Posted by Dr. Jane Doe.
There have been some major overhauls in the way students can gain entry to medical school in Ireland in the last year or so. I read about the proposals in the papers before I left Ireland, but didn’t really think they would go ahead. But now they have, and for all the wrong reasons. When I came across this article in the Irish times recently-I wasn’t even angry, just sad. Like, you know, that “I’m not mad, I’m just disappointed”feeling. This bit in particular really got to me:
“What changes will the new medical entry system bring about?
It will eliminate the four-to-one ratio of females over males. The previous system led to success for those securing between 570-600 CAO points, eighty percent of whom were female. The discounted nature of the points scored between 550 and 600, in the new application rules will eliminate that female advantage. The development of 240 post-graduate entry places which will also see a balanced male/female profile of entry, will copperfasten this trend.”
You can read about the rest at: http://www.irishtimes.com/newspaper/education/2008/0916/1221430248987.html
For those who are unfamiliar with the Irish educational system here is a brief explanation of how it all works. It is (was) to my mind one of the fairest systems I’ve heard of yet, and I used to be proud of it.
In 6th year in secondary school at the end of the year, all students all over the country take an exam called the Leaving Certificate. There are a number of subjects to choose from, everyone is required to sit the core subjects, Maths, English and Irish, and then you have to sit at least three others, usually at least one foreign language and your choice of subjects like another foreign language, History, Geography, Chemistry, Physics, Biology, Home Ec, Business Studies, Art, Music, etc etc. For language exams you have oral and aural as well as written exams.
If you sit a subject at Honours level, the maximum mark you can obtain is 100 points. If you sit it at Pass level, the max is, I think, 60 points (it used to be in my day). No matter how many subjects you choose to sit, only your best scoring six are counted when tallying up your total number of marks, and your marks are out of 600. In addition, certain college courses require students to have taken certain subjects in the Leaving Cert before they will even consider them for a place on that course. So in case people are going to say stuff like, "Well women would do stuff like Home Ec, French and Art and those would be easier to get points in so that's why they're in medicine", I will point out that medicine required as a prerequisite at least two Higher level Science subjects, and Higher or Applied Maths, so there's three subjects right there that I would imagine wannabe boy docs would have some natural advantage in (boys seem to be better at these types of subjects than girls). So DESPITE this, girls are still doing better and getting the medical school places. Geez. Quite the little problematic pigtailed achievers, aren't they?
Students get a form before they do their exams to choose which courses they want in order of preference, and this is used to allocate them their college course after they have taken their exams and gotten whatever number of points they score.
College courses are each allocated a certain number of points for entry-and the principles of Supply and Demand as well as academic requirements regulate how many points are required for which course.
For example, nursing used to be about 390 out of 600 years ago, but as the nursing unions fought for better pay and conditions and it turned into a degree course, the points to get into nursing have soared. Primary teaching too, as salaries increased and people woke up to the fact that the holidays are AWESOME has experienced some increase in points required to get in. Actuary, the course with the highest earning potential, usually requires nearly 600 out of 600.
Medicine has never been lower than 540/600 and points have increased in recent years as demand for limited numbers of places increased.
While no system of choosing students for college places is ever going to be completely fair, the Leaving Certificate was one of the best ways I can think of. Each student is given a number, so it’s all anonymous. The examiners don’t know who you are, what sex you are, what race you are, or if you’re their cousin.
But see, the problem was, girls do better in standardized exams than boys. These exams were thought up back in the days when women weren’t even allowed to work after they got married (as recent as the 70s in Ireland by the way!) And girls did better in the exams because they worked harder and competed on the same playing field as the boys. Particularly in medicine. And now there are going to be lots of female doctors in a few years time because women did better academically than men in the same exams.
And we can’t have that.
Women as employees in the medical workforce may cause some problems. They may want to not work 36 hour shifts with no break for years at a stretch anymore. No matter what the overtime rate is. Women are more likely to want more complex things, like reasonable time off, job security, and good working conditions, and may be willing to take these in lieu of extra money. And these desires are not compatible with absolute obedience and complete self sacrifice.
Big problem here-they may take maternity leave like other employees. How dare they?
At present in Ireland, many NCHDs do not take the maternity leave they are entitled to, and I know of at least two Surgical Registrars who took only a long weekend, to give birth, and were back operating the next week wearing TED stockings so as not to get a DVT. In addition, pregnant juniors are forced to work 30-50 hour shifts and 100 hour weeks with no sleep. The Irish doctor’s union has been exceedingly slow to address these issues. But recently they have tried.
There are no childcare arrangements for parents who are junior docs of either sex, and so some, usually the women, are forced to go part time. And since there are virtually no part time hospital jobs, certainly none that are training posts, many females apply for GP training schemes so that at last, they can have some control over their working lives, maybe, just maybe, have a life outside of medicine and see their kids. And here is the problem.
GPs are expensive to train apparently, and this situation of GPs wanting to work part time because of the lack of childcare, or maybe, just because they, like any other independent contractors, are entitled to work the hours they want and accept the financial consequences, is causing some problems apparently with out of hours GP access.
Again, the GP training scheme in Ireland (used to) look for academic excellence as part of the selection criteria, another important reason so many women were selected for it, a fact which is conveniently overlooked when people moan and writhe and agonise about the fecking women doctors ruining everything for everyone. They are usually the best of the best, and highly trained and hard working. People moan about accessing their GPs, and blame the fact that they can't make a routine appointment with a GP for an ingrown toenail at 9pm on the fact that some work part time.
People these days in fact can access their GP if they need to, they just don't want to take time off work to do it. And employers share some of the blame in that they are reluctant to let people take time off to visit the doctor.
Yes out of hours access is a problem, but it was a bigger problem back in the day too, and in fact co-ops that have been formed recently (formed in fact when the influx of WOMEN happened and they recognised the need for a sensible and fairly distributed out of hours rota) provide easier access now than when I was a kid in the 80's. But people who don't want to take two hours off to see the doctor because the account is too important are pissed, hence they gotta blame someone. And why not the fact that the GPs are girls?
I would also like to point out that I for one,were I a GP and many other docs I know would quite happily open at noon and stay open till 8pm or something and hence allow other working professional access to us. Problem is, GPs are expected to be open 9-5 Mon-Fri, and hence out of hours still means, for us, EXTRA hours. Hell, if I were a GP and had control over my own hours, I'd happily take weekend surgeries 9-5 Sat and Sun and have two days off midweek instead. How much more lucrative would that be? But they're not allowed to for some reason.
How many women would have remained in Irish hospital medicine if the hours were such that the longest shift you did was something like 15 hours long as opposed to 36? If there were part time options and flexitime options widely available? If there was affordable easily accessed employee childcare available?
I suspect a lot more.
Down Under there are TONNES of part time options and flexitime options and TONNES of female doctors, and all of us feel loyal to the system because we know it will find a way to get value out of our training no matter what our personal circumstances. And the system doesn’t appear to be self destructing from the oestrogen.
Far from it.
But rather than reorganize the system so that everyone, male and female, works LEGAL hours, gets their contractual entitlements to maternity (and paternity leave, a meager 3 days in Ireland which is ridiculous), and has access to childcare, the easiest thing to do appears to be to begin phasing out the wimminfolk by denying them access to the system they will eventually be forced to leave in the first place.
You see, reorganizing things to be sensible takes work. It initially takes money, although it will save heaps in the longer term as more Irish trained doctors are retained within the Irish medical workforce. The most important thing it takes though, and the thing that is most lacking: It takes a change in attitude.
Oh and one more thing. I guess by this: "The development of 240 post-graduate entry places which will also see a balanced male/female profile of entry, will copperfasten this trend.", what they may really mean is "We're going to negatively select against gurrls".
In which case I'd suggest that any woman who does well in the new entry requirement assessments, does a good interview, and then doesn't get in should ask for a breakdown of the scores of all the other applicants and if anyone male who scored less got the place instead due to subjective factors such as interview technique, personality etc, then they should get a lawyer and sue for discrimination. They will only have to look at the newspaper articles for proof that discrimination was likely intended in the first place. Although no doubt one will have to disclose one's sex before applying in the first place, and hence will magically do "worse" in the assessments than the candidates who aren't, what do we call it in thess faux PC days? Chromosomally impaired?