women are entering medicine, and that’s been happening for long enough that there should now be parity at the top levels.”

The medical landscape today shows parity is still very much lacking. Men hold just under two-thirds of consultant posts in hospitals, according to HSE figures, although women account for 56% of trainees. Female consultants are particularly underrepresented in areas such as surgery (15%), emergency medicine (29%) and anaesthesiology (34%).

Dr Ina Kelly, president of the Irish Medical Organisation, argues that the working culture in hospitals can be particularly challenging for women. “Unsocial hours, roster issues, difficulties in accessing flexible training and childcare – these are issues that affect both genders, but they generally affect women more than men.”

The public health specialist says that training programmes with less than full-time hours, or in locations appropriate to people’s personal circumstances, would make a big difference. The HSE currently only offers up to 32 flexible training posts a year – a very small proportion compared to other European countries.

“The period in which doctors train is also the period in which they’re most likely to be having children and establishing families,” she says. “The system is still designed to suit someone with no attachments and external responsibilities, and we’re losing out on a rich diversity of people for that reason.”

Fitzgibbon agrees that hospitals need to be more proactive about supporting parents with long working hours. She points out that shifts often begin well before creches have opened, or finish much later than when they close. “Childcare that goes beyond nine to five is very routine in a lot of countries, but it’s extraordinarily rare in Irish hospitals.”

The lack of workplace supports means that men’s careers are often prioritised in heterosexual relationships where both partners are doctors. “The male partner will be the one whose career tends to follow the routine path, while the female partner will do bits of work wherever her male partner is based.”

Women in medicine are not immune from sexist treatment either. A recent study of Irish cardiology – where only 8% of consultants are women – found that close to 80% of female trainees and consultants had encountered sexism during their training. The study’s author, Dr Bethany Wong, highlighted that this is a much higher proportion than in the UK, where a similar survey reported a comparable figure of 48%.

Research by the IMO suggests the problem is not confined to any one speciality. One study from 2016 showed that 21% of female non-consultant hospital doctors had been sexually harassed in the workplace, while 28% had experienced gender-based bullying.

Kelly says discrimination can also take more subtle forms. “The literature suggests that women are expected to be empathetic and to be peacemakers and take on challenging psychosocial situations, dealing with people who have more complex problems and so on. Certain work gets channelled their way, which means they likely end up seeing fewer patients.”

She was no stranger to sexism in the early years of her own career. “I noticed once we started working as doctors that the surgeons were recruiting men rather than women. It was the first time I realised we were being treated differently.” There were inappropriate comments as well. “I would have overheard some very derogatory sexual discussions. That was all seen as perfectly acceptable at the time.”

Kelly stresses that gender diversity can only improve healthcare in facilitating different approaches and perspectives. She points to research showing that female surgeons have particularly strong outcomes. One recent Canadian study found that women are in fact 32% more likely to die when their surgeon is male. “If there are differences between the way men and women work in medicine – which there may or may not be – those strengths should be encouraged. We should be encouraging everyone to have them.”

Patient-centred care is now the norm in medicine, but she says that that ability to look at the whole person was undervalued during her own training. “I felt that if you had compassion for your patients, you were seen as a bit weak. There was little value placed on being kind and actually listening to the patient.”

For Fitzgibbon, gender equality is not just about getting more women into senior positions, but also about recognising what’s already being done on the ground. “There’s so much great work being done by female doctors that we don’t hear about. These are people who aren’t at the highest table, but without them our society and communities would be a lot poorer.”

This work is co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work is the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.