Female GPs are struggling more than ever before. Why is no one listening?

This post deals with suicide and might be triggering for some readers.

Long hours. Low pay. Little sleep. Rigid hierarchies. It doesn't come as a surprise that doctors experience higher rates of burnout, depression, anxiety and suicidality compared to non-medical professions. 

In fact, in Australia, both male and female doctors report substantially higher rates of psychological distress and suicidal thoughts compared to any other Australian profession. 

"GPs are one of the highest risk professions, with a study in 2017 finding that compared with doctors in other specialties, GPs have a 42 per cent higher risk of being classified as having burnout," explains Dr Lisa Beckett.

Being in medicine is hard. But if you’re a woman in medicine, it’s even worse.

Watch: Dr Melissa Kang - 'Dolly Doctor' - shares her experience growing up. Post continues below.

A new Dutch study suggests the suicide rate for female doctors is 130 per cent higher than the general population. While in Australia, female medical practitioners are alarmingly more than twice as likely to die by suicide than women in the general population. 

For Dr Lisa Beckett, the recent statistics are not surprising. "I am personally aware of two female Australian doctors who took their own lives this week," she tells Mamamia.

The major reason behind an increase in the number of women in medicine struggling with depression? Female doctors endure a tougher mental load. 

Female doctors, gender bias, and the mental load.

While there might be more female GPs than ever before, the fact is that women continue to carry prime responsibility when it comes to household and childcare duties. 

Because while it's 2022 and times may have seemingly changed, the distribution of domestic labour and the support for those trying to balance work and home remains the same.

Meaning? Gender imbalances are still very much thriving.

"Medicine doesn’t foster a culture that embraces weakness. Nor does it allow time to get the help that is needed," said Dr Beckett.

"Our expectations of female doctors are unrealistic. Have a family but don’t take leave. Be empathic and thorough but don’t run late. Succeed but don’t make waves."

For many female physicians, their work experience is very different to their male colleagues - usually involving longer, more involved consultations with female patients.

"Women tend to prefer seeing a female GP," said Dr Beckett. "Women’s health issues tend to be more complex and women are generally more in tune with their bodies and aware when something isn’t right."

"Female GPs are also the frontline support for many patients in a psychological crisis. It isn’t uncommon to hear that a patient who sees a male GP for their every day concerns switches to see a female doctor when they have emotional or psychological stresses they need to address."

Studies have shown that female doctors tend to have more empathy than male doctors, making it more common for them to consult mental health patients. 

Research has also found that women physicians ask their patients more questions about feelings and emotions, and spend more time talking to patients and discussing treatment options than their male colleagues.

But it comes at a cost.

"This often expands the scope of the appointment," said Dr Beckett. "A patient might come in because they want a prescription, but female GPs will often recognise if a patient is experiencing acute stress and try to create a safe space for difficult conversations to take place."

Dr Beckett said male doctors are therefore more likely to see patients with acute issues like sports injuries or repeat scripts - which are generally short appointments - or perform procedures which are better remunerated. 

"In a bulk billing clinic, Medicare pays the same amount for a six-minute appointment as for a 20 minute appointment. So, a male GP with straightforward six minute appointments may see up to nine patients in an hour while a female GP in the same practice may have three appointments that require 20 minutes each."

The result? Female GPs are being paid a third as much as their male colleagues. 

To add to this, GPs are usually contractors. This means they are not paid a salary, but for the patients they see. 

"We’re not paid for admin work, or sick leave, or even maternity leave and we’re not paid if patients don’t show up for their appointments." 

"After tax, super, practice fees, and admin time many GPs make less than $10 a patient, so while a male GP might be taking home $90 an hour, his female counterpart is making less than $30."

Less than $30 an hour.

"I don’t know any GPs who went into the field for the money, but it’s easy to understand why many female GPs feel underappreciated."

For female GPs who wish to start a family, the situation is even more unfavourable. As contractors, GPs don’t get sick or carers leave, maternity leave or annual leave.

"This means you will often find doctors returning to general practice weeks or months after giving birth in order to support their families. It’s easy to see why there are increased rates of postnatal anxiety and depression, resentment, and increased stress and emotional exhaustion," said Dr Beckett.

And the pay gap is only half of it. 

The impact of these biases and the prejudice female physicians face bleeds its way into mental health and wellbeing.

Studies indicate that female doctors are at greater risk of burnout than male doctors, leaving them feeling exhausted, emotionally detached and drained. And the consequences are great.

"The amount of energy expended being an emotional support for a patient is huge and very isolating. You get 15 to 20 minutes with a patient who may be having the worst day of their life, and you give everything to them, often taking on the weight of their situation.

"When they leave you, you must reset and do it all over again. And again. You may get to debrief with colleagues at lunch (if you’re all running on time) but there’s no team sharing your load. It’s you alone."

This feeling of isolation is something Dr Beckett said has only intensified in COVID times, causing many female physicians - including many of her colleagues - to leave their profession and enter a different career path.

"All of these problems are only being exacerbated the longer they remain unaddressed. As female GPs struggle with burnout and choose to leave for alternative careers, the ones who stay find themselves fully booked weeks in advance.

"When a patient does finally get to their appointment date, they often have a list of concerns that have been building up. So appointments run overtime. GPs work more hours to catch up. The work days get longer. The burnout increases. It creates a cycle that fuels itself."

What it's really like working as a female GP.

When Dr Beckett was in general practice, she would arrive at work an hour before her first patient. Every day the hours were long. Draining. And increasingly brought stress on her work-life balance.

"I would check results, action anything urgent, and try to stay on top of the paperwork," she said. 

"I’d go through my appointment book and flag any bookings that needed changing, especially patients that may need longer than they were booked for.

"Admin for a GP is constant and uncompensated, but in medicine having accurate records can be the difference between life and death, so there’s no getting around it."

Throughout the day, Dr Beckett said the bulk of her consults would be young women, often with new families, with at least half of which would be seen for mental health focused issues - such as depression, anxiety and domestic violence. 

"The others may be sexual health advice or cervical screening, lactation consults, children for immunisations or developmental checks, patients with complex conditions or chronic pain, or procedures such as Mirena insertions or skin excisions," she said.

"I always did my best to avoid staying late but this would often mean catching up on the paperwork for each patient after I got home. This was juggled with making dinner, taking care of my family and - where possible - a little self-care."

At the end of each day, she said she would be left feeling burnt out, overworked, and completely disconnected.

"Often, I would find myself dwelling on patients, feeling the need to find resources to help them or dealing with my own emotional reaction to their distress," she said. 

Why the system is failing female GPs.

We know that female doctors are more than twice as likely to die by suicide as the general population. We know they earn significantly less than their male colleagues. We know they're at greater risk of burnout. Discrimination. Bias.

With COVID, the underlying impact of this reached new heights.

So, why has nothing changed? Why are our female doctors still suffering?

"If we continue to expect women to do so much, we need to at least create the systems to support them. There are several peer groups for female doctors that provide a safe space to debrief and connect with others. These are immensely helpful, but they can’t address the systemic issues that lead to burnout in the first place," said Dr Beckett.

"We need better Medicare funding and we need our politicians to understand the precarious situation they’ve put us in. Doctors are leaving general practice. It’s not sustainable to work in a job that is so misunderstood that the government didn’t classify us as 'frontline workers' during the pandemic.

"Childcare assistance for contractors and better paternity leave for men would also help by lessening the burden that mothers in medicine face."

For Dr Beckett, the unrelenting pressure she was under at work and her inability to switch off forced her out of general practice.

"I recognised that I couldn’t continue like that. To provide high-quality care and take care of myself and my family, something had to change. So, I made the decision to leave something I’d spent most of my adult life working towards and focus on a new direction."

Image: Supplied/Dr Lisa Beckett.

After leaving mainstream general practice, Dr Beckett launched her own online health platform - Candor.

"Things look a bit different for me now. I actually had a baby the week we launched the business, so life is still about juggling, but more on my own terms," she said.

"A lot of female doctors arrive at this moment at some point in their career. For many it means leaving the field altogether, but each time we lose a good female GP our collective medical knowledge is diminished.

"We live in a time where pressures and expectations, no matter what the profession, are higher than ever. Medicine is just one example of a suite of male-dominated industries where women push on and on stoically in silence to keep their careers and maintain face.

"If we want to see a drop in rates of suicide, anxiety and rates of depression we must keep calling out systemic failures fuelling burn out, we must lead by example and say it’s okay to ask for help."

If you or someone you know requires assistance or support contact:

Lifeline: 13 11 14

Suicide Call Back Service: 1300 659 467

Beyond Blue: 1300 22 4636

In an emergency call 000.

Feature Image: Getty.