The risk of suicide for women doctors can be more than four times higher than other women professionals, the Irish Medical Organisation annual conference in Killarney was told yesterday.
At a seminar addressing the lack of representation of women in medicine, Prof Patricia Casey said studies found that the relative risk of suicide for women doctors was far higher than for other professionals. A further comparison with women as a whole found the risk to be up to more than five times higher.
"Generally in Europe the rate of male suicide is found to be much higher than for females, but in medicine it seems there is some discrepancy. It is not just to do with being a professional but with the demands of medicine. Overall medics have a higher suicide rate than the general population," said the consultant psychiatrist.
Speaking on the same theme Prof Joyce O'Connor, president of National College of Ireland, said that while there had been a dramatic increase in the participation of women in the Irish workforce an "informal but significant policy of discrimination" still existed.
She said there was much dialogue on the external barriers to women's participation. However there were also internal barriers, and she cited self-esteem, self-confidence and taking control as the key issues in breaking these down.
Prof Casey said it was not clear why women in medicine were more at risk of suicide, but that it might be "role overload".
"They have to function in several roles - wife, mother, doctor and this may be a factor. The other possibility is that we know doctors have a higher incidence of drugs and alcohol misuse. Maybe that is a factor that is coming into play."
Questioning whether there was a higher rate of mental illness among women doctors, Prof Casey said it was not clear why the suicide rate was higher since studies examining stress, burn-out and mental illness did not suggest hig her rates among the women doctors. "However these studies were not designed that well," she said.
There was a marked gender difference, she added, in consultant doctor posts, with fewer than one in five permanent posts filled by women. Non-permanent consultant posts were filled by women in 35 per cent of cases. "It would seem that appointments committees are happy to have women in non-permanent posts but not permanent. What is that saying about their attitude? Or perhaps women are not putting themselves forward."
A study of Irish medical students, due to be published shortly, found that in the four years up to 1996 the percentage of women students had increased from 38 per cent to 57 per cent. The study, of UCD students, also found that in an aggregate of the final medical examination results women students were significantly more likely to get honours.
Women performed significantly better in examinations in obstetrics/gynaecology, paediatrics and psychiatry, and there was no difference with their male counterparts in the exam performance in medicine or surgery.
However there was a marked difference between those results and subsequent representation of women in those specialities. Surgery, she said, was "abysmal" at 3.9 per cent. Only 13 per cent of obstetric-gynaecology posts were filled by women, with almost a quarter of anaesthesia posts and 29 per cent of pathology and paediatric positions. Her own speciality, psychiatry, was the most egalitarian, she said, with women filling 43 per cent of posts.
Dr Casey said there was no clear explanation for this. However, a study carried out in Norway found that women doctors there were choosing family over career. Compared to male doctors a significant number of women physicians there tended to live alone, making sacrifices for their job.
The study of medical students, to be published in the Medical Education journal in the UK shortly, was carried out by Dr Catherine McDonagh and Dr Ann Horgan, under the supervision of Prof Casey.
Prof Casey said steps had to be taken to make medicine a more attractive profession to women. These included part-time training, flexible working hours, the availability of paternity leave, retraining and proper childcare. She said there also needed to be a change in attitude by appointments committees, particularly those that believed part-time training was inferior.
Prof O'Connor called for an action plan which included creating awareness through medical schools, formal mentoring programmes, workplace training and policies, and training.