Female Doctors in Sebha عامر التواتي

Female Doctors in Sebha

Amer El-Twati Irhuma,*

Editorial:

For many centuries women had a significant role as physicians, notably in the medical schools at Heliopolis and Sais. “Agamede of the golden hair” in Homer's Iliad was skilled in medicine and herbal lore. Some women in classical Greece were known for their medical skill. Philista (318–372 BC) lectured so well that pupils flocked to her, and was so attractive that she had to lecture behind a curtain. About the same time, Agnodice was a pupil of the more famous Alexandrian Herophilus. Women physicians were numerous during Roman times, though few of their writings have survived; but there are a significant number of tombstones like that to “Primilla, my sainted goddess, a medical women...”. In the same period women physicians were common among the Germanic “barbarians”.

On the seventh century on, new hospitals opened controlled by the church, and organized by nuns. This was a formal beginning to the clear division of healing duties along a gender line. The guilds of male physicians and surgeons which were forming did not favour women applicants; for instance in 1322 Jacoba Felicie appeared for examination before the all male Paris guild.

In the dark ages, the best known woman was the mystic Hildegarde of Bingen (1098-1179), she wrote two medical manuscripts, on plant animal and mineral medicines, and on physiology and the nature of disease. Her remedies were partly herbal, and partly spiritual and/or magical. In the 12^th century, at Salerno, Trotula gained repute as a physician and obstetrician, leaving behind at least one manuscript.

That in order to study medicine in England the first woman had to disguise herself as a man! “Dr James Barry kept the secret other sex all her life and had successful career in British Army where she was honored for distinguished service during the Battle of Waterloo. Only after her death in 1865 was her true sex and the fact that she had a child revealed”.

In the mid nineteenth century women began to be admitted to recognized medical schools. Elizabeth Blackwell graduated from the Geneva Medical College, New York, in 1849, and shortly afterwards the Women's Medical College of Philadelphia was founded. The new English Medical Register in 1858 contained the name of one woman.

By the end of the 19^th century, however, the number of women students had increased greatly. Higher education particularly was broadened by the rise of women's colleges and the admission of women to regular colleges and universities. In 1870 an estimated one fifth of resident college and university students were women. By 1900 the proportion had increased to more than one third.

In 1952, Women's Bureau of the Department of Labor reports almost 12,000 female doctors in the United States and 200,000 male doctors. It had been recalled that in 1960 Harvard class of 150 students, there were six women. That was “a banner year” for the time. Dr. Robert A. Witzburg, director of admissions at Boston University School of Medicine, said medical schools reflect changing social norms. His school opened as the nation's first all-women medical school in 1848 and began admitting men in 1872.

The proportion of female applicants to men has risen steadily for years. For the 1993-94 entering class, women made up 41.9 percent of the more than 42,800 applicants, up from 34 percent of the more than 35,100 applicants a decade earlier.

In 1963, they were 8.1 percent of the almost 17,700 applicants. Women obtained 19 percent of all undergraduate college degrees around the beginning of the 20th century. By 1984 the figure had sharply increased to 49 percent. Women also increased their numbers in graduate study. By the mid-1980s women were earning 49 percent of all master's degrees and about 33 percent of all doctoral degrees. In 1985 about 53 percent of all college students were women, more than one quarter of whom were above age 29. By the year 2012, it is predicted that female doctors will outnumber male doctors.

Since the start of Sebha Medical Faculty in 1987-1988, female doctors are increasing in number, as shown in Table 1 and Table 2.

*) Dean, Faculty of Medicine, Sebha University, Sebha – Libya.

Table 1: Number of students in the year 2005/2006

	Libyan		Non-Libyan
	Male	Female	Male	Female
First year	44	134	12	9
Second year	17	64	9	8
Third year	12	26	3	7
Fourth year	11	51	4	11
Fifth year	12	21	2	3
Housemanship	7	18	2	1
Total	103	309	31	40
	25%	75%	43%	57%

Table 2: Graduated students during the period 1994-2005

	Graduated females	Graduated males
1994-2005	108 (54%)	93 (46%)

Gender patterns of specializations

It is obvious from the tables I, II, that the number of female medical student of Sebha university is increasing dramatically and seriously. We believe that remarkable increase in female studying medicine and other since is due to the sociocultural transformation over the last 4 decades which changes the way the society think.

Female doctors leaderships

In a Norwegian study, it has been found that, 14.6% of the men were leaders compared with 5.1% (4.4% to 5.9%) of the women. Adjusted for age men had a higher estimated probability of leadership in all categories of age and job, the highest being in academic medicine with 0.57 (0.42 to 0.72) for men aged over 54 years compared with 0.39 (0.21 to 0.63) for women in the same category. Among female hospital physicians there was a positive relation between the proportion of women in their specialty and the probability of leadership.

It has been concluded that women do not reach senior positions as easily as men. However, medical specialties with high proportions of women have more female leaders.⁵

Patients preference of female doctors

As the number of female practitioners increases, patients have expanding options from which to choose the gender of their practitioner. In Iraq, Most respondents (73%) prefer a female gynecologist and (79%) a female obstetrician. Eight percent preferred a male ob/gyn and 18% had no gender preference. Most female clients had a strong preference for a female ob/gyn. This was associated with social tradition and religious beliefs. The preference for female practitioners declined with rising educational levels.⁶ Similarly in UAE, most women prefer female providers because of embarrassment during pelvic examination and reproductive counseling, religious beliefs, and sociocultural values.⁷ In Egypt, patients prefer physicians of the same gender, but in actual practice a male physician is believed to be more competent.⁸ However, only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women.⁹

In 2003, 52% of medical graduates are women, with an increase of 80% of women studying medicine and a decrease of 30% of men, since 1980. The women practice rather in group practices, in the cities and part-time. Working part-time increases satisfaction of the patients, the doctors with a part-time job and their colleagues.¹⁰

Life expectancy in female doctors

Female doctors and stress

Job stress is related to mental health problems among young doctors, even when the variables of previous mental health problems and personality traits are controlled for. More support during internship is needed.¹¹ Female physicians face more stress than male doctors.¹² Kash et al (2000)¹³ reported greater emotional exhaustion, a feeling of emotional distance from patients, and a poorer sense of personal accomplishment. Negative work events contributed significantly to level of burnout; however, having a “hardy” personality helped to alleviate burnout. Nurses reported more physical symptoms than house staff and oncologists. However, they were less emotionally distant from patients. House staff are most stressed and report the greatest and most severe symptoms of stress. Interventions arc needed that address the specific problems of each group. Women reported a lower sense of accomplishment and greater distress.¹³

An estimated 1.5% of U.S. women physicians have attempted suicide, and 19.5% have a history of depression.¹⁴

Also Hawton et al (2001)¹⁵ stated that there is an increased risk of suicide in female doctors, but male doctors seem to be at less risk than men in the general population. The excess risk of suicide in female doctors highlights the need to tackle stress and mental health problems in doctors more effectively. The risk requires particular monitoring in the light of the very large increase in the numbers of women entering medicine.¹⁵

Female physicians also exhibited significantly higher prevalence of suicidal ideas. Suicidal ideas were associated with work-related stress. Correlation analyses confirmed a significant relationship between high prevalence of suicidal ideas and long working hours (>8 hours), severe anxiety and work-related stress, and role conflict.¹⁶

The rates of successful suicide and divorce are much higher. Women in academic settings are promoted more slowly, have lower salaries, receive fewer resources, and suffer from a range of micro-inequities. They often lack mentors to provide advice and guidance. They must cope with the pressures of choosing when to have a child and conflicts between being a wife and mother and having a career. Despite these pressures, they report a high degree of career satisfaction. Although women physicians suffer from a variety of stressors that can lead to career impediments, stress reactions, and psychiatric problems, generally they arc satisfied with their careers.¹⁷

Female doctors and Child caring

Many physicians and surgeons work long, irregular hours; over one-third of full-time physicians worked 60 or more hours a week in 2004.

Women doctors, like women in general, tend to spend fewer hours per week at work than men. The difference appears to relate to the sharing of domestic duties between the sexes. Women not only bear the children, but tend to take more responsibility for their care. The more children a woman has, the fewer hours she will tend to work outside the home, while the reverse is true for men, both in medicine 2 and in general 3. Women are also much more likely to take responsibility for dependent parents.

Recommendations

A growing excess of women over men in medical school admissions is no healthier than the opposite, and may lead to shortages of applicants for surgery, acute medical specialties and academic or senior management posts. Patients have the right to see a male doctor if they choose When women arc becoming the dominant workforce in medicine, and with the imminent change in the sex balance of doctors, it has been anticipated that there could be problems ensuring 24 hour services in areas such as acute medicine or sufficient doctors in specialties with long hours in need to bear in mind their biological clock. Some female doctors want to be an ear, nose, and throat surgeon but it's more than likely that they are going to need flexible training throughout the early stages of their career while they marry and have children.

It may take them a little bit longer to get there but they would expect to compete with the men and the younger women for jobs once they returned to full time work.

The governments need to address the need for 24 hour childcare support, particularly among junior doctors, who have moved to shift patterns.

Without adequate childcare support, the health services will just continue to lose women doctors who will have to cut down or stop clinical practice in order to care for their children. Not only is that a complete waste of training and talent (Finola Lynch)

De Torrente de la Jarra and his French group(2006) asked the politicians and the medical societies to create a flexible training and adjusted possibilities to practice, so that we won't loose many motivated and proficient doctors especially as the attraction of primary care decreases.

In terms of preventive measures it seems reasonable to systematically inform medical students about stressors they will be exposed to in their later practice and to discuss coping strategies and prevention. Thus, a suitable emotional preparation for future work stress can be assured. For working physicians seminars and professional training on education and prevention as well as supervision should continuously be offered (Reimer et al 2005). Personal coping techniques can help women deal with these stressors. Pressures will continue until attitudes and practices change in institutional settings. Some institutions are initiating changes to end discrimination against women faculty.¹⁷

There needs to be an end to the assumption that a medical career requires total commitment at the expense of family life. The medical service delivery system should enable all its staff to achieve a reasonable work/life balance, and should recognize that with over half the medical school intake now female, the pattern of work for doctors must reflect their other commitments. At the same time, the contribution of those who are able and willing to commit more of their time to the medical service delivery system should be valued and recognized.

References:

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2. Jovic E, Wallace JE, Lemaire J. The Generation and Gender Shifts in Medicine: An Exploratory Survey of Internal Medicine Physicians. BMC Health Serv Res 2006 May 5;6(1):55.

3. Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2003-2004. JAMA, 2004 Sep. 1,292(9): 1060-1

4. Al-Jaralla KF, and Moussa MA. Specialty choices of Kuwaiti medical graduates during the last three decades. J Contin Hduc Health Prof. 2003 Spring; 23(2):94-100.

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6. Lafta RK. Practitioner gender preference among gynecologic patients in Iraq. Health care Women Int. 2006 Feb;27(2): 125-30.

7. Rizk DE, El-Zabeir MA, Al Dhaheri AM, Al-Mansouri ER, Al-Jcnaibi MS. Determinants of women's choice of their obstetrician and gynecologist provider in the UAE.Acta Obstet Gynecol Scand. 2005 Jan;84(l):48-53.

8. Zaghlol AA, Yossif AA, El-Einein NY. Patient preference for providers' gender at a primary health care setting in Alexandria, Egypt. Saudi Med J. 2995 Jan; 26 (1); 90-5.

9. Turner G, Lambert TW, Golacre MJ, Barlow D. Career choices for obstetrics and gynaecology: national surveys of graduates of 1974-2002 from UK medical schools. BJOG, 2006 Mar;113(3):350-6.

10. De Torrenta de la Jara G, Percoud A, Jaunin-Stalder N. Is there a future for women and part-time doctors in primary care? Rev Med Suisse. 2005 Oct 26;1(38):2457-8, 2461-2.

11. Tyssen R, Vaglum P, Grinvold NT, Fkeberg 0. The impact of job stress and working conditions on mental health problems among junior house officers. A nationwide Norwegian prospective cohort study. Med Educ. 2000 May;34(5):374-84.

12. Busse C, and Williamson U. Female physicians face more stress than male doctors do, research show. UNC-CII News Service, April 25, 1998,N0.383.

13. Kash et al, 2000.

                    

14. Frank and Dingle, 1999.

15. Hawton et al, 2001.

16. Gyorffy Z, Adam S, Goboth C, Kopp M. The prevalence of suicide ideas and their psychosocial backgrounds among physi-cians. Psychiatric Hung. 2005; 20(5):370-9.

17. Robinson GF. Stress on women physicians: Consequences and coping techniques. Depress Anxiety. 2003;17(3):180-9.

*- Boyle GJ, Joss-Reid JM. Relationship of humour to health: a psychometric investigation. Br J Health Psychol 2004 Feb;9(Ptl):51-66.

*- Reimer C, Trinkaus S, Jurkat HB. Suicidal tendencies of physicians- an overview. Psychiat Prax. 2005 Nov; 32(8):381-5.

*- Finola Lynch third year medical student, University of East Anglia f.lynch@uea.ac.uk