President-Elect Dr Gill Gibson spoke to AusDoc about her presidency plans, obstetric violence, and fighting for equity in the specialty.

This interview, published on the AusDoc website on 19 May 2023, has been reproduced on the RANZCOG website with the permission of AusDoc.

Credit: AusDoc

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Q&A: Second female RANZCOG president vows to tackle the specialty’s gender problem
Dr Gill Gibson discusses her presidency plans, obstetric violence, and fighting for equity in the specialty.

Incoming RANZCOG president Dr Gill Gibson has a passion for equity, regardless of gender, but acknowledges her role as the second female president in the college’s 25-year history.

In a recent editorial, Dr Gibson said there was a need to address low rates of men pursuing a career in obstetrics and gynaecology, including discrimination starting in medical school.

She spoke with AusDoc about breaking the glass ceiling and the challenges that lie ahead.

AusDoc: Does it feel strange to be advocating for male representation in the specialty, given its history and your position as the second female president?

Dr Gibson: Not at all.

But it’s an interesting question.

I’m sure there are members of the college that think, what the hell, we’ve only just achieved equity and good female representation.

I come from the perspective that something unequitable is going on, and it’s because there are biases and discrimination in the system and it’s unfair.

Addressing those inequities is important, regardless of gender and even in going beyond binary genders — that’s another piece of work looking at increasing diversity in our specialty.

It’s reducing opportunities for a group within our medical profession, and we want to find out why that is.

AusDoc: You recently wrote about the need to encourage more men to join the specialty, including tackling conscious and unconscious gender bias. Will you consider blinding of applicants’ gender during the selection process for the college’s training program?

Dr Gibson: What’s apparent is that men are not applying as much as women are to get into the specialty.

They’re being selected reasonably reliably, so blinding applicants’ gender might not make a huge difference, but there might be a subtle bias going on there.

To make sure that is the case we do need to look at blinding applicants — biases are quite strong, they’re conscious or unconscious so you have to be careful that you haven’t got a selection bias.

But really, it’s trying to get more men in the pipeline, and it appears that the influence is right back at the beginning when we’ve got our medical students.

It doesn’t really discriminate between the genders, but it’s certainly more common for men to report that they’re excluded from clinical situations and, of course, the birthing suite.

It’s a highly charged time, this is a very emotional and a very important time in a woman’s life and I think to add a student into the mix does require talking to the patient about that and the obvious benefits for students to learn.

Patients who have had children already are more likely to accept students and often you hear that phrasing, ‘They’ve got to learn somehow’.

AusDoc: Do you think gender quotas are an option?

Dr Gibson: We recently introduced gender targets to address the lack of representation of women in our senior leadership roles.

When I was elected to the board in 2018, I was the only the only elected woman out of seven.

And we now have over 40% women on the board.

People will say that’s going to happen anyway through the pipeline, but that’s not necessarily true and we know that happens outside of medical situations and in business situations.

Quotas work, they address a particular bias or discrimination.

AusDoc: What are some other priorities and goals for when you officially take over as the college’s president in November this year?

Dr Gibson: My main focus is on workforce, particularly for regional and remote areas in Australia and New Zealand.

I’ve had quite a deep understanding of that because I’ve chaired the New Zealand workforce working group, and I think Australia and New Zealand have got very similar challenges.

And I’ve got an ongoing interest in gender equality and diversity work, I have been the chair of that group and now the deputy chair.

AusDoc: What about workforce issues, like the recent shortages of obstetricians in Queensland — is it an issue unique to the region, or does it point to a wider problem?

Dr Gibson: I don’t think it’s unique to Australia or Queensland, where the focus has been more recently.

I think regional areas do struggle to maintain a workforce and the trouble is if you’re not fully staffed, those that remain on rosters get burnt out and services close, which is really, really concerning to us.

There is Commonwealth-dedicated funding to support training and education for rural GPs in obstetric interests with a diploma to support people to stay in those regions.

That’s part of the workforce solution, I mean it’s a long term one to encourage GPs to do that extra qualification, to continue to practice O&G is really important and to have good ongoing support for them, having connections with bigger hospitals where they continue to upskill and maintain skills.

AusDoc: What else is the college doing to grow its ranks?

Dr Gibson: We’ve looked at ethnicity — we don’t have very many Māori or Pacific Islander doctors, [and] in Australia ever fewer proportionally Aboriginal and Torres Strait Islanders.

One of the strategies needs to be longer term and it’s getting more medical students who identify with those ethnic groups.

We’re looking at some of our selection criteria to improve those numbers coming in.

AusDoc: Is this part of a broader strategy to retain and attract people from all training stages?

Dr Gibson: We certainly don’t have any shortages of applicants — it’s more about the distribution.

Once we’ve trained the specialists, there is a tendency to want to live in cities and the work-life balance seems to be increasingly important.

I think older specialists like me, probably just sucked it up.

Not to say that our current trainees don’t do that, but I think, quite rightly so, we do recognise that burnout happens, and we have to be careful that the lifestyle that our potential trainees see at the end is one they would want to take on.

One of our challenges was particularly for women who should be having babies around the time that they’re training and sitting exams and trying to balance that.

AusDoc: A recent report suggested more than one in 10 Australian women had experienced obstetric violence during childbirth. What can the college do to address this issue of obtaining informed consent when providing care in the birth suite?

Dr Gibson: The consent issue is an important one.

As a practising obstetrician myself of nearly 20 years, the important thing is to try and inform patients and talk to them about what may or may not happen ahead of that happening.

That’s the difficult thing, because in obstetrics you can change from everything being normal to suddenly being quite urgent.

You really want to know that you can trust your obstetrician, your midwife or whoever has responsibility for your care to recognise when complications are happening.

The college is ensuring that we’ve trained our specialists so that they understand that, and making sure that doctors, specialists and GP diplomates stay up to date with things and don’t become isolated from practice.