Women doctors don’t choose to leave work; they are forced out of their careersBlogs
A few weeks ago, I wrote about the women doctors of Pakistan. I was both surprised and humbled by the response.
People wrote in to say how it changed their perceptions of the profession and the place of women in it. Others pointed out errors and omissions.
By writing about women doctors, I only wanted to tell their stories, to understand their perspectives, and to hopefully start a conversation about the state of the medical profession in Pakistan and its gender dynamics.
What I did not expect was that it would lead to an introspection about how we read and perceive research, and what we think about women’s work.
There are three main things I would like to bring attention to in order to clarify the research around women doctors: The lack of data on women doctors, the misleading assumption that women have a choice in leaving work, and the definition of work itself.
Let me begin by the graph that raised the ire of so many people. Here it is again, for reference:
This graph shows the trend of doctors registering with the Pakistan Medical and Dental Council (PMDC) for practice every year. It also shows that since the past decade or so, more women than men have registered to practice medicine.
I had used this graph to question the oft-repeated, but seldom understood, narrative: ‘A majority of women doctors do not work.’
Some of you astute readers pointed out that this graph does not indicate how many of them actually work. And I agree with you.
As I had stated in that article, we really do not know how many women doctors work. And in the absence of any evidence, we really have no basis to claim that a majority of them do not work.
In fact, the little evidence we do have (like PMDC registration statistics), it shows that every year, more and more women doctors complete their house job and register the with PMDC with the intent to practice.
Believe me, not knowing is part of the problem. How I wish every woman doctor who ever hung up her white coat and stethoscope for an apron and tawa could have checked a form ‘not a doctor anymore’, told us why, and submitted it somewhere. But that does not happen.
It also sends a message to them that the state is not interested in hearing their voices. That they don’t matter. This invisibility also allows narratives like ‘women doctors don’t work’ to proliferate and dictate our policy choices.
Remember that these are not just numbers or percentages we are talking about. These are individuals, real and living, and numbers have a way of de-humanising them. They may be someone we know, someone in our family, the person walking next to us, or our best friend.
Each of these numbers represent a girl who spent more than 17 years of her life striving for her career, who gave up playing, going out with friends.
Who left her family to live alone in a hostel, who spent five years in medical college running from class to class.
Who spent night after night poring over Grey’s (who’s kidding, mostly BD), and Guyton, and Ganong, and Harrison, and Bailey & Love.
Each of these numbers also represent a family who broke a barrier: They sent their first girl to college, to a co-education institution, away from home, who invested not just money but also love and support in their daughter’s education.
The fact that any one of them is compelled to leave a career she so cherished, is not something to be used as a rhetoric device in political debate, or to advocate for ill-advised quotas or fines on women. It is indicative of how we, as a society, treat our women.
Statistics aside, let me return to the idea that a majority of the women doctors don’t work, and try to unpack, what we really imply when we say that most women doctors leave their career for their families.
The underlying assumption is that women doctors choose to leave their career, choose to prioritise their families over their career, and choose to waste the valuable resources the state spent on their education and training.
Let us keep in mind that we would not ask a male doctor to make that choice. It would be just fine for him to never attend a single parent-teacher meeting, not know where the plates and spoons are, or how his socks and underwear magically clean themselves.
If he works late, he is dedicated. If he expects his wife to care for his parents, he is a good husband, and a dutiful son.
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Over the course of my own education and research, I met and talked to many women doctors. But I am yet to meet one who, after years of gruelling hard work put into her education, does not want to practice her craft.
I did, however, hear stories of what women doctors faced in the course of their work.
They talked about the 36 and 48-hour duties, with barely a moment to rest in between. They told me how they had to almost fight the attendants of pregnant patients to arrange for blood before delivery, how they sometimes ended up giving their own in frustration, and how the hospital security mysteriously disappeared when patients’ attendants threatened the women doctors’ physical safety.
They also recounted stories of supervisors who wanted their own names included in research papers even when the supervisors had not done any of the work, who told them that they better not get pregnant during the training, and who systematically undermined their women trainees.
They told me of male politics and backbiting in their departments, when their male colleagues who flattered their professors ended up getting all the surgeries and procedures, and those who ‘knew someone’ got promoted.
They also told me of the anguish they felt when they counselled their patients to breastfeed their babies, but had to wean their own before the three months maternity leave ended, because even though policies exist to provide safe spaces and regular breaks for breastfeeding, no one bothers to implement them.
And when they complained about these biases, or harassment, or lack of transparency, or absence of a support structure, they were told that they were being ungrateful.
This is just half of the story. The other half happens in our homes.
There is Dr Naila. Her mother-in-law burned her degrees in a fit of rage when she started her job.
There is Dr Aliya; I saw the bruises on her arms and the black eye, after she mysteriously fell down the stairs one day.
Dr Fazeela: She was a pediatrician, at least until her marriage when on the first night, her husband told her that he did not believe in women working outside their homes.
Dr Fouzia, who did not tell her family or file a complaint when her supervisor tried to grope her in a meeting. She feared that she would be suspected of having a ‘bad character,’ that it would cost her her job.
Dr Sara, who has been rejected for more than 50 rishtas. Not because she does not want to get married, but because she is a surgeon, and always tells any suitors that she will keep working after marriage.
And then there is Dr Seema. Her husband told her after marriage that he wants her to keep practicing since he has three younger sisters to marry, and their dowry is not going to pay for itself.
More common is the everyday abuse: When a woman doctor is called a ‘bad mother’ because she wants to sleep after working for 36 straight hours.
When a mother-in-law rebukes her bahu because she does not bring her breakfast, and does not like how she puts dishes in the drawer.
When a husband expects clean clothes and a sparkling house every day, but cannot even be bothered to make his own bed in the morning.
When a TV ad proclaims that good wives spend their time cooking for their husbands, in order to sell spices.
Majeed is an old man. Three of his daughters are doctors. I asked him why women doctors found it so hard to work, and his answer hits the dilemma on the head.
He said, “When our son comes home we expect him to put his feet up and drink tea. When our daughter-in-law comes home after work, we expect her to make tea for everyone.”
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This is what every working woman, not just doctors, struggles with: The second shift of work that every woman faces, and faces alone. For which she is never paid, or even thanked.
We expect women doctors to care for us in our hospitals and we don’t value it; we expect them to care for us in our homes, and we don’t value that either.
Let me say this, and I cannot emphasise this enough, women doctors do not leave their career by choice. It is the rampant sexism in the medical profession, poor work conditions, and unequal distribution of work in our homes that pushes them away from their careers.
Saying that most women doctors don’t work after their graduation also assumes that doctors can be neatly sorted into two piles: Working and not-working.
I made the same mistake when I started my research, and quickly realised this assumption is far from reality.
The dichotomy of working/not-working is based on the fallacy that doctors have a linear career, one that starts after education, and continues without any interruption till retirement or death (whatever comes first).
This is a model that, as the sociologist Joan Acker astutely pointed out, assumes ‘man’ as the ideal worker: Unencumbered by the biological demands of producing the next generation of human species.
This is a model that does not fit the experiences of the majority of women (and many men, for that matter, in the current state of our economy). Actual careers of actual women doctors are much more complicated, and almost impossible to label.
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Sumera, one of my research participants, was introduced to me as ‘not-working’. She told me she took a break after graduation to care for her three children, and when they were all school-going, returned to complete her specialisation in neurology.
“Now I am looking for a job, close to my home,” she said. Is she working or not working?
Faiza did not practice for 10 years after graduation. Her mother-in-law had a stroke and as a doctor-at-home, she was responsible for her care.
After she died, Faiza decided to go back to work. She realised that she will have to start from scratch and re-do her house job.
“I couldn’t do night duties as I had little kids at home. So, I opened a clinic in my home. I just see patients from my neighbourhood.” Is she working or not working?
Aminah is also taking a break after graduation to care for her two young children. “I cannot do a regular job with two toddlers and no one else to help,” she told me.
“I share a clinic with my husband in the evening. I can stay in touch with my training this way.” Is she working or not working?
After five years of taking a break, Najma bought an ultrasound machine and started doing ante-natal exams at her home. There isn’t any board outside advertising her clinic. It is not even a clinic, strictly speaking, just the guest bedroom in her house. Is she working or not working?
Arshia volunteers at an NGO that arranges free clinics in slums around Lahore. She does not get paid. Seema is doing her MCPS training in a public hospital, and has been working as an unpaid honorary trainee for two years. Which pile do I put her in?
Do not get me wrong. We need doctors to work in our hospitals, to be available in emergencies 24/7, to look after our mothers and children whenever the need arises.
We need women to work because otherwise we miss out on their perspectives, their ability to empathise, to care, and to listen. But this cannot happen without taking a deep and critical look at our homes and our workplaces.
Go to a hospital, any hospital. Take in all the chaos and misery that is around you.
Stand behind the doctor’s table in the emergency ward, with 10 patients thrusting their parchi in your face.
Go to the OPD, where you won’t be able to walk through the crowded corridors.
Spend a night trying to manage a diabetic patient in ketoacidosis, or trying to alleviate the pain of a patient with tetanus. Or see a young child die of dehydration or a mother due to eclampsia.
Then go home. Pick up your child’s toys from the floor. Pick your spouse’s laundry. Wash the dishes. Cook a salan, knead some flour, and make rotis.
Press the uniforms and dress you need to wear tomorrow. Make lunches and fill water bottles. Check that your children have done their homework. And when everyone sleeps, make that crown that your daughter’s teacher asked her to bring.
So next time you feel the urge to say that women doctors leave their career out of choice, walk a mile in their shoes first.
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