The number of women in Canadian medical schools has been growing steadily for the past 30 years, from 14.3 per cent in 1968/69 to 57.7 per cent today; and while women have been responsible for some significant changes in medicine in recent years, there are still very few women moving into medical executive positions in this country.
Dr. Noni MacDonald, the first woman to be named a dean of medicine in Canada, notes that at the moment there is only one female dean of medicine among the country's 17 medical schools. MacDonald was named to the position at Dalhousie in 1999. She has since stepped aside. The only current female dean is Dr. Catharine Whiteside at the University of Toronto.
"We seriously need to get more women in top positions, the upper management structure needs to be changed" says MacDonald. "There's too much internal politics that is often not attractive to women. Women often just turn away. I see it very much still as an old boys' club."
Dr. Cheryl Rowe, a community psychiatrist in Toronto, also feels this is an area that needs improvement. "Women are not as well represented in academic positions, in leadership positions within the hospital. There is recognition that women need to be offered more leadership positions and the Canadian Medical Association has a whole leadership stream of courses that they offer particularly to women."
There have been medical schools in Canada since 1824. MacDonald became the first woman dean in 1999 —175 years into medical school history.
Women have already brought many of their strengths to the field of medicine, says MacDonald. These include better work-life balance for doctors, more doctors doing international aid work, the teaching of improved communication skills and more team initiatives.
MacDonald had her first child in 1976 when she was a resident in Ottawa and there were no policies in place for maternity leave. She had to take four weeks holidays and luckily, she says, her son was born on a Friday night. Exactly four weeks later she was back on a 72-hour weekend rotation.
"Nowadays," says Rowe, "there is much more accommodation for residents who are pregnant or are hoping to have families while in training. There is also a big push for group practices which make it much easier for women of childbearing age to get coverage and to share jobs."
Rachel Johnston, a Canadian medical student at the University of Manchester who wants to be a pediatrician, says that kind of change is important to her.
"A work-life balance is going to be the deciding factor for me in terms of what specialty I actually end up in. I ruled out surgical specialties early because I knew that committing myself to such a career would make raising a family very difficult, and I want to be able to devote myself as equally to my family as my career as possible!
I think more women than ever are studying medicine because so many specialties are offering a reasonable work-life environment, especially when compared to other professions."
MacDonald says the trend has also made it better for male doctors who want to spend more time with their young families.
Another shift prompted by women, according to MacDonald, is the focus on communication skills, an important area of medicine. "In general women tend to be good listeners and part of what you are trying to do in any medical practice is understand what the problem is that the patient has, and make that medical alliance with the patience to help them get better. Because sometimes it's not just the matter of giving them a pill to make them better, it's giving them the pill and supporting them to get better. I think a lot of women are good at building those kinds of relationships."
She says surveys have shown that women spend more time with their patients.
Rowe says, "medicine has to acknowledge women as great collaborators with other members of the treatment teams such as nursing, nursing practitioners and frontline counselors – roles where traditionally men have had more difficulty than women."
Macdonald believes that because society is demanding better communication from its doctors and because there were more women inside medical programs, communication is now taught as a skill in most medical schools.
"I also see that most women in medicine fill the role of the caring doctor very well, not to that men don't. I've already felt my own maternal instincts coming through in some more difficult consultations I've been involved in," says Johnston.
Women still tend to choose the areas of medicine like family medicine, pediatrics and psychiatry, according to Rowe who sees this as positive.
With so many women already in medical school, the question remains, is it a good career?
Rowe says a very definite yes. "The pay is good, the work is interesting and serves the community, the hours are usually flexible and can be negotiated and there is ever more flexibility to change direction."
Rowe herself has been an academic psychiatrist, a psychotherapist, a consultant to northern and rural areas, a fellow in women's studies, a community and medical legal consultant and is now focusing on inner city health and working with the homeless, all in a career spanning 25 years.
MacDonald says that the most important advice she can give to anyone considering any career is to make sure they have "fire in the belly" for whatever they want to make their life's work.