How health system ‘designed by men, for men’ is failing women

Michelle Wisbey

8/03/2024 4:34:12 PM

From pay disparity, to bias, and claims of hysteria, this International Women’s Day has given pause to reflect on the gender inequality in Australian healthcare.

Cartoon of several women's heads in profile.
Around one third of women reported experiencing ‘insensitive’ and ‘disrespectful’ healthcare practitioners.

Two thirds of all females in Australia still feel bias and discrimination when accessing healthcare, according to the soon-to-be released End Gender Bias survey.
The full results, due to be released next week, will share the views of around 3000 women, including healthcare professionals, and are expected to include personal testimonies from patients who were told their pain was not real, as well as others labelled by doctors as ‘drama queens’ and ‘hysterical’.
The inequality is also not limited to patients, with separate research revealing around one third of all doctors in training have experienced sexual harassment in the workplace.
Ahead of the survey’s release, Health and Aged Care Assistant Minister Ged Kearney told ABC Radio women are still battling to access care in a health system ‘designed by men, for men’.
‘A lot of the care, clinical guidelines, a lot of the symptomology that you look for, a lot of those care plans that doctors rely on, even women doctors, are just about men,’ she said.
‘[Women] feel dismissed, they don’t feel heard, they get under-medicated, they get told, and I dare to use this word, that they could be hysterical, that they’re overdramatising.
‘Or even worse that, well, pain is just a woman’s lot – you just have to put up with it.’
Gender bias continues to be commonplace in healthcare across the world, and historically, medical research has often excluded women.
Last year, 40% of women still reported living with chronic pain, and one third said they have experienced ‘insensitive’ and ‘disrespectful’ practitioners.
Diagnosis of heart disease is a well-publicised example of gender differences in research, with women typically diagnosed up to a decade later than men.
Additionally, in the decade prior to 2014, American women suffered more than two million drug-related adverse events, compared to around one million for men, thanks to testing typically being carried out on males only.
Many women’s health conditions and reproductive decisions have also long been considered taboo, including menopause, endometriosis, and access to abortion.
The Chair of General Practice at Monash University, Professor Danielle Mazza, told newsGP women still often report feeling unheard or not taken seriously by their healthcare professional.
‘A lot of women are still facing major affordability issues, and a lot of products that women use, particularly contraceptive products and menopause products, are not PBS listed,’ she said.
‘In terms of maternity services, there’s a rapid discharge home after delivery because of the need for beds or workforce issues in hospitals, so women are facing major changes like breastfeeding or recovery from Caesarean section at home.
‘When women attend healthcare, it’s not a level playing field and women don’t feel empowered in those situations, so they’re looking for more information, they’re looking for choices, they’re looking for patient-centred care and shared decision making.’
Professor Mazza said it is more imperative than ever that both male and female doctors are trained in women’s health.
‘It’s becoming increasingly difficult to receive that training with fewer and fewer GPs rotating through obstetrics and gynaecology,’ she said.
‘And a lot of the gynaecology that GPs do out in the community doesn’t actually occur in the hospital setting, so it’s hard to get the experience that you need in hospital settings.
‘I want to make sure that our GPs of the future, and also our current GPs, have the opportunities to really receive high-quality training in women’s health so they can go on and deliver exemplary services.’
But it is not just patients feeling the pain.
The RACGP says female GPs are still getting a ‘raw deal’ when it comes to pay and entitlements, despite women now comprising more than half of all GPs in training (61% vs 39%).
College President Dr Nicole Higgins said GPs in training experience an initial drop in salary and loss of entitlements when they leave hospital settings to work in community general practice, and this is felt most acutely by women.
This falls in line with society more broadly, with women doing more work for less money.
New data has revealed across all employers, half have a gender pay gap of more than 9%, and just 9% of chief executives in the ASX300 are women.
Outside of the workplace, women also do more than nine hours a week more unpaid work and care than men.
‘We need to fix this disparity so Australia’s female GPs in training are not being paid less than other medical registrars,’ Dr Higgins said.
‘Australia is grappling with an epidemic of chronic disease and mental health issues, which require longer consultations for complex, ongoing care – this trend is not going away.
‘Women GPs should not be disadvantaged for spending the time they need with their patients.’
Those calls come at a time when 80% of female GPs report mental health in their top reasons for patient consults, compared to 60% of male GPs.
‘This is a pay equity problem because the Medicare subsidy for patients gets smaller the longer their GP spends with them, so women GPs who do more longer consultations are being unfairly penalised, as are their patients,’ Dr Higgins said.
As part of its pre-Budget submission 2024–25, the RACGP has already called on the Federal Government to roll out a 20% increase to all Medicare rebates for Level C and D consultations.
It is also advocating for paid parental and study leave to be funded for all doctors to alleviate these gaps.
Professor Mazza said looking to the future, with the increasing number of women in general practice, there is a need for this support and recognition.
‘We need adequate maternity leave, and sick leave, and carers leave in general practice just as hospital doctors receive,’ she said.
‘And if women are experiencing discrimination, they need to get support, to be able to call it out, and use their professional organisations to back them up and to support them to overcome these difficulties.’
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Dr Matthew Piche   10/03/2024 3:48:27 PM

The world today is wracked with inflammatory, divisive political debate. All about us are strong opinions and fractures relating to race, gender, religion, and otherwise.

As individuals we will invariably have opinions on these topics, however as a medical college responsible for training doctors to become general practitioners, it may be more appropriate to leave political opinions at the door.

Dr Irene Rosul   12/03/2024 10:42:01 AM

!!!! :(

Dr Peter James Strickland   12/03/2024 12:07:42 PM

What an absolute load of biased and sexist nonsense for GPs, and society in this report. There is NO gender bias I have ever seen, apart from that in favour of females in treatment of everything, and including specialized hospitals just for women alone. As an example, there are innumerable hormone treatments for women's problems on the general PBS, but virtually none for men without having to go through specialists and innumerable testing. Men and women face pain in equal proportions, but in different ways, and due to their activities and employment differences for guys and girls, i.e. differences in build and anatomy. Examine objectively the amount of monies spent on the hospitalization, treatment, investigations, and medications of men and women, and then you will have an idea/person who gets the most funding. Women GPs get paid the same fees by Medicare etc for what they do. When I was a resident over 50 years ago the female residents got paid the same as the males.

Dr RS   12/03/2024 1:35:14 PM

Couldn’t agree more with the comments above We ALL need to be treated with respect This is divisive

Dr SA   12/03/2024 8:56:10 PM

So is it OK with Dr Higgins if the 39% of GP trainees who are male are paid less than other Medical Registrars?

Dr Lise Susan Legault   12/03/2024 10:10:44 PM

Honestly, how dare they! How dare these men invent medicine. Did they not love their mothers, wives and daughters? How dare they, I say!

Dr Christopher Andrew Angus Irwin   12/03/2024 11:23:12 PM

The author of the article has failed to notice that in the health system "designed by men, for men", men die four years younger than women in Australia.

Dr Everest Osondu Nkire   13/03/2024 4:34:41 AM

I keep asking where is the gender bias? when female residents get paid the same as male residents, medicare pays both male and female GPs the same fees. Both male and female GPs work in similar environments. I think we should invest our time wisely on other issues than making hollow unsubstantiated inflammatory and divisive write ups. RACGP should stand for the whole GPs and not a section based on gender .

Dr Rodney Paul Jones   13/03/2024 11:49:50 AM

No GPs ( not just women GPs) should be disadvantaged for spending the time they need to get a safe ethical useful outcome