Broken Scalpels: Why Germany Loses When Women Leave Medicine

In Germany, a large number of well-educated young female doctors start their careers every year. However, when it comes to making major decisions about the future of medicine or patient treatment options, women are rarely involved. Now, some female doctors are seeking changes and trying to break through the “career ceiling.”

I start with a guessing story. A father and son had a car accident. The father died on the spot and the son was taken to the hospital. The surgical team was ready. Suddenly a doctor said: “I can’t operate on this child. He is my son!” How is this possible? Isn’t the child’s father dead? This guessing story has been circulating for many years, and more and more people have guessed the real answer, which is: the doctor who spoke is the child’s mother, who is also a surgeon.

| The female doctor who disappeared into the black hole |

A survey shows that in 2021, less than 1/3 of American college students think of female doctors when they think of surgery. The belief that people only trust male surgeons is deeply ingrained. Over the past 20 years, more women have been studying medicine than men, but very few of them have become top talents. The future development direction of the medical field has been determined, the next generation of reserve talents has been selected, and decisions have been made on how to care for patients… In short, the industry culture has been formed. On their way to the top, female doctors not only encounter professional bias, but also face male leaders who prefer to promote male doctors and day care centers that close at 4 p.m.

“There is no other discipline where the gender gap is as big as medicine.” said Gabriella Kaczmarczyk, a German female doctor who has been practicing medicine for more than 60 years. This situation is very detrimental to society as a whole. If men decide which drugs to produce and what to research, then the medical system that is supposed to protect everyone’s health cannot ensure that it benefits everyone. Each of us may get sick at some stage in our lives, and every patient wants better medical services. Therefore, introducing more female medical decision-makers in the medical field and redistributing power is not only related to gender equality, but also a topic closely related to each of us.

A few years ago, researchers investigated the association between doctor gender and emergency room success rates and found that patients treated by female doctors had a slightly lower risk of death than those treated by male doctors. Another survey of about 1.5 million people also showed that patients treated by female doctors were less likely to need to go to the hospital for follow-up treatment. Why does this happen? Studies have shown that female doctors use preventive medical measures more frequently than male doctors and value scientifically based physical therapy methods more. Researchers from the Universities of Cologne and Bonn surveyed 51,000 diabetic patients and found that female doctors were better than male doctors at lowering their patients’ blood pressure and blood lipids, and could also better control their blood sugar. “We sometimes hold the patient’s hand,” says Sylvia Weiner, director of the Obesity Surgery Clinic at Sana Hospital Offenbach. Patients need a doctor who can not only make a correct diagnosis of the disease, but also patiently explain the condition to them or listen to what they have to say.

In 2022, the proportion of women in the medical profession in Germany will be approximately 2/3, the same as in 2021 and 2020. “In the beginning, these women had the same ambitions as the men,” Kaczmarczyk said. This 83-year-old woman’s face does not look old, making it difficult for anyone to guess her age. At the moment, she is wearing a bright green blazer and sitting in a café in Berlin overlooking the Spree River. She is a witness to the tenacious rise of contemporary women in the medical field: 60 years ago, she started as an anesthesiologist and rose through the ranks; as a professor of applied physiology, she is widely recognized; as a female representative of Charité Medical College, she Debate with male colleagues who “don’t want to see how good their female colleagues are.” In 2010, she was awarded the Federal Cross of Merit, but she continued to fight. Statistics show that the higher the position, the fewer female doctors there are, as if they disappear into an invisible black hole. Male dominance is evident at high-level seminars and on the boards of professional associations. In Germany, until now, medical journals are named after “male orthopedic surgeons,” “male surgeons,” “male anesthesiologists,” or “male internists.” Drug ads would say, “Ask your male doctor or male pharmacist.” The message was that the drug was approved by a male doctor.

| Motherhood becomes a career obstacle |

This gender imbalance has always existed in medicine. Years ago, when a friend of the mother of female doctor Marilyn Addo was applying for a job as a gynecologist, her boss said to her: “If you give me your uterus in a glass bottle, you can get this job.”

At an annual scientific conference held by the Association of Surgeons of Northwestern Germany in the late 1980s, the female doctor Doris Bruns, who was the chairperson of the conference, attended the closing dinner but was told that “only men can enter the dinner hall.” “. Some 12 years later, Bruns became the first female president in the history of the German Association of Surgeons. In response, some male colleagues complained that if women could also hold such positions, surgery would no longer have value.

“I love my job, and I think I do a good job,” said Bruns, who retired in 2020. However, her career has not been easy. When she became director of the Ulm hospital, her son was only in the first grade and her husband worked in Hamburg and could only come home on weekends. “There’s no proper daycare,” she fussed. “Luckily we found a good day nanny.” The image of motherhood makes it harder for women to pursue careers. In Germany, women are often told that you should always be with your children while your husband is working.

Once pregnant, a female doctor is temporarily unable to go to the operating table, which effectively interrupts her professional career. Germany’s Maternity Protection Act stipulates that pregnant female doctors should be allowed to continue working if they wish. But at the same time, in order to ensure safety during pregnancy, pregnant female doctors are prohibited from working at night or overtime. This makes lengthy surgeries almost impossible, so deans tend to find a replacement as quickly as possible who can completely replace the pregnant female doctor. In a survey of doctors, about half of female doctors said they had concerns about telling their boss that they were pregnant. More than 50% of female doctors who became pregnant between 2016 and 2019 believed that legal restrictions hindered their career development. One interviewee said: “My supervisor clearly told me that since I became a mother, I have become too inflexible and unreliable to adapt to the work requirements of the department.” Another female doctor was once asked: ” Do you want to have children, or do you want to be a surgeon?”

Angelica Behrens, a senior physician in the Department of Gastroenterology, is not surprised. She said: “Female colleagues who have taken maternity leave will no longer get their labor contracts renewed. I have seen this happen many times. Assuming that these colleagues have not given birth to children, they will definitely continue to be employed.” Fortunately, Behrens’s own The boss is not like this. Despite opposition, he allowed Behrens to return to work after maternity leave. Eventually, Behrens became a senior physician. “Some colleagues didn’t believe that I could work while raising a child, and they were afraid that the work would fall on them when I took time off.” But, in the end, she did it. More importantly, because she set a good example, more female doctors were able to successfully return to work in the hospital after giving birth.

“In male-dominated fields, the role of role models is very important.” Chief physician Katja Schlosser said, “If you have seen it, maybe you can do it. If a female doctor becomes a mother and can continue to be a doctor , then someone will follow this pace and embark on this path.” To this end, in 2021, she and 20 other female surgeons established the Association of Female Surgeons to provide consultation on the career planning of young female doctors. “The higher you go, the harder it is because there are almost no female role models at this level. Even when senior positions are vacant, female doctors will have self-doubt and feel that they are not qualified because their resumes do not meet the requirements even a little bit. ” Schlosser said.

Various male doctors’ associations have been around for decades, and now women’s organizations like the Association of Women Surgeons are a counterweight to them. The existence of these organizations confirms a simple social psychological truth: people like people who are like themselves. A few years ago, American researcher Katherine Milkman conducted an experiment. In the name of a student applying for graduate school or doctoral study, she sent an email with the same content to a group of graduate tutors or doctoral supervisors, asking if there were any opportunities. Do scientific research. For the sender, she chose names whose genders could be easily identified. As a result, male senders received significantly higher response rates than female senders. In 2018, the German Health Foundation studied how doctors evaluate their colleagues and found that male colleagues received overall better evaluations than their female colleagues. In fact, mixed teams of male and female doctors tend to be more effective because they can approach challenges in a more integrated and diverse manner and have different priorities. In 2022, a report by the German Leopoldina National Academy of Sciences pointed out that the lack of women in leadership positions will harm the future of German science, and abandoning women’s creativity will cause losses to the German scientific community.

“Just look at gender medicine,” Kaczmarczyk said as he sipped his second cappuccino. “For decades, women have been treated as ‘smaller men’ when it comes to treatment. .We know next to nothing about sex differences in disease: We don’t know that men and women’s immune systems work differently, we don’t know that women tend to have different symptoms from men when they have a heart attack, or we don’t know that certain medications When taking these drugs, men and women must take different doses in order to have beneficial rather than harmful effects. The reason why we know this today is also due to the efforts of female scientists.”

| Women in Medical Need |

In any case, gone are the days when male doctors, who wielded scalpels, enjoyed exclusive honors and were almost regarded as “demigods”, dominated medicine. Now, both male and female doctors taking parental leave can join associations for support, there are research foundations that provide career security for female doctors with children, and an increasing number of industry conferences allow doctors to attend online. Still, more changes are needed in medicine to achieve true gender equality. For example, working patterns should be more flexible, allowing doctors to work part-time. Rheumatologist Stephanie Sacks left her job at a major hospital in 2020 because a full-time job that required shifts, nights and weekends made it difficult for her to juggle her role as a mother. She now works part-time for a rheumatology specialty clinic. As the mother of a two-year-old girl, she said: “Now, I can combine parenting and work very well.” Sacks is not alone on this road. Of all newly opened clinics, 60% are opened by female doctors. In addition, it is becoming more common for doctors to cooperate with each other to open clinics, which provides everyone with more autonomy.

“In terms of improving work flexibility, traditional hospitals have not made many changes, and I think this is a failure.” said Ado, a female doctor. “The medical profession needs women, and women have the right to say: ‘I gave birth to a child, now I’m going back to work, I just won’t be able to do it full time for the time being. What options can you give me that would allow me to do valuable work while still meeting my family responsibilities?'” To be sure, in a system where patients require round-the-clock care, Being flexible with your doctor’s schedule is no easy task. “But if we don’t get better at solving this problem, we won’t be able to meet the future challenges in medicine,” Addo said.

Angelica Behrens and Vera Steele from the Elisabeth Evangelical Hospital in Berlin describe to us new models for the future of the medical profession. “After working as a senior physician for several years, I originally wanted to go one step further,” Behrens said, “but I couldn’t imagine being a chief physician while raising children.” Her colleague Steele felt the same way, “ So, we came up with an idea: the two of us would jointly apply for a full-time position as chief physician in the Department of Gastroenterology.” The idea of ​​sharing the position was very successful. Today, the two doctors’ children are grown and, in addition to Elisabeth Hospital, they head the internal medicine department at the nearby Martin Luther Hospital. They may become role models for others to follow. In this way, 20 years later, no one will ask how a dead surgeon can operate on his son.

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