Written by Carolyn Rasmussen, Independent Scholar
At the beginning of the 20th century, almost all Australian women had full citizenship rights and access to secondary and higher education, provided they (or their families) had the financial means to attend school or university. The women who had led the campaigns and battles to achieve these rights were still active and inspirational for a younger group of women beginning to savour the new possibilities. These rights in themselves, however, conferred little economic power. Women, when they were in the workforce, were paid considerably less than men, in line with the prevailing assumption, enshrined in the Harvester Judgment of 1907, that the basic male wage should include a component for a dependent wife and children. While this judgement undoubtedly freed many working-class women from the drudgery of low-skilled work and allowed them to care better for their families, it condemned single, independent women to harsh stringencies. For middle-class women seeking entry to the profession of medicine, however, the issue was not so much lower wages as entrenched resistance from the male guardians of its privileges, practices and institutions.
Women seeking to enter the professions, especially medicine, challenged a deeply conservative view of the social and economic order and of the roles and abilities of women. The men guarding access sought to control entry as fiercely and stubbornly as any guild of skilled artisans. In such conditions, almost any woman seeking to become a doctor was, until well into the 20th century, of necessity, a leader. Or more precisely, she was a pioneer in a long, drawn-out battle to gain access to all areas and levels of the profession, and even now the fight is not fully over. While some of these pioneers took advantage of gaps in service provision to make satisfying careers of great public utility, the battles to achieve genuine equality of opportunity often blunted or diverted the energy of highly talented and energetic women- energy that might otherwise have been applied to developing the profession of medicine itself. Only when women were securely entrenched in a particular area of medicine could they apply the equivalent drive of their male colleagues to developments beyond normal, everyday medicine.
Paradoxically, the social and institutional obstacles placed in the way of women in the early years ensured that they would make some sort of mark in the world, disproportionate to their numbers. Those women who completed medical training at university were usually among the top performers in their class, and exceptionally determined. As pioneers they had to be. It was not a path for the faint-hearted, or for the struggling student. Then there was the challenge of securing the essential hospital training to be fully professionally accredited and, beyond that, to become a specialist. Most were acutely conscious of multiple responsibilities- to their patients, to their profession and to women generally in their quest for access to all areas of medical and surgical practice. They found multiple ways around the obstacles in their path and, in the process, pioneered new forms of medical service provision, especially in the area of women and children's health, and public health more generally, before gradually penetrating the full range of specialities.
In retrospect, the first groups of women doctors broke down the overt barriers to their entry to the profession quite quickly; it was the more subtle and covert barriers that proved more tenacious. So it is that, over the century, the pioneering or 'transformational' style of leadership remained a necessity in some areas, while, in others, women were able to develop leadership or management styles appropriate to advancing the profession, particular areas of medicine or public health, or administering aspects of the health care system.
Becoming a doctor at the turn of the 20th century in Australia was not easy. A degree in medicine was the longest and, in terms of fees and income foregone, the most expensive course available at a university. And such a degree could only be undertaken at the universities in Melbourne (since 1862), Sydney (since 1882) or Adelaide (since 1874). Entry to university required matriculation, but only a handful of schools, most of them fee-paying, offered a full course to that level. The course was challenging, and the expectations high. The young men whose families supported them along this road felt very entitled to the income, personal autonomy and social power associated with membership of a profession that closely guarded the entrance to its ranks. Of necessity they were usually from the wealthier classes, above average academically, and inclined to be socially conservative.
Though medicine has a long history, the medical profession was still in the process of consolidating its modern form. Over the course of the 19th century, new institutions and formal mechanisms for training doctors and regulating medical practice had been gradually created. A key development in the United Kingdom, with a natural flow through to the colonies in Australia, was the passage of the Medical Act of 1858, which established the Medical Register, a public list of all recognised practitioners. Over the same period of time, doctors had also largely succeeded in establishing medicine as a body of scientific knowledge and practice of unique social utility over and beyond its potential benefits to individuals receiving treatment. Major developments in the scientific basis of medicine and in clinical practice- not the least being anaesthesia and asepsis- led to improved outcomes for patients that, in turn, greatly enhanced the reputation, incomes and social power of doctors generally. Women were not formally excluded from the register, but the prevailing assumption was that doctors were and should be male.
These developments in medical practice were synonymous with modernity and progress-ideas that also encompassed greater access for girls to higher education and to participation in public life. In Australia, girls won admission to university in the 1880s, but the medical schools balked. A host of objections, ranging from the impropriety of young woman looking at naked male cadavers to insufficient physical and mental stamina to undertake surgery, collapsed in Australia in the face of a few very determined young woman, but gaining the right to study in the medical school was only the beginning of a long road with obstacles encountered at nearly every turn. Nevertheless, to the extent that women overcame these obstacles they have been publicly recognised and honoured almost disproportionately to their numbers practising medicine- at least until the last third of the century. The reasons for this lay partly in the women themselves and partly in the nature of the medical profession and its place in Australian society.
Until recently, 'leadership' has received little explicit attention within the medical profession.1 Until well into the century, all doctors comfortably assumed a mantle of leadership and authority, derived from their social position, their acquired expertise and a code of ethics that involved a duty to serve whenever and wherever it was required. In the contemporary context, much of the proliferating literature on 'leadership' is, at base, more about attracting doctors into the management of the highly bureaucratised and audited systems within which much health care is now delivered than considering the kind of transformational leadership that leaves a sufficiently significant legacy for individuals to be celebrated and remembered by posterity.
Current discussions, which speak of 'doctors at the helm of change' and express dissatisfaction that 'the individual orientation that doctors were trained for does not fit with the demands of current healthcare systems' (Chadi), ignore or oversimplify the developments in medical practice, public health services and the place of doctors within institutions that challenged and exercised many of them in the early years of the 20th century-and called for 'leaders'. It certainly overlooks a great number of doctors- men and women- from earlier periods who can deservedly be labelled 'transformational'. Such leaders, however, do not necessarily fit easily into the management paradigms that underlie much of the current discussion of leaders in medicine.
Transformational or charismatic leaders see opportunities, take risks and demonstrate persistence and courage in the face of strong opposition. They are able to 'cope with change … set direction … align people to participate in that new direction' and motivate others.2 Given that advocacy on behalf of patients and an ethical responsibility to speak out on health issues in public is intrinsic to the practice of medicine, a certain level of leadership is automatically expected of doctors, and so, to some extent, the characteristics of leadership are reinforced in their training- if implicitly. Only recently has 'leadership' begun to be included formally in the medical curriculum. For much of the 20th century, the extent to which individual doctors became significant leaders, honoured by their peers and posterity, depended more on opportunity and personality than training. With the benefit of hindsight, it is possible to make assumptions about personality on the strength of achievement. The actions and achievements of leaders in the profession speak for themselves, even when they themselves were reticent or modest, or the personal record is sparse.
While the practices and assumptions of medicine at the beginning of the 20th century were undoubtedly coded 'male', women doctors could not be denied the natural authority that went with their social ranking and their qualifications. Furthermore, as long as their numbers remained few, they constituted little real threat to the established order, either within the profession or in the community generally. Indeed, they might well fill in some gaps where men preferred not to practise. So, given the barriers and level of resistance to women entering the profession, those women who succeeded in the first half of the 20th century were exceptional and, almost by definition, possessed what Jay Conger and J.N. Kanungo found was the 'unique characteristic' of charismatic or transformational leaders- a 'desire to challenge the status quo and to act as reformers or agents of radical reform' (Conger & Kanungo, 1998, 121).
In late December 1910, the influential Argus journalist Vesta, in her column 'Women to Women', declared that 'the natural leaders of women … are women. And already we have amongst us a very considerable body of women who are acting as leaders of more or less large groups of their own sex'. These women, Vesta noted, 'have been forced to the front so often that they have gained confidence in themselves'. Vesta approved this response to 'what they have regarded as the call of duty', but above all, she argued, if women were to 'wield their power rightly', they must be 'guided and controlled by knowledge' (21 December, 15). Twenty-five years later, this long-standing advocate of 'intellectual training for women' could look back with satisfaction on the number of distinguished university graduates- foremost among them doctors- who had led the way in developing new health services, especially for women and children (23 January 1935, 13). These women had taken up Vesta's challenge to be leaders of and for women.
Leadership in medicine generally can be exercised across a range of areas: institution building, clinical practice (surgery, internal medicine (physiology), pathology), research, public health, administration, teaching and development of the profession. A survey of entries on women doctors in the Australian Dictionary of Biography (ADB) born in the last half of the 19th century reveals an extraordinary range of engagement across all of these areas, often by the same person. Undoubtedly these women were pioneers, and have been honoured as such, but an emphasis on being the 'first' can undervalue the extent to which many of these women were 'leaders' in a broader sense- and would have been in any context. Pioneers display some of the characteristics of transformational leaders. They see opportunities and they take risks to blaze trails, but leaders bring others along with them and help to build new institutions or innovative practices and consolidate the newly revealed opportunities.
Women doctors, living embodiments of challenge to the status quo, combined a dual commitment to the practice of medicine and the enlargement of opportunities for other women to follow in their footsteps. They also understood that they were initiating changes that could not be fully effected in a single generation. The contemporary concern that poor women and children should have more access to doctors, and women doctors in particular, allowed a space for them to train and practise where male doctors did not already have a strong foothold. As Hutton Neve neatly summed it up: 'Here was an untouched field of vital importance which women doctors alone could handle: and by their tact, sympathetic understanding and clear explanations they performed invaluable service'(Hutton Neve, 38). And, since philanthropy was viewed as the natural province of middle-class women, this element in the provision of medical care 'worked well to draw attention away from the fundamental subversiveness of all-woman or women-only enterprises', and dampen lingering objections to the very idea of women doctors (Bashford, 1997, 207, 209). The clustering of women doctors in this area can be construed as a form of ghettoisation forced on them by the intransigence of a male-dominated profession but, for the women at the time, it was not only an area in which many of them actively chose to work (Bashford, 1998, 222; Hutton Neve, 37.), it also functioned as a strategic beach head from which they could gradually develop the resources to make inroads into other areas of medicine, while developing and participating in new areas of practice. As Rosemary Pringle observes, even at the end of the 20th century:
'Where jobs are of relatively low status, or not of interest to men, and where there are also staff shortages, new lines of career development may open up for women. Before formal training programs are set in place, it is often possible to walk into positions at short notice, to work without formal training, and to have a hand in shaping new occupational identities (Pringle, 128).'
Situations where there are considerable obstacles call for 'leaders'- people who are 'adept at perceiving not only environmental opportunities but also obstacles that stand in the way' (Conger & Kanungo, 1998, 121). Leaders can make the most of those opportunities, rather than founder on the obstacles. The history of women in medicine in 20th-century Australia is a tribute to the singular number of women who demonstrated this capacity.
While a duty to offer treatment irrespective of capacity to pay and public advocacy are inherent in the ideals of the medical profession, the philanthropic underpinning of women's work in medicine remained especially significant until well into the 20th century. It helps explain the disproportionately large number of women who worked in medical missions in outback Australia, India and other parts of the British Empire (Bashford, 1998, 223), and who sought with great courage and dexterity to find ways to serve on the front lines during World War I. Back home, the coincidence of philanthropic and professional needs led to institution building. The Queen Victoria Hospital, founded in 1896 in Melbourne by eleven women doctors lead by Dr Constance Stone, provides a singular example of transformational and strategically acute leadership.
Forced to study overseas, Stone gained experience in the New Hospital for Women (later the Elizabeth Garrett Anderson Hospital-named for its founder) in London. This lit a spark of ambition to found a similar institution in Melbourne that burst into full flame when she found, first, that private practice bored her, second, that there was a huge unmet need for services to indigent women and, finally, that women doctors desired such a hospital to further facilitate their training and subsequent practice, even though the general hospitals were no longer formally closed to them. This was a project that demanded fund-raising and management skills as much as medical expertise. First Stone hosted the meetings that led to the formation of the Victorian Medical Women's Society, an important milestone in the professional development of women doctors, then worked closely with prominent suffragist Annette Bear Crawford to develop an ingenious fund-raising campaign to build a hospital. The vision, and its subsequent achievement, were attributed by all to the 'inspired leadership' of Constance Stone (ADB; Hutton Neve, 37-38).
A similar hospital was not founded in Sydney until 1922, perhaps because greater resistance to the appointment of women doctors to public hospitals forced them to move to Melbourne, Adelaide or Brisbane to complete their hospital experience (Hutton Neve, chs 13, 14). The Sydney Medical Mission, conceived by Dr Julie Carlile-Thomas (later Fox), who enlisted the financial support of Mrs Hugh Dixson and then gathered about her a large group of volunteer helpers, had served the charitable functions of the Queen Victoria Hospital, but Carlile-Thomas withdrew when she married in 1903 and the mission closed in 1917 as the number of volunteers dwindled (Hutton Neve, 109-110, 141, 103-108). Then Dr Lucy Gullett (ADB), one of a younger generation of doctors, emerged as the transformational leader who quickly garnered enough resources (including her own) to establish the New Hospital for Women, which opened in January 1922. Renamed the Rachel Forster Hospital when it moved to Redfern in 1925, it proved as necessary and as successful as its Victorian counterpart (Hutton Neve, 109-114). Like Constance Stone, the kindly, gregarious but decisive Gullett also founded a professional body, the Association of Registered Medical Women in 1921, and remained involved in the development of the hospital until her death in 1949.
Another area of significant leadership by women doctors flowed naturally from their engagement with the health of women and children, their ready perception of evident need and dogged determination to implement reform. A significant group of early medical graduates including Ida Halley (ADB), Jean Grieg (ADB), Mary Booth (ADB), Roberta Jull (ADB, MacKinnon, 1997, 106-108), Eleanor Bourne (ADB) and Ida Bell Broderick (Matthews) (Matthews, Age, 11 July 2011) pioneered health services for school children in all the states of Australia (Bashford, 1997, 216). Others, like Margaret Harper (ADB; Bashford, 1997, 216), Hilda Kincaid (ADB), Isabella Younger Ross (ADB; Hutton Neve, 127-130), Vera Scantlebury Brown (ADB; Hutton Neve, 123-125; Sheard, 90-104), Phyllis Cilento (ADB; MacKinnon, 1986), Doris Officer (ADB), Eleanor Stang (ADB) and Grace Cuthbert Browne (ADB) focused their attention on infant welfare and child care, and yet another group, including Gertrude Mead (ADB) and Constance D'Arcy (ADB) worked to improve and advance the nursing profession. Grace Boelke (ADB) and Ethel Osborne (ADB) made early forays into industrial health for women. All of these activities required the characteristics of transformational leadership- an ability to visualise the essential lines of the required new services, and then to set about implementing them with the right mix of tact, forthrightness and determination that ensured success.
Many of these women doctors revealed a talent for administration, financial management and political advocacy far beyond that required of an average doctor. The narrow gate through which they had passed to achieve their qualifications apparently ensured that they were by most measures unusually talented. Nowhere is this more obvious than in the difficulty of assigning any of these early women doctors to one area of activity. Leadership came easily to them wherever they saw a need. Helen Mayo (ADB) might stand as an example of their range and reach. The second graduate in medicine from the University of Adelaide, after varied experience overseas she set up in private practice, combining midwifery with the medical problems of women and children while also acting as honorary anaesthetist at the Adelaide Children's Hospital. In 1911, she was appointed clinical bacteriologist at the Adelaide hospital, where she established the vaccine department, and submitted her findings on biological therapy for the award of MD in 1926- the first granted to a woman in Adelaide. Previously, she had published an influential paper on infant mortality calling for a range of measures to improve ante-natal and post-natal care. She worked to see the implementation of these measures in institutions such as the School for Mothers' Institute and Baby Health Centre in 1927, which grew into the state-wide Mothers and Babies Health Association. Mayo remained honorary chief medical officer until her death in 1967, actively engaged in bringing to the attention of doctors and nurses the latest developments in birth control, gynaecology and children's welfare.
In 1913, in close collaboration with social worker Harriet Stirling, and against some opposition, she also opened a small hospital for babies. Though it was taken over by the government for financial reasons, Mayo dominated its policy formation and development until 1947, ensuring that the hospital was at the forefront of assessing and implementing new methods in infant feeding and the prevention of cross-infection. During the four decades when Mayo was most active, infant mortality in South Australia fell by 60 per cent- ample evidence of the need for work such as hers.
During World War I, Mayo had acted as a demonstrator in pathology at the University of Adelaide and, from 1926-1934, she was clinical lecturer in medical diseases of children while also working as a physician at the Children's Hospital. During World War II, she came out of retirement to organise the Red Cross donor transfusion service and instruction in infant feeding. Mayo was also active in the development of the profession through bodies such as the Australasian College of Physicians and the Australian Paediatric Association, and for twenty years sat on the State Advisory Committee on Health and Medical Services. Clearly, Mayo made a notable contribution in every possible avenue for leadership open to a doctor: institution building, clinical practice, research, public health, administration, teaching and development of the profession.
Mayo also accepted the imperative to lead, not just within her profession, but with regard to women in general. In 1914, she was elected to the University of Adelaide Council- the first woman in Australia- where she remained until 1960. She helped found St Ann's University College for Women, was the first president of the Lyceum Club, and later presided over the Australian Federation of University Women. In 1909, she was among the founders of the Women's Non-Party Political Association. Like so many of the early doctors, Mayo was appointed an OBE, due recognition, even celebration, of her leadership at the time.
The sad ravages of World War I opened up some new opportunities for women entering the medical profession but a good number of the newly opened doors soon closed again- even in areas like children's health, where outstanding women doctors like Annie Jean Macnamara (ADB) and Kate Campbell (ADB) had strong claims.3 Even so, women like Naomi Wing (AWR), rheumatologist and leader in the development of rehabilitation medicine,4 were keenly conscious of progress. As an undergraduate in the 1920s in Sydney, she recalled how much she had learnt from the pioneers who were still active, and felt the role of woman in the profession was well established.
'We had no problems in obtaining hospital appointments … I personally have never asked privileges from my male colleagues, but I have always been accepted as an equal, not only in my profession but also on the many associated committees of the organisations involved in Medicine (Hutton Neve, 7).'
Wing's view was rather rosy. Women doctors remained largely confined to women and children's health, general practice and emerging areas such as rehabilitation. If anything, the pressures on women to concentrate in these areas were more powerful than ever.5 Significant barriers and restrictions in general medicine, especially at senior levels, remained at nearly every turn, while the feminist imperatives that had activated many of the early graduates weakened in the face of the rise of maternalism as a dominant discourse between the two world wars, and for some time after. Women doctors were, as Bashford points out, largely co-opted by this set of ideas in which women were defined as 'mothers in an all-encompassing way', enveloping all aspects of their lives, 'not simply childbirth itself'. This newly elevated 'motherhood' was also increasingly constructed as 'scientific', thus enhancing the possibility of representing women doctors as 'even more effective scientific mothers' (Bashford, 1997, 212, 215 and 214).
It would be a mistake however, to see this concentration of women doctors in women's health as entirely regressive. As Mackinnon has pointed out, inherent in the actual practice of medicine in this area was a subtle but ultimately effective 'critique of state and society. While rational motherhood often legitimated women's domestication, it also provided the rationale for smaller families, a new career structure for professional women, and improved a woman's power to negotiate within marriage' (Mackinnon, 1997, 111). Nowhere was this clearer than in the development of family planning services, and the demonstration effect of larger numbers of women occupying professional and managerial positions.
Drawn mostly from the conservative ranks of Australian society, and rather more inclined than other professional women to marry and have children of their own, many women doctors felt less need to niggle and scratch at the male-dominated areas of medicine when a challenging enough career was available in women and children's health. The activities within the women's hospitals soon extended well beyond gynaecology and obstetrics. Opportunities to exert leadership in clinical practice and medical research within the broadening fields of maternal and child health proliferated. By the 1940s, a number of women had emerged as significant leaders in paediatric medicine, including Charlotte Anderson (ADB; Yule, 324-326), whose ground-breaking research into cystic fibrosis eventually led to her appointment as professor of paediatrics and child health at the University of Birmingham in the United Kingdom, and Elizabeth Turner,6 the first woman appointed medical superintendent at the Children's Hospital, where she was involved in a number of significant 'firsts' such as obtaining penicillin to treat osteomyelitis in a young boy before it was available for civilian use, and the performance of exchange transfusions in Rh- babies. Margaret McClelland (AWR) rose to the position of director of anaesthetics at the same hospital.
Several women doctors also emerged as world leaders in research into treatment and management of childhood afflictions such as polio and cerebral palsy. Indeed, a quartet of women who graduated from the University of Melbourne in 1922-Annie Jean Macnamara (medical scientist) (ADB), Kate Campbell (paediatrician) (Campbell; ADB), Lucy Bryce (haematologist) (ADB) and Jean Littlejohn (an ear, nose and throat specialist) (AWR), the first two of which were honoured with damehoods-would all assume significant leadership roles within their profession and the wider community. Another to lead in this area was Claudia Bradley (orthopaedist) (ADB), while Clara Geroe (ADB) made an important contribution to the development of psychiatry in Australia after her arrival from Hungary in 1940, and Ida Mann (AWR) brought ophthalmology services to Indigenous communities and PNG after her arrival from England in 1949.
The women doctors born between the wars fit much the same mould as their predecessors. Their numbers were still few and the barriers to promotion and senior leadership roles across the full range of medical specialities remained formidable, not the least being the difficult choice between a full medical career and raising a family in a society where even many woman doctors frowned on working mothers. As Kate Campbell put it as late as 1982, 'I think that women have to pay for the joy of children by not being able to do other things' (Campbell, 170).
Even so, there was a change in the tone and style of some leaders from this group. A revitalised feminist perspective is discernible- and a stronger push into a wider range of medical specialities. As Pringle has observed, while the existence of diversity within medical practice had served to lock women into more marginal positions, it had also 'created choices and opportunities. Ironically, it was as medicine became less holistic and more specialised that women were able to colonise at least some parts of it' (Pringle, 133.) In terms of public prominence though, with some notable exceptions such as Joyce Daws (thoracic surgery) (AWR), Lena McEwan (plastic surgery), Priscilla Kincaid-Smith (nephrologist) (AWR) and Shirley Dallas (radiology) (Fabrikant, Age, 28 November 2011), the leaders were still clustered in women and children's health, including Marie Bashir (psychiatry and later governor of New South Wales)7 and Dorothy (Jean) Hailes (older women's health) (ADB).
By the 1960s, the experience of a number of women doctors who were reaching positions of influence dove-tailed with that of younger generation doctors, such as Judith Lumley (epidemiologist and public health physician),8 who chafed harder against the social and professional impediments to their progress- and the assumption that they must choose between family and a high-flying career. They also contributed to a renewed critique of male medical and scientific practice that would find fuller expression among an even younger cohort influenced by the discourses of second-wave feminism. Jean Hailes was especially concerned to confront 'myths' about women's health and extend their control over their fertility and general health. 'Her emphasis on autonomy was shared with the feminist movement's concurrent campaign to establish women's health services' (ADB).
By the 1970s, women were studying medicine in roughly equal numbers to men and the social prohibitions on female ambition had weakened, opening up a larger space for women doctors to seek and assume leadership. At the same time, women's health became a new area of radical activity and contested authority, in ways reminiscent of the intersection of feminist politics, professional development and institution building that characterised the early years of the entry of the women into the profession. As Pringle sums it up:
'There is the heroic past, when they played a key part in the history of feminism, scaling the heights of patriarchal power to gain entry to the profession, enduring ridicule and hostility from male doctors and medical students. And then there is the present, when women doctors in the main, are seen as a conservative group with little sympathy for feminist causes.'
One powerful element in second-wave feminism was deeply wary of 'professionals' and 'experts' and of the very concept of 'leader'. Within this view, women doctors were seen at best as still exploited and oppressed within the profession, or worse, the more successful ones especially, were assumed to be complicit in patriarchal subjugation of women and their bodies (Pringle, 1). Such a view was strongest in the women's health movement, which held that doctors should hold no special authority above other women or other forms of knowledge. Thus, young women entering the profession from the 1970s were caught in the tension between achievement in a deeply hierarchical profession that was still quite hostile to their presence, though less overtly so, and the powerful new feminist discourse that had put added force into their claims for equality and access to leadership roles.
An important element in feminist discourse throughout the whole period centred on whether female leadership styles were different from those of men. At the level of 'transformational' leadership, gender seems of little consequence. Such people are recognised and celebrated as such but, in other areas of the profession, the arrival of larger numbers of women and the changing nature of medicine itself suits the collaborative, distributed style of leadership with which women have usually been more comfortable. Notwithstanding the dilemmas presented to young women doctors by second-wave feminism, their presence in larger numbers has of itself modified the pressures to become what was, it should be acknowledged, close to a caricature image of the steely, aloof, arrogant, highly individualist male doctor. Women are still not present in equal numbers across all areas of the profession, but the reasons are more structural than a result of active discrimination. Their presence in such high numbers in urban general practice especially-54.4 per cent of women practitioners in 1994, comprising 30.9 per cent of the total medical workforce reflects the great length of time it takes to become a specialist, the compatibility of general practice with marriage and family, and the preference of many women doctors for the on-going patient relationships that are a feature of primary care.
In the complex modern hospital environment, constrained by burgeoning costs, where medicine is more often delivered by diverse teams than by a single physician or surgeon, leadership development workshops have become commonplace. The 'more modern and inclusive concept of leadership' is now the actively encouraged model of medical management.10 It is a development that women doctors, through bodies such as the Australian Federation of Medical Women (AFMW), support and work actively to develop. Women doctors are also spearheading the moves to modify the punishing time demands on doctors- male and female (Pringle, 10-13), improvements in communication between doctors and their patients, and a more holistic approach to their care. Indeed, the AFMW argues explicitly that the 'feminising' of medical training has 'the potential to bring significant benefits to all medical students, doctors and their future patients' (Tomlinson, 4). In this context, though, it is less easy to discern 'leaders' from the outside, however highly esteemed they might be by their peers. Some are concerned that such a model of leadership might serve to mask continued discrimination against women in exercising their full potential. As Yadidia and Bickel suggested in 2001, 'the persistent scarcity of women in leadership positions is a national concern, and raises questions about women's access to effective mentors, career development opportunities, and a work environment that is free of gender bias' (Yadidia & Bickel, 453). It seems that the need for at least some women doctors to adopt the heroic leadership model in order to push forward into the areas of medicine, such as surgery, that are still relatively closed to women has not diminished. And, as in the past, the exacting standards required for admission to medical school ensure that at least some of each cohort will have the necessary intellectual and personal qualities to emerge as transformational leaders.
For all the talk of collaborative team work, distributed leadership and conformity to bureaucratic hospital management systems, medicine has a propensity to call forth heroic effort. In the last third of the 20th century, women doctors have continued to build institutions and pursue significant lines of research, though it is instructive of the distance still to be travelled that the focus remains heavily on women and children's health. To name only a few: Helen O'Connell (AWR), the first Australian woman to complete urology training, carried out ground-breaking research on female anatomy; Susan Beal (AWR) was a major contributor to both the research and public awareness campaigns that almost halved the incidence of Sudden Infant Death Syndrome (SIDS) after the mid-1980s; and Caroline Crowther,11 professor of obstetrics and gynaecology at the University of Adelaide, is a world leader in the management of maternal and peri-natal health. As institution builders, two women stood out as the century drew to a close. Professor Fiona Stanley,12 epidemiologist and founding director of the Telethon Institute for Child Health Research in Perth, and Professor Fiona Wood,13 plastic surgeon and inventor of patented spray-on skin, is clinical professor in the School of Paediatrics and Child Health at the University of Western Australia, director of the world-renowned Burns Unit at the Royal Perth Hospital and director of the McComb Research Foundation.
A certain level of challenge to the status quo was almost encoded into the idea of being a woman doctor from the very first moment women entered medical school. The high demands of training and practice, combined with the class background of many, allowed them to assume positions of significant leadership in effecting change in the way health services were delivered and to whom, and in the development of public health in Australia. They were able to challenge existing practices, set direction, inspire others to follow their lead and translate their ideals and opportunities into concrete reality. The history of medicine in Australia in the 20th century is immeasurably enriched by the contribution of all women doctors, but especially by the technically brilliant, courageous, persistent and inspirational leaders who devoted themselves to clinical research and strengthening the profession, built new institutions, pioneered the implementation of wide-ranging public health measures and demonstrated with ever greater force to each succeeding generation that women were more than fit to be doctors.
- S. Bruce Dowton, 'Leadership in Medicine: Where Are the Leaders?', Medical Journal of Australia 181, no. 11/12 (6/20 December 2004): 652-654. On p. 652, he notes that in a survey of articles indexed over thirty years in five Australian journals he could find barely fifty articles-and very few of them provide commentary on the 'making of leadership'. And the eMJA did not even index 'leadership'. Return to text
- J.P. Kotter, What Leaders Really Do (Boston: Harvard Business School Press, 1999), summarised in Thomas Alserius, 'Leadership in the Medical Profession: A Subjective Analysis by Personal Experience', Frontiers in Leadership Research 5 poäng, Examensarbete, Vårterminen 2008. [Institutionen för Lärande, Informatik, Management och Etik (LIME), p. Ii. See also, Peter Spurgeon, http://www.fishpond.com.au/Books/Medical-Leadership-Peter-Spurgeon-John-Clark/9781846192463. Return to text
- For a discussion of early women doctors at the Children's Hospital in Melbourne, see Peter Yule, The Royal Children's Hospital: A History of Faith, Science and Love (Melbourne: Halstead Press, 1999), 118-123 & 232-235.Return to text
- The Rehabilitation Centre at the Royal South Sydney Hospital was named in her honour in 1976. Return to text
- Penny Russell argues that a pervasive ideology of motherhood and race survival was significant in the success of the first generation of women doctors, but it seems to have become more overt as women doctors become more numerous. Penny Russell, '"Mothers of the Race": A Study of the First Thirty Women Medical Graduates from the University of Melbourne', BA Hons Thesis, Monash University, 1982. Return to text
- www.racp.edu.au/page/library/college-roll/college-roll-detail&id=567; Yule, The Royal Children's Hospital, 288. Return to text
- http://en.wikipedia.org/wiki/Marie_Bashir. Return to text
- http://www.eoas.info/biogs/P004287b.htm; Judith Lumley, 'Woman Confined', in, The Half-Open Door: Sixteen Modern Australian Women Look at Professional Life and Achievement, eds Patricia Grimshaw & Lynne Strahan (Sydney: Hale & Iremonger, 1982), 328-344. Return to text
- Australian Medical Workforce Advisory Committee, Australian Institute of Health and Welfare, Female Participation in the Australian Medical Workforce, September 1996: 9. It is noteworthy that of this 30.9%, 65.5% were working part-time and 83% were working in a capital city. In 1994, only 14% of specialists were female, and only 3.1% of them were surgeons. The common assumption at present that women do medicine differently and better because of inherent female characteristics is potentially a trap. As Pringle observes in Sex and Medicine: 'it may come to restrict then as surely as the injunction to be "lady-like" restricted earlier generations'. Return to text
- Peter Spurgeon, Bob Klaber, Matt Green, 'Becoming a Better Medical Leader', 31 January 2012. Return to text
- health.adelaide.edu.au/og/people/crowtherc.html. Return to text
- www.ichr.uwa.edu.au/people/fiona_stanley; A conversation with Professor Fiona Stanley, http://www.nhmrc.gov.au/media/podcasts/2009/conversation-… Return to text
- http://en.wikipedia.org/wiki/Fiona_Wood. Return to text
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