John Zigar, your comment about the non-efficacy of anti-hypertensive medications is misleading.

Although I certainly would like to read the results of this survey that you quoted - I have my doubts as to the accuracy of the findings. Being a survey, I doubt it was at all methodologically sound (i.e. was it randomised, double blinded or placebo controlled?) and therefore making conclusions from it is fraught with danger. Do include a link so that we may examine it in detail, though.

Hypertension is a major risk factor in the development of cardiac disease, stroke and renal disease. The statement you made about these drugs affecting your kidneys is moot, as hypertension itself induces renal vascular disease. You are probably referring to the mechanism by which these drugs act -usually by inhibiting ion pumps (namely Na-K-2Cl) or enzymes (peptidyl dipeptidase) which invariably involve the kidney. Of course these drugs affect the kidney, because that is how they act to help reduce blood pressure. I recommend reading Vander's Renal Physiology for further clarification on the matter. Once you understand the (patho)physiology behind it all, I'm sure you will agree that anti-hypertensives are the lesser of two evils.

The widely available consensus statements by the European Society of Cardiology and the American Medical Association (our MJA guidelines mirrors these quite closely) both recommend treatment of hypertension to prevent aforementioned adverse effects. This includes pharmacological treatment - something which you think does not work 80-90% of the time. If you had ever seen a persons change in blood pressure once on an ACE-inhibitor, Angiotension II antagonist or even a thiazide diuretic - making a statement like that is akin to saying 'wind don't exist 'cause I can't see it'.

In addition, this makes me wonder how accurate all your other statements are. This does show how easy it is to make someone else look foolish, particularly when the other party cannot defend his/herself. I don't claim to know what happened with you all those hundreds of times you've sought medical attention, but it makes me wonder if the man whom you consider to be an idiot felt the same way about you.

Also, you claimed in your post to be an intelligent man - but the spelling mistakes seen in your post sadly undermines your declaration. This is especially important to address if you wish to continue insinuating the superiority of your accent over another person's. Examples of your spelling errors include : abdoman pain, difficultiers, dizzyness, tirage? - maybe you meant tirade - even then the syntax is questionable, blatent, tranfer, labled and of course my favorite, jecket. Some of these appear more than once, implying a true incompetence of the written (typed?) English language.

Fixing the state of our nations health service is an important task, and by no means is it an easy one. However, there are other things that need fixing too, some of which are a little closer to home than we think.

I agree with all comments so far. Australia needs to look at those European economies where there's one government health system for all, properly managed and resourced. The billions we throw away for subsidising industries that are broke could easily be used to 'fix' our health system. I remember in the late nineties when we were warned that a severe doctor and nurse shortage was looming. 13 years later - nothing has changed.

From the MJA back in 2003:

"Feminisation of the medical workforce has been a major change over the past 20 years. The sex ratio in Australian medical schools is now 50:50, or with a slight excess of women.7 The flow-on effects of this change are particularly obvious in specialties like general practice, in which more than 50% of current trainees are female.8 Female doctors have a working life that approximates 60% that of male doctors."

https://www.mja.com.au/journal/2003/179/4/medical-workforce-issues-australia-tomorrow-s-doctors-too-few-too-far

A lot of water under the bridge since 2003. We now have more than double the number of medical schools producing more than double the number of medical graduates. We also have ongoing changes to migration of medical practitioners into Australia. Not sure whether that particular article remains relevant.

Hi Tracy, I think its still quite relevant. KPMG produced a report for the National Health Workforce Taskforce in 2009 which shows the number of health workers as a proportion of population has rmaind pretty static since then and is predicted to continue to do so, with a small increase predicted in the next 5 years.

It also makes the following comment:

"While earlier studies estimated a female doctor will work approximately 60 percent of the
productive hours of her male colleague 33 , more recent Australian research places the number at just over 80 percent (37.6 compared with 46.7 hours per week) (AIHW, 2008).34There is substantial discussion about this topic with the OECD reporting that ‘all things being equal the supply of medical services will fall if female participation in the workforce increases’.

It looks like the earlier piece may have slightly overestimated the negative impact of a feminised workforce, but is otherwise sound.

http://www.ahwo.gov.au/documents/NHWT/The%20health%20workforce%20in%20Australia%20and%20factors%20influencing%20current%20shortages.pdf

I'm not sure how this relates to the topic of the article. Are you suggesting 'feminising' of the medical workforce is somehow responsible for increased aggression and violence in our hospitals?

Hi Regan, I was responding to the post from John Zigar. If availability issues affect 50% or more of the graduates, then it is also relevant to the discussion, since it may also help explain the aggressive patients.

Basically if we're training female doctors instead of male ones we need to either train more of them, or we need to make them work considerably more and for longer working lives and perhaps where they don't necessarily want to go. I favour that approach, because otherwise we risk a situation in which part-time medical practise becomes the norm for female doctors or the male doctors become disenchanted at working harder and thus exacerbate the shortage.

I'm not having a go at women doctors, either. My own GP is a woman I regard highly. They have genuine priorities competing for their time and attention and the reports clearly show how some struggle to maintain full focus on their medical careers over their working life. Public health and education decision-makers must consider the impact of their feminised workforce as well.

OK so if I understand your premise, it's that we are producing more medical graduates but, on average they are working fewer hours. Those working fewer hours are, on average, female. The net effect is fewer front line doctors on duty at any given time and therefore more frustrated patients. (I'm not sure that's necessarily the case but I'm happy to take it at face value for the sake of argument.)

However, I'd be surprised if there are many part-time doctors in the hospital system, particularly in specialties such as Emergency where you need enough hands on deck to staff a 24-hour roster. This is in contrast to GPs where it appears that part-time work is common, if not the norm. It becomes chicken-and-egg: I gather women are attracted to GP work precisely because the hours are flexible and family friendly, whereas other specialties with lots of long on-calls and weekend shifts tend to me male dominated (for instance Intensive Care, which is my partner's specialty).

In short, I'm not convinced the change of the overall gender mix of doctors (which is unevenly spread across specialties) has had a significant impact on the staffing levels of front line services in hospitals. Other factors besides the number of doctor hours (e.g. number of beds, monitoring equipment, scanning and testing facilities, etc) are probably more significant.

You may be right, I am simply going off the KPMG and AMWAC reports as to the impact of a feminised workforc. I've got no real idea whether it also has any causal relationship with the aggression and violence discussed in the article, but it seems a somewhat plausible connection.

I just want to clarify what is actually happening in reagrds to women in medicine in the workplace:

Hospital doctors (consisting of emergency and other specialists and junior doctors (interns, residents and those in specialty training)) are employed based on funding for numbers of FTE (full time equivalents). For example - 1 hospital may require 22 FTE junior doctors, for which it is funded 100% by the state government. If 1 medical graduate wants to work 0.5FTE, then there will be 21.5 FTE remaining.

The hospital positions are generally filled, regardless of your gender, FOR THE FUNDING THAT IS SUPPLIED. The problem isn't the feminisation of the workforce in the hospital system at all, it's inadequate funding for positions by the state government.

The feminisation of the workforce is not having an impact at the front line in hospitals, but may be having an effect on general practice, where increasingly more female AND male doctors are not working a traditional 40 hour week.

We also need to remember that women have children, and that takes time out of your working life, of course how long depends on how many children each woman chooses to have. We must not begrudge women this. To do so is sexist and is considered illegal.

The feminisation of the frontline workers in hospitals is not related to increased perception of violence or aggression: drugs and alcohol, poor treatment of mental health conditions, and only occasionally, lack of respect, are the main factors. We're not talking about the majority of attendees at the hospital - just the few who have behavioural issues as a consequece of intoxicantion or self-medication with drugs/alcohol for their mental illness.

I also believe that woman are targeted because they are perceived to be "weak".

Having discussed this issue recently with paramedic colleagues, I'd like to point out they they are at greater risk than women in hospitals: I have all the resources (security) of a hospital - my friends/colleagues who are female paramedics go to people's houses and can be assaulted and even raped there. One has had a knife pulled on her, another was stalked.

None of us go into this job prepared to be physically or verbally assualted. This is not part of the job description or part of what you expect when you decide to be a health care worker. We should not have to tolerate this behaviour. We do have empathy for those who are mentally unwell, and we understand this. However, for those who are behaving this way out of fear or anxiety, you need to take a hard look at yourself and ask: would I want someone to treat my wife/girlfiend/sister/daughter this way? If the answer is "no", then stop, apologise and get on with it - becasue that's what we'll be doing.

Thanks for pointing out the important distinction between the number of staff and number of FTEs so eloquently - it was a point I skirted around.

I'm not in a position to know if there has been a significant change in the workload:FTE ratio in hospitals over time. I suspect yes, as "efficiency" is the mantra and we are all expected to do more with less. This can only go so far until the system breaks, of course.

Thanks for the info Kate, but the workforce planning people don't agree with your take on it. The statement from the OECD quote by KPMG is quite unequivocal; "all things being equal the supply of medical services will fall if female participation in the workforce increases", while both AMWAC and KPMG have arrived at similar figures for the difference in female and male doctors' work hours. If it is illegal to do anything about that situation, then perhaps the law needs to be changed?

If GPs are not working full time this increases the stress on hospital staff. If some doctors are choosing not to work full-time in hospitals, then the workload for their colleagues must increase, even if it's only because of the handovers and inefficiencies that result from having 2 people doing the one job, as well as the loss of attachment to the workplace that part-timers may experience compared to full-timers.

As well, the AMWAC report makes the point that when female staff take advantage of workplace flexibility to work fewer hours, this also rubs off on the male staff, who become dissatisfied and may choose to do fewer hours as well.

I have no problem with women wishing to satisfy their biological imperatives, my point is that we have encouraged women to become the dominant gender in medical schools and because they do have those biological imperatives, this is leading to less capacity in the medical workforce than if men had been trained instead. What do you suggest could be done to rectify this shortfall?

I completely agree with your points regarding violence being the result of well-understood external factors, which also applies to violence generally.

Craig, I'm intrigued that you think handovers are an avoidable inefficiency in a hospital setting. There always will be handovers in workplaces that operate 24 hours a day, 365 days a year.

Day person hands over to night person who hands over to day person and so on. Whether it's the same people you hand over to each day makes little difference when the patient cohort turns over almost completely in a 24 hour period, which is the case in ED.

Forgive me but it seems you have already decided that feminising of the medical profession is a problem and that aggression in hospitals must be a consequence of this, ignoring other possible factors and explanations in the process.

I'm not trying to ignore anything Regan, just interested in what seems to be something of an elephant in the room when it comes to discussing medical resourcing.

The point about handovers is that if there are more of them required because of people working hours then there are more time losses. Shift changes are unavoidable, but additional changes are unnecessary.

As for aggression, I've already said I agree with Jane's summation. I'm simply offering a possible (speculative) explanation for some of the perceptions that may influence the reported experiences in different groups.

I just think this particular elephant has been brought into the wrong room.

The latest data for EDs show that presentations are rising exponentially, and even more so in the >65years age group. resourceing hasn't significantly changed, and in fact, most hospitals have fewer in-patient beds now than 20 years ago, leading to worsening access block despite an average decrease in in-patient length of stay (LOS).

I think Craig has missed the point completely about female doctors in hospital: they work the same hours in a shift if they're not 1.0FTE, just fewer shifts per week. For example, if you are 0.5FTE, you weill work 2 x 10 hour shifts in ED. There are no more handovers.

Regan, as you are probably aware, handovers are the most dangerous time for a patient in a hospital - and we have 3 a day. This occurs in every hospital in Australia, every day. The number of FTE makes no difference to danger, as the patient's turnover so much more quickly and things change in terms of medical status so quickly as well.

I think it is vitally important (although I am somewhat biased, being a woman and a medico) that we have the same proportion of women in medicine as men, especially given that 52% of the population that is serviced by doctors are, in fact, female.

And yes, Craig, I think you may have fallen well wide of the mark in suggesting that women misinterpret signals/behaviour as violent or aggressive: of the 2 cases that I mentioned in my first comment, one was a woman and one a man - being threatened to be hit with a fist, being grabbed around the neck and once a patient told me he was going to find where I lived an hurt my family, is no misinterpretation. Nor is the time when I calmly asked a child's father to leave the paediatric ward (because he was shouting at his partner using F*** and C*** at the top of his voice - on a kids ward! a placed where children are even more vulnerable!), and then having him physically threaten the staff. It is just not on.

I'd love to invite you to be a fly on the wall of a tertiary referral public hospital emergency department between the hours of 10pm-4am on any night of the week, but particularly a Fri or Sat, and then see how you felt about some of the opinions that have been expressed on this page. The reality is far removed from some people's imaginings.

Thanks Kate, I'll put my dunce cap on - I should have thought about the way the rostering would be handled.

I think you're missing the point of the numbers quoted by the workforce planners, which is that if you want to have a 50:50 gender ratio presented to patients, you need to train at a gender ratio of 60:40, since the women will on average not be available for 20% of the time.Since men are as entitled to see a male doctor as women are to access a female one, that means we need to train more doctors in total than were needed previously, which costs more.

I think you've taken my speculation with respect to the response to violence of women doctors vs male ones the wrong way, but I'm happy to acknowledge your greater expertise and experience and apologise if you felt I insulted your professionalism.

Kate Field is 100% correct. The anticipated doctor shortage led to the training of more medical students. The current problem is no government funding to employ these graduates. An anticipated 50-100 interns will not get a job next year. Not enough funded positions. A significant number of specialty graduates face the same problem. Those doctors who have been extensively and expensively trained in the public system will vanish off into the private system because despite lengthening waiting lists and crowded EDs the government will not fund the jobs to care for the patients. The male/female issue just doesn’t rate a look in. Lots of people looking for work, no jobs out there. Simple.