Psychiatry and gender equity: Creating change for our profession

Abstract

Objectives

The principles of gender equity are important to achieve the Royal Australian and New Zealand College of Psychiatrists (the College) strategic goals. (1) To present the data on gender equity, (2) To describe how the action plan was developed, (3) To discuss how this work aligns with a commitment to inclusion and diversity.

Methods

Firstly, the formation of a working group with representation from across the College. Secondly, undertaking a data snapshot and discussion paper on gender equity to support consultation. Thirdly, reviewing similar action plans, a literature review, and undertaking broad consultation across the College. Finally, collating data using a thematic analysis to support the development of an action plan.

Results

Data obtained on gender equity identified clear gaps in leadership roles, academic activities and awards. Our review and consultation identified themes focused on gaps in gender equity including a role for organisational leadership approach. Together this has then informed an action plan for gender equity for the College.

Conclusions

There are no simple solutions that will solve gender inequity; this requires systemic solutions to achieve meaningful change. However, the development of the action plan is a significant step towards addressing the current gender inequities.

The issue of gender equity was first raised within RANZCP (referred within this paper as the College) in 1967 by Dr Isobel Williams in her Presidential address as the first woman President of the College. Since then, there have been a number of commentaries by Fellows raising awareness and calling for action.^1,2 However, it was not until November 2019 that at the Members’ Advisory Council (MAC) a request was made of the MAC, in its capacity to provide the Board of the College with advice on matters of policy and strategy, for the College to consider the development of a gender equity action plan and to commit to ongoing change. Identifying the need for a formal commitment by the College was spurred by the ongoing disparity in data on gender equity in representation across the spectrum of clinical, academic and leadership roles.

It is well acknowledged within the broader literature on gender equity that without clear and unambiguous organisational leadership there is unlikely to be any real change. ³ Furthermore, the opportunity cost for the College in not addressing gender inequity was to potentially impact engagement and support. Finally, the College was at risk of being perceived as out of step with community expectations and increasing intolerance of organisations that are slow to make progress towards equity.

Methods

The framework focussed first on laying the groundwork for highlighting the issue, and second on the interconnected web of parallel solutions – an approach associated with greater impact on sustainable organisational change.

Establishing a structure‐a working group

The first step was the commitment by the College to forming a Gender Equity Working Group (GEWG) supported in its work by the College staff. The GEWG reports to the Member Engagement Committee and includes representation from across the College including trainees and community representatives. Progress in making a difference to gender equity is likely when men and women are allies ⁴ and the group includes men and women. ⁴

Making the problem visible: Identification of data and developing a discussion paper

The first role of the GEWG was to develop a discussion paper for membership presenting the currently available data and an accompanying discussion paper outlining why this was needed and how this aligned with the College values and vision. This was critical to raising awareness of why there was a need and reflecting in data what the current state was for gender equity in psychiatry. The data was collated from College data sources as well as a survey of clinical and academic leadership roles held by psychiatrists outside of the College. A dedicated webpage was developed (https://www.ranzcp.org/membership/gender-equity).

Consultation and membership engagement

The consultation process was proactive and widely reaching of the membership in order to hear about the experience of individuals, to gather ideas for solutions and to stimulate discussion. An anonymous six-question survey was undertaken and made available to all of the College membership to take part in, presentations and invited submissions to 20 separate committees within the College, as well as the 10 College branch and New Zealand National Office committees, presentations at Congress held in Sydney in May 2021 and New Zealand National Conference held in Queenstown in September 2021, 12 peer groups identified as focused on women or gender issues were contacted for feedback, external interest groups and updates were provided by the College President, the College Psyche newsletter, social media and various branch and member newsletters. This consultation feedback was integrated with data collation, a review of all relevant action plans and a systematic review of the literature on improving gender equity as the methodology to develop a statement of commitment and action plan by the GEWG. Ethics approval was not required for this engagement and development project.

Results

The initial data gathered in 2021 identified that 45.1% of the overall membership were women with 53.8% of trainees. At this point only male or female identification was possible; however, that has been rectified for subsequent College data collection to enable broader gender identities. For College Committee Chairs, 63.2% were men with women making up 43% of overall committee membership. For Directors of Training 74.3% were men, 78.5% of Clinical Directors were men and 80% of senior academic roles were held by men despite 42% of clinical academic positions being held by women. For College Awards, 65% had been awarded to men with the percentage for senior awards higher. At that time, there had been no women appointed as Editors of either of the College journals, Australasian Psychiatry or the Australian and New Zealand Journal of Psychiatry. The discussion paper developed identified why gender equity should matter to psychiatry as a profession and how addressing this aligned with the values and vision of the College within the current strategic plan.

Over 2022, the consultation included a survey with six open ended questions open to every College member and resulted in 213 individual survey responses. The survey was open from 28 January to 31 May 2022. In addition, the GEWG received 9 direct email responses, 2 external submissions, 1 peer group submission, 4 committee responses and 17 separate responses from the Congress in-person survey that were provided by the membership. Further feedback was also gathered at Congress and the New Zealand National Conference scientific program sessions. The results from the consultation were analysed using a deductive coding framework. Firstly, qualitative responses were transcribed, then coded and grouped into common themes. These themes explained larger sections of the data by combining different codes that were connected through key concepts and repeated patterns of thematic issues raised (e.g. leadership positions). Six major themes emerged from the consultation process: bullying and sexual harassment, College training fee structures, inadequate support for work-life flexibility, unconscious gender bias, too few female leaders in psychiatry and a confirmation of the positive change within the College regarding gender equity. The feedback resulted in an early commitment by the College to conduct a review of training fee structures and commit to equity in keynote speakers at Congress 2023.

A review of Action Plans undertaken identified 10 from other Medical Colleges and other relevant bodies in Australia, as well as the Royal College of Psychiatrists, United Kingdom. This review highlighted a range of approaches with the majority specifically focused on improving gender equity. All had visible commitments such as equity in representation as speakers, committee membership and lead roles within their organisation. Many of the Australian organisations had joined the Advancing Women in Healthcare Leadership initiative to learn as a community how to support gender equity specifically in healthcare leadership. ³ A recent commitment by the College was to join as an affiliate member of this organisation in 2023.

Ongoing member engagement during the development of the draft action plan and statement by the GEWG also identified the need for broad definitions of gender equity within a gender diverse framework, accounting for intersectionality and actions that while targeted at those who identify as female, would benefit the membership and community regardless of gender identity.

A literature review searching for papers including commentaries, reviews or original data on three topics (1) leadership in medicine and women, (2) training in medical specialities and women and (3) academic medicine and women and were search terms used to identify 18 papers for in depth review by the GEWG. A thematic review of these papers for key recommendations and findings when addressing gender equity was undertaken and identified the following key themes: organisational leadership, commitment and accountability for successful action; organisational leadership systems and structures; mentorship, peer support and sponsorship; implementation of gender equity plans; ongoing data collection and review; implementing targeted initiatives to address areas of specific inequity. These themes identified in the literature also informed the work of the GEWG in developing a statement of commitment and an action plan with short-, medium- and long-term commitments.

The collation across all the data gathered informed the development of 4 areas of action across the themes of (1) Leadership and Accountability, (2) Advocacy, (3) College Data Gathering and (4) Research. At the time of writing, the statement of commitment and action plan are in the process of consideration for approval by the College Board.

Discussion

A statement of commitment and action plan for gender equity is now developed for the College through a process of widespread consultation across membership as well as synthesis of relevant information from other medical societies and from the scientific literature. It was sobering to hear during the consultation themes consistent with the experience of many women across our community, such as discrimination in the workplace, sexual harassment, microaggressions and an ongoing theme of belittlement in the context of attempts at advocacy. ⁵ Equally shared were the challenges of the narrow definitions of success, that prioritise career advancement over carer roles, and undervalue the significant contribution that women make every day to our community in their contribution of disproportionate levels of unpaid household labour. ⁶ While not the focus of the GEWG, these are real barriers in the current structure of training and professional development and must also be considered in our profession as we strive towards equity. ⁷

Addressing gender inequity is a critical quest for psychiatry. The GEWG recognises that the lived experience of gender equity in psychiatry is more than about the balancing numbers alone. Equally listening to the differences in experiences, aspirations, priorities and needs is required for progress. This project elevates gender equity as a priority within the College and sets a deliberate path. To achieve this critical quest for psychiatry will require sustained commitment by members, the College and our communities.