Males still outnumber females in post-graduate medicine

There are approximately 20 per cent more males than females enrolled in post-graduate programs at the School of Medicine. Despite these numbers, the medical profession and academic world have undergone changes in the last few years that may make medical programs more attractive and accessible to females.

“Things are evolving in a very positive way,” said Dr. Leslie Flynn, assistant dean of post-graduate medical education. “Is there work to be done? Absolutely, more work can be done.”

A recent article published in the the Times Higher Education Supplement quoted a member of the British Medical Association’s Academic Staff Committee as saying women are underrepresented in senior academic positions in medicine.

Dr. David Walker, dean of faculty administration for the School of Medicine, said the number of women in academic positions is growing, and the University employs many females.

“Women are well represented in the upper echelons,” he said, listing several positions occupied by females including the director of the School of Nursing, the assistant dean of medical education, and the director of faculty development.

Walker said there were fewer women in senior academic positions in the past.

“There are lots of reasons why in academic medicine there has not been a lot of women,” he said. “The leaders now are coming out of a generation where less women were in medicine ... you have to attend to your patients as well as doing things to get you promoted into leadership positions and that [was] more difficult for women.

“In the past family responsibilities and having babies tended to get in the way,” Walker said.

In post-graduate medicine, female enrolment fluctuates significantly depending on the program, Flynn told the Journal.

She said the duration of a program’s residency is an important factor in attracting females.

“In some specialties more than 50 per cent enrolled are females—family medicine has a high female enrolment,” she said. “Our general surgery program has more males.

“It’s not Queen’s per se, it’s the duration of training ... family medicine is a minimum two-year program, surgical tends to be a minimum of four years, and most progress to five years,” Flynn said.

Flynn said the length of post-graduate programs can discourage women who wish to have children.

“If you think of medicine’s time-line, it’s a minimum three years before med school, add four years of medicine, you’re 25 by time you finish and you have to do a residency, which is a minimum of two years,” she said. “A two year residency in family medicine is very attractive to women because they can complete their education and still have a family ... all other residencies are up to six years so you’re 31 when you finish your training.

“That’s a real issue for women,” Flynn said.

The flexibility of working hours in a specific field of medicine also influences the number of females in a given residency program, she said.

“It’s whether there’s any flexibility in practice,” Flynn said. “There tends to be more flexibility in a family medicine practice, particularly if you’re not at an academic centre.

“In a community there is more flexibility to accommodate additional responsibilities,” she said.

Walker said he thinks the medical field is attending to the lack of balance between work and home that was typical of medical professions. He said more women are entering the medical field in general as a result.

“There has been a critical mass effect—as women get into fields where they didn’t have numbers before, they start to feel more comfortable,” he said. “The field of medicine is more welcoming to diverse peoples in general,” Walker said, adding the profession has become more considerate of the needs of both males and females.

“You don’t find a doctor today who is available 24 hours a day, seven days a week, 365 days a year to the exclusion of personal and familial responsibilities,” Walker said.

There are structures in place in the medical field that make allowances for people who want to have families, he said.

“People are able to work less hours, workload issues are much more easier to arrange,” Walker said, adding many medical professionals now work less than full time.

“It’s considered much practical to balance your life,” he said.

Flynn said there have been changes to the field, and specifically to post-graduate programs, that have made it less time-monopolizing to be a resident.

“All the specialties in medicine are becoming increasingly aware of lifestyle issues,” she said. “There have been huge changes in terms of the work hours and the need to respect that residents are not able to work the hours people used to work.”

Flynn said in the early 1980s it was common for a resident to be on- call in the hospital for an entire weekend and then have to be back at work on Monday morning.

“Now that’s not allowed ... if you’re on call for a 24 hour period in the hospital, you must be relieved from all your responsibilities and able to go home the next day,” she said. “And that’s to the benefit of males as well.”

Walker agreed that the changes are beneficial to males and females.

“It has been called the feminization of medicine,” he said. “But it has been shown that physicians are more effective when they’re healthy and well-adjusted and this is credited to the entrance of women in the field, to the benefit of men also.”

Flynn disagreed that the changes in expectations are due to the entrance of more females into post-graduate medicine.

“The population we would have had in medical school would not accept those working conditions,” she said. “It has just been an evolution in the profession.”

Flynn said it was a shift in lifestyle and family dynamics that was the impetus behind the ongoing changes.

“I think it would be pretty self-serving to say it was because women have come into medicine,” she said. “It was very difficult back in the old days to juggle family commitments and obligations because of the working conditions, but now both males and females are juggling job and family—there’s not one person maintaining the home while the other is away at work.”

Flynn cited the recent resolution by the Canadian Medical Association to demand maternity leave for residences as a significant change in post-graduate programs.

“They could take maternity leave before but they had no income and they had overhead expenses.”

Maternity and paternity leave are now available for residents.

Flynn said a significant issue facing women who are in high academic positions in medicine is childcare.

“Day cares do not stay open till 6:30 at night,” she said. “All the late-in-the-day meetings become challenging—the meetings at 7 a.m. or 7:30 a.m. are challenging for young women.

“You get keen, interesting, dedicated people [who want to be in medical academics] but you also want those people to still have a successful home life,” Flynn said.

Having on-site day care or day care within close proximity that would not run on the regular nine to five hours and would provide care before and after work would make things easier, Flynn said.

Flynn also cited the lack of parking as a seemingly insignificant but important issue.

“Ridiculous as this may sound, if you have a young family at home and you have to park at West Campus and you finish your day and you have to go all the way there to get your car and get to day care, that’s a stress,” she said. “There are very practical things that we are not attending to, because our funds are so tight that we don’t have enough clinical space so it becomes a question of priorities.

“Is your priority a day care clinic or an out-patient clinic? The priority has to be patient care,” Flynn said.

She said there are many things that could be done to improve the general well-being of medical academic professionals, and the issue is a lack of funds.

“There is a lot of literature about industry and health and how to have a good, happy, healthy workplace, and [that information talks about] exercise and health care and healthy eating,” Flynn said. “We’d go a long way if we could provide it but frankly we just don’t have the resources to do that.”

Flynn said she was wary of saying ascending the medical academic ladder was a constant uphill struggle, because so many people have been supportive and have helped her along the way, and males struggle for many of the same reasons females do.

“I could not have [held down a senior academic position] five or 10 years earlier,” she said. “I have family commitments that would not have allowed this.

“It is a collaborative effort with your partner—who is going to go out to work and who is going to stay home with your family,” Flynn said. “If a female academic is going out to a 7 p.m. meeting then someone has to be at home ... I’ve been given lots of support to succeed academically but it’s a constant juggle.”

Medicine: Faculty and Enrollment

StudentsFacultyYears One to Four
48 per cent female
52 per cent male

Nursing and Rehabilitation
Over 95 per cent female

Clinical Fellows and Residents
Male: 168
Female: 135 Rehabilitation Therapy
Male: 5
Female: 25

Nursing
Male: 5
Female: 57

Medicine
Male: 558
Female: 235

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