#MedBikini: Gender Inequality in Healthcare
Written by Jasmine Cho 27 Aug 2020
What is this hashtag and how did it all start?
Since July 2020, many medical professionals worldwide have been participating in the #MedBikini challenge on various social media platforms, where they post photos of themselves relaxing in swimwear and holding an alcoholic beverage. The hashtag is intended to be a light-hearted but nonetheless empowering mockery of what was a blatantly prejudiced study titled ‘Prevalence of unprofessional social media content among young vascular surgeons’. It was published in the August 2020 issue of the Journal of Vascular Surgery, but was later retracted in light of fierce criticism.
The authors of the scientific study, some hailing from the Boston University School of Medicine, created ‘neutral’ social media accounts in order to evaluate the extent of professionalism displayed by young vascular surgeons in their social media accounts. Results of the study showed that 26% of accounts screened were considered ‘potentially unprofessional’ or ‘blatantly unprofessional’. Examples of such content include ‘discussing controversial political and religious opinions’, ‘holding or consuming alcohol’, and ‘provocative posing in swimwear and inappropriate attire e.g. Halloween costumes and bikinis’.
Reasons for backlash
It is important to note that behaviour which constitutes a breach of the code of conduct for medical professionals e.g. using obscene language to badmouth patients and colleagues and possessing illegal drugs, is not justifiable under any circumstances. However, much of what the authors had established as ‘unprofessional’ were subjective and misogynistic. There are three main points of contention behind the powerful backlash against this study.
Firstly, the study argues that doctors should refrain from adopting certain ‘unprofessional’ behaviours in order to consolidate public trust in the capabilities and credentials of doctors. However, many believe that this is an infringement on the autonomy of doctors to make their own lifestyle decisions. Though doctors are legally and ethically bound by a set of rules and regulations to act professionally at all times when on duty, the manner in which they conduct their personal lives should not be scrutinised to the same extent. Whatever lifestyle they decide to pursue can be considered legitimate so long as it adheres to the law and does not come at the detriment of others. Doctors should not be obliged to behave more ‘professionally’ in respect to what is demanded from other occupations, once off duty. It is, of course, ideal if they choose to do so, with emphasis on the concept of free choice.
Secondly, certain types of behaviour which were defined as ‘unprofessional’ in the study, are completely appropriate, given that they are done outside the medical workplace. Consider the ‘unprofessional’ behaviour of ‘holding or consuming alcohol’. There isn’t anything inherently wrong with alcohol consumption, as long as it is consumed responsibly and does not endanger the safety of others, especially patients. Drinking is, arguably, an essential social skill to partake in during one’s career, serving as a form of enjoyment and a way to de-stress and achieve a good work-life balance. It is baffling to see how a responsible cocktail party after work can be construed as ‘unprofessional’ and a danger to the well-being of patients (excluding cases where doctors show up to the medical workplace while still experiencing the effects of intoxication).
Lastly, it is misogynistic to label females who wear swimwear as promiscuous, considering that the same standard is seldom applied to the male counterpart. Women should not be subjected to scrutiny and receive criticism for doing something which both men and women are perfectly entitled to do. Revealing a bit of skin in a non-workplace area is not an indecent act. Judging someone solely on the basis of how much skin they choose to reveal is indecent.
Examples of gender inequality in the healthcare industry
Historically, there are more male doctors than female. Things have, however, begun to change. Yet, gender inequality still plagues the healthcare sector, particularly in developing countries. Such examples include, but are not limited to:
Disproportionate gender ratios for certain medical specialties.
Neurosurgery is known to be extremely male-dominated, occupying 87.3% of all neurosurgeons in the US and Canada, whereas, in stark comparison - 83.4% of obstetrics and gynaecology trainees in the US, are female, according to the American Medical Association. The nursing industry continues to be predominantly female.
Acute lack of females in leadership or executive positions in the healthcare industry.
According to the 2017 US Bureau of Labor Census, 78.5% of healthcare workers were female. However, only 26% of CEOs overseeing hospitals were women.
Pay disparities between men and women in healthcare.
According to the Journal of the American Medical Association, women in leadership positions earn an average of 20% less than men with similar experience, ability, and educational record. Female physicians also earn, on average, $20,000 less than their male counterparts per annum*.
*year
Gender-specific bullying in the workplace.
Bullying in the workplace, can cause great distress and harassment to the person concerned. This can significantly compromise patient safety and lead to a higher risk of medical errors and accidents. It is important to note that both females and males can be victims of such bullying.
4.1 Where the victim is female
The Occupational Safety and Health Administration in the US reports that 59% of registered nurses and nursing students undergo regular verbal abuse or threatening behaviour. They are much more likely to be unmarried female employees belonging to a racial minority, and of a lower socio-economic status.
Male-dominated specialties are more prone to exhibit misogyny in the workplace. Examples of such behaviour include using demeaning language to humiliate and undermine the female gender, deliberate isolation from particular females, or displaying gender-targeted, aggressive body language.
4.2 Where the victim is male
Many male nurses report feeling burdened with a much heavier patient load, e.g. more obese and physically disabled patients, because they are assumed to be physically stronger, and hence more capable of handling these patients. They are also frequently teased for choosing to pursue a nursing career because it is considered to be a non-masculine job. Males working in female health, e.g. obstetrics and gynaecology often experience similar kinds of bullying and mockery, with their peers constantly questioning their real reason for wanting to become an ob-gyn doctor. Additionally, there is a traditional expectation on males to be resilient, and indifferent to whatever may come their way. Neurosurgery as a specialty, has a particularly high patient mortality and surgical error rate. This results in heightened anxiety levels among neurosurgeons (mostly male), because they often feel pressured to suppress their feelings during such times of emotional hardship and difficulty like when facing the death of a long-term patient.
What can be done to challenge gender inequality in the healthcare sector
It is essential that meaningful change is initiated both at the grassroots level (bottom-up), and from the top (top-down). By no means is this an easy undertaking, but it is nonetheless necessary, simply because it is the right thing to do.
What healthcare providers and governments can do
Healthcare providers and governmental organisations play a crucial role in reversing gender disparities in the healthcare sector, which will contribute to the improvement of workplace morale, correction of social injustices, and the guarantee of patient safety.
So, what can be done?
Firstly, executives and government leaders need to recognise the advantage of having an inclusive, and diverse leadership team. Women are excellent listeners, problem-solvers, and empathisers. They need to be recognised as an asset, not a liability to the working of a team. Much more has to be done to increase the number of women in executive positions - this can be done by creating an environment which ensures that such women will receive the appropriate amount of respect they have rightfully earned and not considering gender as a factor for promotion. It is also important to properly equip them with the resources to do so. A feasible form of action could be launching mentoring or career programs which are tailored to and led by females. This can help promote a culture of female leadership, empower women to aim high and offer women a conducive platform to seek advice or support whenever needed. Hospital executives can also spur change by further diversifying their recruitment procedures, and enforcing achievable gender ratios within each department or specialty. Employers must emphasise that taking time off to conduct further postgraduate study, raise a child, or take maternity leave etc, will not negatively impact any job applications or promotion opportunities. This helps to establish a healthier, and more fruitful culture of competition within an already competitive field.
Secondly, employers should consider pay transparency. Audits should be rigorously and regularly carried out to ensure gender bias does not play a role in such salary disparities. There should also be diversity, or equality, committees set up in every hospital to make sure that research, career advancement, and learning opportunities are handed out fairly, irrespective of gender.
Third, healthcare providers and executives need to adopt a zero tolerance stance on gender-related bullying and harassment in the workplace. Hospital policies should explicitly state the parameters and provide examples of such behaviours and make clear the consequences of committing them.
Lastly, improving work-life balance, and flexibility for both male and female healthcare workers is an important milestone on the path to achieving true gender equality in a healthcare environment. The fact that women often shoulder greater domestic or childcare responsibilities should be taken into heavy consideration. Offering more flexible working schedules and opportunities to work remotely or on a part-time basis for those who require it can help raise job satisfaction, and ensure that gender-specific needs of all employees e.g. pregnancy-induced discomfort and morning sickness, can be sufficiently accommodated.
What the general public i.e. you can do
It may seem as though individual efforts in challenging gender inequality in healthcare will not achieve a transformative effect. However, bear in mind the maxim ‘The sum of the parts is greater than the whole’ and have faith in your potential to create tangible change. Whether it be choosing your family doctor or obstetrician or otherwise, do so based on their clinical experience and competency, rather than considering gender stereotypes. Recognise that these two factors are not inextricably linked at all.
Gender inequality continues to pervade many aspects of our lives, not only in healthcare provision. Grappling with this issue whenever it appears can help embolden those working in the healthcare sector to continually support the aim of achieving gender equality.
Speak up whenever you witness injustices being committed.
Approach the perpetrator and explain composedly how his or her behaviour was inappropriate, without compromising your safety.
If escalation is required, you can also report these incidents to your direct superior (e.g. teacher, hospital consultant) and they will be able to handle it skilfully.
Hold difficult, but nonetheless necessary conversations with those around you, and feel empowered to defend your stance assertively.
Utilise your knowledge to challenge any misappropriate preconceptions on gender you hear or witness. However, it’s also important to recognise that uprooting such entrenched biases in people can be a difficult process. Have the grace and compassion to support them and provide them with the necessary space and time to do so.
If you were, or still continue to be a victim of gender harassment and bullying, approach the relevant authorities and people to seek help and bring justice around you. If you are a student, take the courage to open up to those you trust. They will be best positioned to advise you. You can also consult the therapy or mental health counselling team at your school. If you are a medical student or trainee, there will always be a gender diversity / inclusion committee, and occupational and mental health services team at your university or placement hospital. Speak with them directly and relay your concerns to them.
Furthermore, keep in mind that your gender should never be a deterrent for you to pursue any career advancement opportunity or path. Choose a medical specialty where you can thrive in and have a genuine passion for. Do not be discouraged from embarking on particular specialties because they do not seem to align with casually assumed, baseless gender stereotypes