International Journal of Dermatology, Vol. 34, No. 8, August 1995

COMMENTARY

WOMEN IN DERMATOLOGY:A PERSONAL VIEW XII

SARAH ROGERS, M.S.C., FRCP, FRCPI

I arrived at a career in dermatology largely by a processof elimination. I would love to be able to say that Iwas greatly inspired by a dynamic teacher but, trutb totell, I had no teaching at all as a student on the subjectof skin. Otber than in anatomy and physiology that is:the memory of the H&E stained section of normal skin,painstakingly prepared by me, floating down tbe plughole on a gentle eddy of tap water during the physiolo-gy practical examination, still causes me to break outin a cold sweat.

HARD WORK

As a student, I hated Obs and Gynae; ditto for psychiatry;too much holding the retractor as a junior in surgery; Iwas quite taken by patbology—forensic pathology inparticular—but my sense of smell was too acute. Anes-thesia was out because several people told me it wouldbe "a nice job for a girl." A nice job for a girl—therewas nothing guaranteed more to make me choose al-most anything else: I wanted to get there because I wasas good as the boys, not because I cbose that which was(or was perceived to be) an easy number!

I was looking for a discipline wbich would have alarge clinical component, for communication wassomething I was good at, and, at the same time, wouldbe interesting enough for me to be engaged in for therest of my working life. Someone suggested skins. I satin on some dermatology clinics and was hooked. Afterthat, as they say, the rest is history.

It was 11 years, including my houseman's (intern)year, before I was appointed a consultant dermatologistin the Irish Health Service. During that time, I wouldhave to say that I was never discriminated against be-cause of my sex, eitber in Ireland or the UK. Not gender,a term which should be retained for Latin nouns: I stilllike my data broken down by sex, as it were.

One might have expected discrimination in thoseearly days when women were something of an un-

From the Department of Dermatology, City of Dublin Skinand Cancer Hospital, Dublin, Ireland.

Address for correspondence: Sarah Rogers, M.S.C., FRCP,FRCPI, Department of Dermatology, City of Dublin Skin andCancer Hospital, Dublin 2, Ireland.

known quantity in the profession. In 1962, when Iwent to study medicine at the Royal College of Sur-geons in Ireland, there were 120 students in first year,of whom 16 were women (13.3%). The number ofwomen consultants could be counted on balf tbe fin-gers of one hand and there were no women consultantdermatologists at that time. In 1994, the intake to thatmedical school was 141, 60 of whom were women(42.5%) and for all three Dublin medical schools, thefigure was 46.5%. In the United States, 41.6% of allmedical students were women.

Now that almost half those qualifying as doctorsare women, surely this must be reflected in the numberof hospital consultants? Not so: only 17% of the con-sultant workforce in Ireland are women. Most (90%)are in the "9 to 5" disciplines—psychiatry, anesthesia,and pathology. Only 9% are in general (internal) med-icine which includes dermatology. There is, as yet, nochair of dermatology in Ireland which comes under thedivision of medicine.

Things appear to be not so different in tbe UnitedStates where only 18.1% of practicing physicians arewomen.' In Ireland, though only 9% of physicians arewomen, 50% of consultant dermatologists are women.This is similar to the 40% women consultants in pedi-atrics in the USA which is considered to be the tradi-tional territory of the woman physician.'

In the USA, the number of women dermatologistshas risen from 6.9% in 1970 to 16.5% in 1985 and, in1994, to 26.4%. This is similar to the present figure inthe UK of 27% women consultant dermatologists;however, if we look at those in training we find that thefigures for women are 48% in the UK and 49.6% inthe USA. And so, it will not be long before 50% oftrained dermatologists in all three countries are women.

OTHER COMMITMENTS

In her 1994 paper in the Archives of Dermatology,Stephanie Pincus writes "dermatology has traditionallybeen considered a 'woman's field,' at least in part be-cause of lifestyle issues such as few emergencies."' Thismakes me feel a little sad, as I would rather think thatdoctors, men and women, chose the specialty because itattracted them for its intrinsic values rather than for itssocial convenience. But then, it is easy for me to pontifi-

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International Journal of DermatologyVol. 34, No. 8, August 1995

cate for, as fate would have it, I was single during mytraining and for the first 5 years of my consultant ap-pointment. Since then, I have had two children and,while this has made life extremely busy, I have been ina position to afford the best of child-minding help. Ihave wondered at women colleagues who got marriedearly on in their training and determined to follow afull-time career, while at the same time having a family.I think that if that had been my lot I might well havedone what many women doctors do, opted out untilthe family was reared. By then, of course, one might re-turn to work at a lesser grade, not having obtainedpostgraduate exams and not having full training.

One should not begrudge women wbo work out thebest way to survive marriage and raise children whilepursuing a career. And yet, it somehow rankles those ofus who have pursued it on an equal footing with ourmale colleagues—doing nights on call for internal medi-cine and hawking around to interviews for both train-ing posts and the final consultant post. There is a slightworry that if the choice of dermatology is based onlyon convenience, this may lead to mediocrity with nohope for women to attain the high positions in adminis-tration and chairs of dermatology on a par with theirmale counterparts. At present in the US, only 2.8% offull professors are women.

In the UK, it is possible for women to train on apart-time basis and, though this may increase trainingtime by 50%, it allows a woman to combine rearing ayoung family and pursuing a desired career. It is alsopossible in tbe UK to job-share when it comes to thefinal consultant appointment. Such an option is not yetopen to us in Ireland. In spite of this, women doctorsin the UK still feel discriminated against. In a recentsurvey of 400 British women doctors published in theBritish Medical Association News Review, tbe womenfelt that they were given second class treatment and80% found it difficult to cope with juggling home,family, and career. They felt that more part-time posts

would improve their lot but, unfortunately, part-timerswere often regarded by male colleagues to be "balf-time, half-committed, half-there, and half-witted."

My colleague in Dublin, Dr. Gillian Murphy, a highlysuccessful and academic consultant dermatologist, con-siders that the choice of spouse is very important. Gillianbelieves that in a marriage where the husband's careeris regarded as paramount, the wife's career is bound tobe sacrificed if the going gets rough. Where botb ca-reers are regarded as equally important a solution willalways be found. I certainly consider that I chose wiselyin this regard, for my husband has given me nothingbut encouragement, praise, and support.

REWARDS

Dermatology bas provided me not only with an inter-esting career which I continue to enjoy and cherish,but also with an opportunity to travel. I don't justmean trotting off to conferences such as the AmericanAcademy of Dermatology, but to travel with groupssuch as the Dowling Club and the Anglo-Chinese Der-matological Society traveling with colleagues to meetdermatologists in their own countries, seeing how theypractice dermatology and exchanging ideas. There werenever any qualms about traveling alone, as a singlewoman, with the Dowling Club for one travels as witha large boisterous family who know all about combin-ing work and fun to maximum capacity.

Lastly, dermatology has provided me with a circleof friends, not only in my home country, but through-out the world, particularly in the United Kingdomwhere 1 trained.

REFERENCE

1. Pincus S. Women in academic dermatology: results ofsurvey from the professors of dermatology. Arch Der-matol 1994; 130:1131-1135.

On Bathing

After getting through with the bath, immediate means must be taken to establishthorough and permanent reaction. If the person has a good degree of strength, hemay go out, well dressed, for a brisk walk, or to split wood, or fodder the cattle,or do anything which will keep him stirring. But in the case of very delicate per-sons, it is often better, particularly if the weather is inclement, to go to bed, wellcovered up with a cool cloth on the head, and a warm blanket at tbe feet, if need-ful, and lie for an hour or two, till the circulation becomes entirely quiet. Andsometimes comparatively strong persons do well to follow this course, and get upand take their exercise afterward. If a person uses these means, and still growschilly thirty or sixty minutes after his bath, or if after an hour or two he feels anunusual languor or exhaustion, his bath has done him harm instead of good.From Austin HN. Baths, and how to take them. New York, 1873:3.

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