The Glaring Case of Indian Medical Ecosystem: More Female Medical Graduates, but Less Female Doctors
By Younus Ahmad Dar
Researchers from the Harvard University found that female physicians tending to hospitalized patients over 65 had fewer patients die under their care, and fewer patients return to the hospital after 30 days than their male colleagues. This was from a scientific perspective on the significance of female physicians. From a moral perspective, women prefer to be treated by female physicians, particularly in a country like India which is known for its traditions. It's no secret that visiting a male physician and allowing him for an intricate inspection & examination of women (which can be our mother, sister, daughter, or wife), causes anxiety in her as well as in her family members. Well from both perspectives, the prominence of female physicians can't be starved. Alas, we (Indians) never acknowledged this.
There is a grave deficiency of female doctors in India. According to a paper titled "Human Resources for Health in India", only 17 percent of all allopathic doctors and six percent of those in rural areas are women. This is less than one female allopathic doctor per 10,000 population in rural areas (0.5), whereas the ratio is 6.5 in urban areas.
While the rising trend of women joining medical colleges in India gives us a green signal that there will be more female doctors in the future. Over the last five years, India has produced over 4,500 more female doctors than male ones. In India, women constituted 51 percent of the students joining medical colleges, cornering 23,522 seats in 2014-15 compared to 22,934 men. In fact, the topper of NEET-2018 was a female.
Unfortunately, the green signal turns red instead of yellow, when they graduate. Even though women medical students outnumber the males, catastrophically they all do not take up medicine as their career, thereby causing the paucity of female doctors in India. It is not uncommon that family pressures and environments even at work begin to subtly guide their choices. "As adolescents grow into women, purposes and motivations appear to change. They fall in line with society?s expectations of their traditional roles in India that include balancing the needs of a future family home and work, inflexible working hours, & more. Eventually, they are left to take hard decisions on further higher studies and even choices of specialization or even choices of jobs they prefer," says Dr. Sanjiv Lewin, Chief of Medical Services, St. John's Medical College Hospital.
A paper on women in medicine published in the Indian Journal of Gender Studies noted that medicine has been a male-dominated profession because it demands long working hours that are disadvantageous to women who, even today, struggle to juggle career and family responsibilities. "Existing work environments in hospitals rarely cater for part-time positions or flexible hours. This makes many departments male-dominated. Women thus take on specialities and jobs like teaching in hospitals and college the pre and para-clinical subjects or in lab-based specialities where work hours are limited, or in-home or nursing home based predominately dealing with Out-Patient care," asserts Dr. Sanjiv. Paraclinical and pre-clinical subjects tend to have many more women compared to males probably because of work hours and the ability to balance home and work. There has always been a preponderance of women in preclinical subjects like anatomy, physiology and biochemistry and paraclinical subjects like pharmacology, pathology and microbiology rights from the 1970s.
While one may argue that women go for higher studies, which is also good, however, that is not the case. According to a paper on women in medicine published in the journal Indi5 an Anthropologist by sociologist Dr. Mita Bhadra, the gender gap of 51.1 percent persists at the post-graduation and doctoral levels - the percentage of female doctors here is around one-third of male doctors.
Besides social rituals, age is also a factor that discourages women to go for higher education or practice. As marriage in India happens at an early age, a woman has to cater to her child also. As in Indian education system, educational institutes rarely support the parents in upbringing their kids, the responsibility solely comes on the shoulders of parents where one of the parents take this responsibility and put child above his/her dreams. Unfortunately, the parent is generally a mother.
India Wants Female Doctors, Not Home Sitting Female Medical Graduates
With selection criterion that does not select students from rural backgrounds, most doctors rarely locate in rural areas to serve. Many migrate to urban conglomerates where earning capacities are higher and facilities easier with challenges less, while some migrate to foreign worlds where earnings and facilities challenges are all optimized. To some extent, their migration is justified. Why? Even if a doctor is sent to the rural area, he/she is not given proper support. Especially for women doctors, safety, transportation, & proper sanitation are more important as compared to men. "Why should doctors especially our daughters toil in rural settings where earnings are relatively less, facilities less, safety-less and challenges sometimes overwhelming with poor support systems," adds Dr. Sanjiv. Another problem is the private sector. In a country like India which is already lacking funds, huge investments are made in private colleges which are located in urban areas thereby again causing a shortage of doctors in the rural areas.
The need of the hour is to address these issues. If a candidate has no future plans of practicing medicine, why to offer him/her a seat? Why don't have a reservation for women? "The question is raised presuming that the purpose of medical education is to educate a graduate that will play the role of a physician with commitment and competencies to serve the community. This very purpose is blown away by the wind when one selects students purely based on knowledge with no scoring of aptitude, commitment, & intention," adds Dr. Sanjiv. Medical education has grown huge in information but fails to drive education towards the true goal of producing competent professional and committed physicians. Most medical graduates excel at MCQs and cracking theory based examinations by the end of their graduation but fail to utilize opportunities to care for patients holistically. "You can't blame them either. Today's medicine demands the super specialties; a headache you go to a neurologist, burning urine you go to a urologist. But there is no specialty like women consult a female doctor," concludes Dr. Sanjiv.
Concluding with the statement of the first lady doctor of India, Dr. Ananabai Joshee, who strayed from orthodox customs and left India to become the first Indian woman to study medicine in America. At her famous speech at Serampore College, she said, "In my humble opinion, there is a growing need for Hindu lady doctors in India, and I volunteer to qualify myself for one." Dr. Joshee's educational victory is an inspiration for medically-minded Indian women."
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