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The Wonca Working Party for Women and Family Medicine (WWPWFM) was organized in 2001 with the following objectives: to identify the key issues for women doctors; to review Wonca policies and procedures for equity and transparency; to provide opportunities to network at meetings and through the group’s listserve and website; and to promote women doctors’ participation in Wonca initiatives. In October 2008, at the Asia Pacific Regional conference, the Wonca Working Party on Women in Family Medicine (WWPWFM) held a preconference day and conference workshops, building on the success and commitment to initiatives which enhance women’s participation in Wonca developed in Ontario, Canada (2006) and at the Singa- pore World Congress (2007). At this meeting fifty women workshopped issues for women in Family Medicine in the Asia Pacific. Using the Action Plan formulated in Singapore (2007) the participants identified key regional issues and worked towards a solution. Key issues identified were professional issues, training in family medicine and women’s health. Solutions were to extend the understanding of women’s contributions to family medicine, improved career pathways for women in family medicine and improving women’s participation in practices, family medicine organizations and academic meetings. Introduction barriers in training, in practice, in medical organisations Gender equity is a pressing need for family medicine , and in academic medicine [3,5,6]. The lack of gender and in the communities of the Asia Pacific. Women equity in medical leadership, including the historical earn less, are more likely to live in poverty and income lack of women in senior World Association of National inequality is rising . Women are less likely to be man- Colleges and Academies for General Practitioners/ agers and legislators in most countries within the region, Family Physicians (Wonca) positions, is a challenge and with the exception of the Philippines . Women are an a concern for family medicine . integral part of family medicine, in the professional Best possible care in family medicine requires gender workforce and as patients. Women doctors are increas- competent professionals who understand the cultural, ingly represented in the family medicine workforce social and political determinants of health and can around the world. In some countries of the Asia Pacific respond effectively to them. Medical knowledge and Region, women are the major providers of family medi- research evidence must include male and female partici- cal care (Philippines), in many countries the numbers of pants  and gendered professional perspectives to bet- women are increasing (Australia), while in some parts of ter support gender-competent care. For example, the Asia there are still few women family doctors [3,4]. same serious illness, like myocardial ischemia, may pre- The health of our communities depends, in part, on sent differently in male and female patients and doctors the ability of the community to access appropriate medi- need to be trained and able to recognise gender differ- cal care and the ability of the healthcare workforce to ences in presentation. Being a victim of intimate partner deliver the best possible care. Women still face barriers violence is much commoner for women than men, and to achieving their full potential. Women doctors face has significant impacts on health, prevention, recogni- tion and early intervention can improve health out- comes. Women, as professionals and patients, can assist * Correspondence: firstname.lastname@example.org Department of General Practice, Monash University, Australia © 2010 Coles et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Coles et al. Asia Pacific Family Medicine 2010, 9:1 Page 2 of 4 http://www.apfmj.com/content/9/1/1 the development of gender competent knowledge and Professional issues which emerged were healthcare. � Challenges in achieving of gender equity in the pro- The 1998 XVth World Congress of the Wonca in fessional consultation: time, complexity, financial Dublin saw the foundation of the Women in Family remuneration; Medicine Special Interest Group. The group audited the � Negative attitudes to women family practitioners structures of Wonca and the conference and challenged focused on their gendered workload; “longer consulta- the “invisibility” of women in leadership and plenary tions”, “tears and smears”, “touchy feely stuff”,patient- positions. This, and their experiences of being made centred approach and family priorities; invisible in their own profession, generated the momen- � Devaluing of part time work as “not a real doctor"; tum for change. The result was the establishment of the � Challenge of recognising women practitioners’ pro- Wonca Working Party on Women in Family Medicine fessional work outside the consultation e.g. teaching; th (WWPWFM) at the 16 International Conference of � Inequality of opportunity e.g. funding for confer- Wonca in Durban, in 2001 . The WWPWFM aims to ences, presenting at conferences; develop policy which would enhance the role of women � Challenges attracting women practitioners e.g. to family doctors in Wonca and within health systems  rural practice, to leadership roles; through representation, training, support, research and � Lack of female and cross-cultural role models; leadership for women in family medicine. � Lack of clear career paths, career flexibility and The Wonca 2008 Asia Pacific Regional conference was support; th hosted in Melbourne, Australia from 2-5 of October � Maintaining a work/life balance. and held with the Royal Australian College of General Training issues which emerged were Practitioners (RACGP) Annual Scientific Meeting. The � Rigid training models e.g. compulsory professional WWPWFM held a preconference day and conference training placements often involving geographic reloca- workshops, building on the success and commitment to tion, lacked of flexibility, were full time placements with initiatives which enhance women’s participation in limited or no access to part-time placements, trainees Wonca developed in Ontario, Canada (2006) and at the reported a lack of maternity leave and a lack of clear Singapore World Congress (2007). This paper reports career paths and choices; on the preconference workshop. � Need to develop negotiating skills and confidence; � Lack of female supervisors and mentors; Taking Action at the Asia Pacific Regional � Importance and facilitation of women in training Conference in Melbourne when successful female supervisors and mentors were Local representatives in WWPWFM organised a full day available; preconferenceworkshoptocontinuethe work of � Difficulties in maintaining work/life balance, particu- including women. The workshop was dedicated to pro- larly in relation to professional roles with family work moting Wonca’s Ten Steps to Gender Equity and Health and childcare.  and engaging with local issues of concern for Issues for women Women in Family Medicine. Fifty women doctors regis- � Attitudes to women; tered and attended the workshop, most were from Aus- � Violence against women; tralia and New Zealand, with representatives from the � Gender inequity in “family work”. Philippines, Vietnam, Thailand, Indonesia, Pakistan, India, Canada, United States of America and the United Towards a solution Kingdom. Participants focused on solutions to professional issues. Consistent with the principles of participatory action These solutions included: extending understanding of research and a democratic respect for the knowledge of women’s contributions to family medicine, valuing women doctors, the workshop focused on the experi- women’s abilities, providing clear career paths and ences of all participants. Doctors from the region identi- improving women’s participation in practices and fied local gender and health equity issues, and areas of organisations. need, as well as strategies to address them. These strate- Extending understanding of women’s contributions to gies are locally and internationally relevant. family medicine Changing attitudes to women’s work was a key process Asia Pacific Issues for Women Doctors needed to create a greater understanding of women’s Themes contributions to medicine. Many attitudes to women Three key themes were identified by participants. They and their work are culturally embedded but not clearly were professional issues, training and issues for women articulated as a gender bias within medicine. Medicine as patients. has tended to reinforce the traditional views of women Coles et al. Asia Pacific Family Medicine 2010, 9:1 Page 3 of 4 http://www.apfmj.com/content/9/1/1 [10,11]. As family medical practitioners, we must first leadership during their training as medical students, and explore the assumptions underlying our profession’s atti- in family medicine specialization, would be beneficial. tudes to gendered social and professional roles if we are Improving women’s participation in practices and to extend our understandings [12,13]. organisations Sexism and discrimination based on the sexual stereo- Attitudes were identified as a major barrier to women typing of female behavior and work is destructive and participating actively in medical organisations. The cul- its effects were explored by workshop participants. ture of medicine and the expectation that doctors are The women at the workshop reported their colleagues male remained a significant barrier to women’sactive described their medical work as “second rate” because participation. Work and organizational practices made it they took longer with patients and because of the type difficult for women to contribute for example: directive of consultations patients requested of them. They talked leadership styles are more valued than collaborative of complex consultations where they practiced preven- ones, gender differences in consultation styles are poorly tive care and addressed psychosocial as well as medical understood, emotional work is barely recognised, the issues as very important and they valued their work lack of flexibility, part-time training and maternity leave, highly. Some were visibly upset when they described the and timing of committee and management meetings are discriminatory language they had heard from others. not family friendly. “Tears and smears” wasthe exampletheyusedto describe the systematic and professional discrimination Outcomes against their skills despite complexity and difficulty of Participants elected to carry two projects forward to bet- the work they performed. The medical literature sup- ter support women doctors of the Asia Pacific in their ports women’s professional consultation styles as professional roles. The first is to contact and survey the improving patient outcomes [5,14-16]. As women doc- needs of trainees and academy/college policy across the tors, the participants felt, it is important to have confi- region to allow the WWPWFM to actively address trai- dence in the quality of their work and its value to nee needs. This initiative is directly linked to the Action patients. This will help colleagues understand women’s Plan (See below) 2007-2010 from the Triennial Wonca th contributions and redefine “quality” in terms of patient Meeting of the WWPWFM 24-26 July 2007, Singapore outcomes. Participants urged their colleagues to take to “Promote the development of young/new family phy- action. Participant’s urged their colleagues to challenge sicians with the aim of overcoming the challenges and others when they dismiss women doctors’ professional barriers to their full development”. The second is an work by responding “Yes, I do many complex consulta- internet based leadership module based on previously tions” and ask if they do and if they do not then why run conference leadership workshops as a resource not? Valuing women and their work, will model and within the region for women in family medicine to teach others (both male and female) to do the same and develop, support and celebrate the ways in which challenge old and outdated cultural attitudes. women doctors of the Asia Pacific practice medicine. Improving career paths for women in family medicine Both will be further progressed through meetings in Participants felt that transparency in training was impor- 2009 and beyond. tant for women doctors: knowing up front what was required and the flexibility within those requirements; in ACTION PLAN FROM TRIENNIAL WONCA MEETING some countries part-time training and/or re-entry was WWPWFM 24-26 JULY 2007, SINGAPORE not an option and participants felt that this should be (UPDATED version 3, 26 Aug 2007) reconsidered and supported. Models from countries 1. Promote implementation of Gender Equity Bylaw with flexible and part-time training could be explored Amendments. and adapted where necessary. 2. Ensure that Wonca 2010 (Cancun) and other The near invisibility of women doctors as leaders, role Wonca regional and rural meetings have gender equita- models and mentors was explored. Participants felt ble programmes. women doctors in academic, professional and organiza- 3. Develop a Code of Conduct for Wonca Meetings to tional roles were important in supporting the careers of promote equity for women and related ethical issues. others and assisting them to identify career paths and 4. Support Wonca activities in ensuring FM is a speci- choices and to better manage academic and clinical ality throughout the world. work, medical politics and policy, research, teaching and 5. Promote development of young/new family physi- family time. Institutional and medical organisational cians with particular attention to overcoming their chal- support for women as leaders and role models was iden- lenges and barriers to full development. tified as a key part of this modeling process. Participants 6. Work with the WWPRFM (Rural) to amend the suggested training in negotiation, assertiveness and Wonca guidebook to reflect a gender equity perspective. Coles et al. Asia Pacific Family Medicine 2010, 9:1 Page 4 of 4 http://www.apfmj.com/content/9/1/1 JW workshop conceptualization, recording and preparation documents for 7. Use Wonca as a forum to highlight areas where analysis, critique analysis and history WWP. professional leaders could be influential in legislating ZL history and WWP document provision. and regulating conditions which support equity and SS workshop facilitator. All authors have read and approved the final manuscript. wellbeing for female practitioners. 8. Explore, promote and translate the 10 Steps to Gen- Competing interests der Equity and Health into the core publications and The authors declare that they have no competing interests. mission statement of Wonca. Received: 12 August 2009 9. Work within Wonca to ensure that the ICPC codes Accepted: 7 January 2010 Published: 7 January 2010 can deliver accurate information about the issues high- lighted in the care of women patients. References 1. Coles J, et al: Gender equity mission of the Wonca working party for 10. Support members of the WP to showcase the ways women and family medicine. Asia Pacific Family Medicine 2007, 6(1):1-8. in which their practice and research contribute to the 2. Organisation for Economic Co-operation and Development: Society at a care of women patients, by sharing these in the group Glance: Asia Pacific Edition 2009. OECD/Korea Policy Centre 2009. 3. Levitt C, et al: Working Party Seeks to Enhance Role Of Women Family and presenting related work in Wonca meetings. Doctors in Wonca and Health Systems. Wonca News 2006, 32(3):4-6. 11. Ensure that our website, list serve, meetings and 4. Wainer J, et al: Predicting Supply and Demand for General Practice all communications are effective and inclusive, serving Training. Monash institute for Health Sciences Research: Monash University, Melbourne 2008. the purpose for which the WWP has been set up, and 5. Levitt C, et al: Women Physicians and Family Medicine Monograph/ progressing this vision by celebrating the work we are Literature Review. Wonca Working Party on Women and Family Medicine: doing. Orlando, Florida 2008. 6. McDonald M, Wainer J, Spike N: Towards best practice delivery: Meeting the 12. Provide mentorship to others within the group as needs of female registrars within the VMA 2006. requested, specifically the younger participants whose 7. 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Create a prize for recognition of the work done by 12. Clearihan L, Coles J: Women’s contribution to general practice: Medusa a family physician who has embodied the issues of gen- or Mother Theresa?. Medical Journal of Australia 2008, 189(2):122-124. der and equity for women in their clinical and academic 13. Candib L: Medicine and the Family: A feminist perspective. New York: Basic Books 1995. practice, and getting this awarded by Wonca as a high 14. Roter D, Hall J: Physician gender and patient-centred communication: A profile event. critical review of empirical research. Annual Review of Public Health 2004, 15. Convene a WWPWFM meeting in 2009 to ensure 79(2):497-519. 15. Henderson J, Weisman C: Physician gender effects on preventive that the activities of the WWPWFM continue - to screening and counseling. Medical Care 2001, 39(12):1281-1292. review the vision, objectives, action plan, and to plan for 16. Berthold B, et al: Physician gender is associated with the quality of the the preconference and ‘women’s track’ in Cancun 2010. type 2 diabetes care. Journal of Internal Medicine 2008, 264(4):340-350. 16. Continue to secure and distribute bursaries for tra- doi:10.1186/1447-056X-9-1 vel to maximum effect, using the budget in an equitable Cite this article as: Coles et al.: Making the 2007-2010 Action Plan work for women in family medicine in the Asia Pacific. Asia Pacific Family fashion. Medicine 2010 9:1. Author details 1 2 Department of General Practice, Monash University, Australia. School of General Practice, Rural and Indigenous Health, Head, Rural Clinical School, Publish with Bio Med Central and every Australian National University, Australia. School of Medicine Health Policy scientist can read your work free of charge and Practice, University of East Anglia, UK. Gender and Medicine Research "BioMed Central will be the most significant development for Unit, Faculty of Medicine, Nursing and Health Sciences, Monash University, disseminating the results of biomedical researc h in our lifetime." Australia. Department of Planning and Development/Family and Community Medicine, University of the Philippines, Manila, Philippines. Sir Paul Nurse, Cancer Research UK Faculty Affairs Unit, Northern Ontario School of Medicine, Canada. Your research papers will be: available free of charge to the entire biomedical community Authors’ contributions JC workshop facilitator, analysis transcripts from workshop and principal peer reviewed and published immediately upon acceptance author. cited in PubMed and archived on PubMed Central AB workshop facilitator, critique and ordering of final manuscript. 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Asia Pacific Family Medicine – Springer Journals
Published: Jan 7, 2010
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