A Melting Iceberg Sinks More than the Titanic

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Photo Source: https://thelittleislandthatcould.com/2014/01/15/kiribati-and-what-theyre-doing-about-climate-change/

Josh Druery reflects on #auspol’s abysmal year on climate change, reminding us of the sobering reality of rising temperatures for small island nations like Kiribati.

The rise of One Nation has been a frightening, surprising and simultaneously entertaining development for Australian politics. Already Pauline Hanson has refused to partake of the Halal Snack Pack with Sam Dastyari and has slammed the ATO for installing squatting toilets as part of an inclusive workplace (despite Squatty Potty’s assertion that squatting actually helps relax the puborectalis muscle while you do your business – but I digress). Worryingly, Hanson has also recently called for the complete ban on Muslim immigration to Australia, a call for a regression to the White Australia policy that blighted our nation’s history over 100 years ago.

Malcolm Roberts, another of the four senators elected under the One Nation banner, has been making headlines of his own. On an August episode of “Q and A” Roberts more or less dismissed over 2000 reports of abuse in Nauru’s offshore detention centre because Hanson talked to a single security guard that used to work there. He also spent the majority of that program arguing that climate change was a myth fabricated by the UN and NASA. Roberts would not even be assuaged after distinguished scientist Brian Cox pulled out two graphs and a report from the Australian Academy of Science – he needed to be shown “the empirical data”.

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Picture: Courtesy ABC/Q&ASource:ABC

While climate change skepticism is thankfully becoming a rarity among mainstream media, government policy is nowhere close to reflecting the depth of the problem we face as an international community. Part of the problem with the climate change debate is that it’s an inaccessible discussion for most people. It’s clear that many politicians also can’t see the relevance of these environmental changes. The Lancet has published two commissions on climate change and its impact on health to address this particular problem and put a human face on an often complicated science, informing both medical professionals and politicians in order to drive a more effective policy change.

One change that has become evident with a rise in global temperatures is an increase in the frequency, severity and duration of heatwaves worldwide. The less a country is prepared for a heatwave the more people it can affect, most often causing fatalities among the elderly. Somewhat less intuitively is the link between climate change and ocean acidification – both contribute to a reduction in agricultural produce as well as fishing. This increases the price and availability of food, a phenomenon known as food insecurity, and causes the greatest harm to the poorest and most vulnerable. Climate change will also increase the number of natural disasters around the world, including droughts, floods and long-term desertification in some countries. All of these factors push people out of their homes and the number of displaced people in the world will continue to increase.

To put this in perspective, the number of people who have been displaced from their homes and have nowhere safe to live is at an all-time high of 65.3 million.

Migrants moving because of environmental changes will most likely travel to poor neighbouring countries that are themselves struggling with climate change. Displacement also increases the spread of communicable diseases and malnutrition through overcrowded housing and limited access to safe food and water. Resources will no doubt be overwhelmed in these areas and access to healthcare will be little or nonexistent. Currently these environmental refugees have not been designated as “refugees” under the 1951 UN Refugee Convention and are therefore given no legal long-term protection under international law.    

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Figure from Lancet Commission: An overview of the links between greenhouse gas emissions, climate change, and health.

These trends are best explained by looking at some island nations in the Pacific as examples. Climate change is an immediate threat to Tuvalu, the average height of its islands just two metres above sea-level. It’s estimated that the island of Fongafale, which houses Tuvalu’s capital city Funafuti, will lose 20% of its land to temporary or permanent flooding by 2040. Successive Tuvaluan Prime Ministers have pleaded with the UN for action on climate change but have achieved little traction, in 2007 John Howard refused to meet with the Tuvaluan Prime Minister to discuss climate change at all. This is despite the fact that Australian institutions such as the CSIRO are currently doing climate change research alongside Tuvaluan centres. Cyclones are a semi-regular event in Tuvalu and between 1969 and 2010 a total of 33 tropical cyclones passed within 400 km of Funafuti causing flooding and storm surges that ruined crops and disturbed daily life. These cyclones are set to become less frequent but more intense with climate changes.

In addition to directly causing fatalities, large storms can also destroy fresh water supplies. Low-lying islands (atolls) such as those found in Tuvalu, Kiribati and the Republic of Marshall Islands rely on freshwater lenses, collections of freshwater that sit on top of denser seawater, for clean drinking water. When cyclones strike they can disturb these delicate freshwater lenses which take many months to recover.

A permanent loss of many water sources in Kiribati is now certain and the construction of desalination plants is one possibility the government is considering to increase its water supplies.

It’s estimated that the cost of desalination, to increase water supply by 1700kL a day in Kiribati, would be around 2.2 million USD per year between now and 2050. The funding for these plants would have to be donated by other countries as the current government is unable to afford to pay for these projects. If this funding isn’t found then all 110,000 inhabitants of Kiribati will have to consider resettlement and the country and culture of Kiribati will be all but lost.

It’s baffling that these problems are not more widely discussed in Australia given our proximity to and scientific collaboration with these nations. Climate change is often depicted as a concern of radical young people, a problem that isn’t severe or immediate. Unfortunately, this is clearly untrue. Climate change has already caused damage to many other countries but it poses little immediate threat to ours. The difficult truth in this debate is that climate change is a challenge of inequalities. Developed countries produce the overwhelming majority of greenhouse gas emissions and developing countries have to deal with the brunt of the consequences. When natural disasters hit these countries the most disenfranchised are hit the hardest. The world is not sticking up for the little guy.

To quote UN Secretary-General Ban Ki-Moon “there is no Plan B because there is no planet B”.

It’s high-time the Australian government took responsibility for the footprint that we leave and acknowledge that the problems it’s causing are enormous for other nations. In the meantime, we might chuckle at Pauline Hanson’s antics on the Australian political scene but she has real influence among the Australian public. The major parties will have to play ball with Hanson on a whole host of issues but entertaining the possibility that climate change does not exist is an inexcusable way to treat the largest global health problem of the century.

Referenced by this article and for further reading: 

 

The views and opinions expressed in this article are those of the author and do not necessarily represent those of SUMS.

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Gender pay gap: is it a thing? Yep

More women are entering medicine than ever before, and yet men are still earning a lot more money. What is the go with that? Leah Ginnivan looks at the evidence. 

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Image by the author.

According to last year’s tax returns, the average male gynaecologist/obstetrician earned $446,500 in that year. His female counterpart made $264,600, around 40% less. The average employed female GP earns about $840 less per week before tax than the average male employed GP.  

So, what’s going on? Is some guy sitting in payroll doing a heap of Ctrl + F for female names and marking their payscales down?

Sounds unlikely, hey! And yet, it’s true that female doctors earn quite a lot less than male doctors. Across the profession, this gap is currently estimated at around 17-23% *depending on the data you’re using and whether you consider employees only or people who are self-employed or run a medical business.

While these kind of statistics are eye-catching (that’s why some people put them at the beginnings of articles), they are often presented without much explanation. It turns out the reasons behind this pay gap are a complex mix of policy, culture, gender roles, and personal desires that all combine to create a lot of missing money. In this article, I’m going to step through the factors contributing to the pay gap in medicine.

Medicine certainly isn’t unique in having a large gender pay gap — pretty much every professional setting in Australia has some weird gender stuff going onIn many fields women are generally younger, working fewer hours than the men, promoted less and in more poorly-paid niches of the sector.

Yet, these factors alone fail to explain the size and persistence of the gap.

In this article, I’ll mainly be focussing on the issues that affect female doctors, though many of these are applicable to other professionals.

Firstly, though, note that this article isn’t about how much doctors should be making, or about whether being motivated primarily by money is a good thing. We know that doctors are well-compensated. The average employed GP, for instance, earned more than twice ($2618) the weekly wage of the average employee ($1182), so I am hesitant to label doctors as battlers at this point. I also want to flag this article refers mainly to male/female couples with kids, simply because that’s the kind of analysis that current data allows. We know very little about doctors of any gender who are single parents, or how queer doctor couples choose to balance work/family time.

  1. More female doctors are junior (and more junior doctors are female)

This first reason is pretty straightforward. Since 1996 female medical students are in the majority and the proportion of women in the medical workforce has been rising for some time (currently 40%) the additional female doctors are more junior (and therefore earn less).  Most doctors under 35 are women, but this proportion declines when considering older groups of doctors. The more senior, and more highly compensated, generation of doctors is predominantly male.

For instance, check out the numbers of male and female doctors by age group in 2014.

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Source: National Health Workforce Data Set: medical practitioners 2014

Many professional women will leave full-time work in their late 20s or 30s, and doctors are not an exception to this. When women take ‘time off’ under most current policies, it becomes more difficult to advance to senior positions. This is one reason that it shouldn’t be assumed gender equality will be attained solely through more women beginning med school. The hope that more senior women will undo aspects of bro-y culture can only be realised when there actually are a lot of senior women.

  1. Female doctors work fewer hours, especially if they have children, and do lots of unpaid care work

Another straightforward partial explanation for the pay gap is the number of hours worked. Male doctors worked 6.4 more hours per week than female doctors in 2015. Female doctors also work part time much more frequently than men, with about a third going part-time compared to 13% of men.

Why such indolence? Well, it’s babies, isn’t it. Babies, which many people have.  Children are very costly, and it’s women who bear both the time and pay implications of having them. For instance, female GPs with children earn $30k less per year than similar female GPs without kids, mainly due to being the primary carer for these children. Many female GPs stop working altogether, or work part-time (female GPs make up 80% of all GPs who work less than 30 hours a week.).

The implications of having children, under current policy and workplace culture, are essentially less money for women and no change (or more money) for men.

This has negative implications for women’s long-term career prospects and earnings, as well as their retirement income. It should also be noted that pregnant women also have a difficult time of it, with their commitment and ability called into question, and barriers put up on their return to work.

Across Australia, only 24% of working men took leave for more than two weeks when their partner had a baby. And male GPs with children work more hours than their childless counterparts, working an extra 328 hours and earning $45,000 more per year on average. This is called the ‘breadwinner effect’ by some economists, where men are motivated to spend less time with their families and more time making money, once they have kids.

All this adds up to the pretty gnarly reality that female GPs with kids earn 53% less than male GPs with kids.

The differences in earnings between female GPs with and without kids will persist long past the age that the children are in school and the doctor goes back to work, because they may still work less hours, and work in practices as employees rather than as bo$$es. Meanwhile, male doctors do out-of-hours work, and are more likely to own their own businesses, do consulting, and other work that makes money.

  1. Female doctors are not working in highly-paid specialties

This is another major reason why male doctors make more money.  Overall, only 25% of female doctors are specialists, compared to 41% of male doctors. By comparison, women are more evenly represented in lower-paid jobs — 42% of GPs, for instance, are women.

Surgical specialties, which are generally the most profitable, have very few women, and women also earn less in these specialties (probably mainly due to the seniority/part time issues discussed earlier). We all know that the proportion of women in surgery is ultra-low — there were 11 female cardiothoracic surgeons in Australia last year compared to 191 male ones, and overall there are nine times as many male surgeons as female ones.

The reasons as to why this is the case are often cited as an inhospitable (pun) culture of macho exclusivity, sexism, and a work environment not compatible with having a life unless you already have someone taking care of your meals, family, and life admin. It’s difficult to estimate how much this is changing in very recent years, however, as a bit of un-rigorous anecdote, a glance at my hospital’s photo board reveals that 3 out of the 30 surgical registrars are women. One in ten!

  1. Female doctors do work that isn’t rewarded by current incentives

More research has been done on GP remuneration than other medical specialties. Here, studies have shown that female GPs have longer and more complex consultations. These consultations pay less per minute than the short consultations, so female GPs earn about 6% less per hour as a result.

Female GPs also manage more social and emotional problems, provide more preventative care, and manage more psychological problems — all factors that are considered to be good care, not to mention more cost-effective for The Taxpayer.

The time/cost divide is more stark with young female GPs, who are more likely to have unbillable time where they were, for instance, arranging patient care or communicating with patients. This time would be worth between $10,000 and $23,000 per year if it was billed through Medicare, but it is instead borne disproportionately by younger and female GPs.

In primary care, moves towards capitation-based payment models (where doctors receive a fixed payment for taking care of a patient with chronic conditions for a fixed period, rather than charging them for each visit) may alter the way GPs are remunerated, potentially meaning the current underpaid additional work female GPs do is better recognised and rewarded. Yet this is far from certain.

  1. There is still an unexplained gap

After adjusting for the factors above – hours worked, specialty choice, having children, and seniority, up to half the pay gap is still unexplained (though again, estimates of this gap vary).

That is, while we know that all these things contribute, there is something more we can’t account for. For instance, In the GP study I discussed earlier, childless female GPs under 40 earned $6 less an hour than their childless male peers, while this gap widened to about $14 an hour when comparing childless older GPs.

The reasons behind the ~extra~ gap in pay in medicine are not well understood, but it’s worth noting here that the medical training system has been historically built around training and promoting male doctors. Regardless of what you consider to be innate or socialised differences between genders, it stands to reason that the qualities, skills and abilities that the broad group of individuals known as women bring may not be fully recognised by a system that wasn’t designed by them or for them.  

There is some evidence that male doctors are more confident, more prone to overestimate their competence and have fewer reservations about putting their hand up for things they aren’t qualified for, where female students shied away out of concern about doing the wrong thing. Regardless of skill, apparent confidence makes people more likely to see you as competent, which then may be reflected in more opportunities for learning and promotions.

It’s also worth noting that women who do present as ‘confident’ are often seen as being ‘full of themselves’ in a way that men are not — so telling women to be more confident is both kind of wrong from a patient safety perspective and also because it probably won’t help.

Interestingly, male doctors are twice as likely to be ‘complaint-prone’ (with more than four complaints against them) than female doctors, and surgeons are nine times more likely than GPs to be at a swirling epicentre of patient complaints. I’m not saying there’s a connection between overconfidence, machismo, and being a doctor who is ‘not good’, but I’m not not saying it, either. Just something to ponder if someone queries whether women are a good fit for surgical careers.

More generally, women are less successful in salary negotiations (even when they ask), are expected and motivated to do more caring work without expectation of monetary reward, and are considered to be less competent even when they are equally or more competent, but the extent to which these factors shape doctor income hasn’t been well-studied in Australia.

Where to from here?

There are many reasons why women earn less money as doctors. This isn’t to say that any particular female doctor can’t be absolutely making a stack of cash, if that truly is her #lifegoal, but rather that the average one earns less than her male counterpart. A large part of this phenomenon can be explained by a large proportion of women doctors taking time out from work to raise children, while male doctors do not do this, and indeed may spend less time with their family in this critical period.

And this is the next frontier in the fight for equal pay — not just in our work lives, but in our life-lives.

It’s about the way that we view gender roles, what commitment to a profession looks like, and how families make choices about who will care for whom. Parental leave policies, job-sharing, part-time training positions and less insane work hours are all good ideas, but they should be available and accessible for all genders.

Men and women report similar desires for having children (or not having children) and men and women also agree that both partners should share parenting and housework responsibilities especially if both parents work. Yet, gendered assumptions about equality persist, with some research showing male/female couples perceive an equal amount of work is being done when a male partner is contributing only a third of unpaid labour (i.e half that of his female partner).

Even the couples that most want to equally share parenting and household responsibilities have the female partner doing between 60-73% of both. Partnered women report they are doing their ‘fair share’ of childcare when they are caring for a child 67% of the time. For some people, this may well be a fair share. However, we should consider the possibility that if both partners have similar levels of education, ambition, health, and so on, then an equal partnership may involve men doing 50% or greater of the unpaid work.

I’m not here to say anyone should run their household in any particular way ¯\_(ツ)_/¯, but I assume most female medical graduates, having put in the effort of going through medical education, actually do want to be doctors, and should be supported to continue with it past the putative birth of a child.

Some people (men) have suggested that the ‘feminisation’ of the medical workforce is bad and inefficient, because it means hospitals and medical schools are having to adapt their culture and practices to the grim reality that women in heterosexual partnerships are generally less supported at home than men are, so cannot simply palm off their childrearing / life admin responsibilities to Bae.

In some ways, you can see their point: medicine is a difficult profession and it is certainly more administratively simple to hold everyone to the same crushing, 100-hour week standards and say you’re being gender-blind. However, what’s easy isn’t always right; there are many reasons to expect that a more diverse workforce will be one that’s able to respond to patient needs, but this is an argument for another day.

A lot has changed for women in medicine in recent years. The recent recognition, and condemnation, of the prevalence of disgusting, male idiots harassing their female colleagues for blow jobs was an important step. Many hospitals have pro-active policies on job-sharing. Colleges are developing policies on recruitment and retention of women. Yet it will take ongoing generations of doctors to use these policies, keep advocating and keep changing the culture to one that celebrates and promotes competent and caring medical professionals of all genders.

 

The views and opinions expressed in this article are those of the author and do not necessarily represent those of SUMS.