Status of Women Committee on April 19th, 2010

[The Chair, Liberal, Hedy Fry]

I think we will begin.

I want to welcome all the witnesses who are here today. As you know, because there are so many of you, we have shifted the way we usually sit. We usually sit in opposing sectors, but we're not doing that this time.

We're going to be discussing today, pursuant to Standing Order 108(2), a study on increasing the participation of women in non-traditional occupations. Today we have, as everyone can see, five sets of witnesses, and we only have a particular period of time within which to fit the witnesses, so I think we will begin. The witnesses are, obviously, the Canadian Medical Association, who will begin first; the Conseil d'intervention pour l'accès des femmes au travail; the Communications, Energy and Paperworkers Union of Canada; then Equal Voice; and the Federation of Medical Women of Canada, the fifth witness.

Under the rules of this meeting, every witness group has ten minutes within which to present. So you can make a decision if you want to split that with however many of you are here. I will give you a two-minute indicator so that you know you only have two more minutes left. So there are ten minutes per presentation, and then we will move to the question and answer rounds.

I'm going to start with the Canadian Medical Association. We have present today Anne Doig, president of the CMA, and Mamta Gautam, who is an expert physician adviser from the Centre for Physician Health and Well-being. I know that Anne and Mamta will decide how they do their thing.

Dr. Doig, can you start?

[Dr. Anne Doig, President, Canadian Medical Association]

Thank you Madam Chair, and good afternoon.

As you said in introducing me, I am Anne Doig. Like the chair, I am a family physician. I provide complete family medicine services, which means that I treat patients in hospital and in my office, including obstetrical services. I have practised in Saskatoon for nearly 32 years.

It is my pleasure to be here today. As president of the Canadian Medical Association, I represent all physicians, but today I am proud to represent women participating in what is now a traditional occupation for them, and that is medicine. Joining me today is Dr. Mamta Gautam, a specialist and champion of physician health and well-being. For 20 years she has worked as a psychiatrist treating physicians exclusively in her private practice in Ottawa, and has been hailed as the doctor's doctor.

The Association of Universities and Colleges of Canada has reported full-time university enrolment increased by more than 190,000, or 31%, between 2000 and 2006. It now stands at record levels. Full-time male enrolment has surpassed 350,000 students and full-time female enrolment has surpassed 460,000. Women account for two-thirds of full-time enrolment growth since 1971, a surge driven by the rapid increase in women's participation in the professions, including medicine.

As it stands now, men outnumber women among practising physicians, 67% to 33%. While there are still more men than women in practice, the percentage of female first-year residents in 2008 was 57%. This is a reversal of the percentage when I graduated, and an increase from 44% just 15 years ago. This means that a significant majority of physicians close to the beginning of their medical careers are women. Not surprisingly, given those figures, there are many medical disciplines where the proportion of women is much higher than it was even just a few years ago. For instance, in general surgery--long held to be a bastion of male physicians--women comprised 18% of the 1993 first-year residents. That's compared to 40% in 2008. And in 1993 just over half of first-year family medicine residents were women, compared to 64% today.

However, women medical graduates still tend to choose residency training in family medicine, pediatrics, and obstetrics and gynecology in greater proportions than their male counterparts. As has always been the case, males continue to have a stronger preference for surgery, at 23%, compared to 11% of females--although that gap is narrowing. The overall numbers of women physicians are increasing, as are the percentages of those going into what one might call non-traditional specialties, albeit at a slower rate.

The so-called feminization of medicine brings with it several other issues, and I will touch on two major ones. The first is the work and home balance. The rise in the number of women physicians is bringing a positive shift in the way physicians practise and the hours they keep. Very few of today's young physicians, male or female, are willing to work the long hours that physicians of previous generations did. That said, data from the 2007 national physician survey, which included responses from over 18,000 physicians across the country, show that on average male doctors still work nearly 54 hours per week. Female doctors work 48 hours--although many work more than that.

These figures do not include on-call time, nor time spent on child care or other family responsibilities. Many members of the committee can empathize with this level of commitment. In contrast, the European Union's work time directive has said that the maximum work week must be 48 hours. If Canada were to try to apply that directive to physicians, our health care system would grind to a halt.

The number of physicians opting to be paid by a means other than fee-for-service has dramatically increased. Fee-for-service rewards the doctor financially for seeing more patients. Female physicians typically spend more time in each patient encounter, a trait that is valued by patients but not rewarded by fee-for-service remuneration.

The second issue is stress. In spite of their increasing numbers, women in medicine still report higher rates of incidents of intimidation, sexual harassment, and abuse than their male counterparts. As well, many female physicians continue to assume primary responsibility for home and family commitments in addition to their practice workload, thus compounding their stress levels. Female physicians are more likely to work flexible hours. Flexibility in work schedules has been the method by which female physicians balance their professional and personal lives. Yet as they take on more and strive to be more flexible, that in itself creates more stress as they battle to be all things to all people.

In its 1998 policy on physician health and well-being, the CMA recognized the need to address and alleviate the special demands placed on women physicians. I have brought copies of that document with me today for you.

As I said at the outset, Dr. Gautam, who is with me today, is familiar with the stress factors experienced by physicians and women physicians in particular. She has broad experience in treating them.

We will be happy to discuss the participation of women in medicine and to answer questions that you may have.

Madam Chair, if I may, I do wish to apologize to the committee for the fact that I will have to excuse myself at five o'clock for an event by Senator Keon. With your indulgence, thank you.

[The Chair, Liberal, Hedy Fry]

Thank you, Dr. Doig.

Now, is Dr. Gautam going to present? You have another two minutes left. No?

[Dr. Mamta Gautam, Expert Physician Advisor, Centre for Physician Health and Wellbeing, Canadian Medical Association]

Not at this time, thank you.

[The Chair, Liberal, Hedy Fry]

Good. Thank you.

Now we will go to the Conseil d'intervention pour l'accès des femmes au travail. Ms. Beeman, will you be speaking for both of you?

[Jennifer Beeman, Coordinator, Employment Equity Portfolio, Conseil d'intervention pour l'accès des femmes au travail]

Yes, I will speak first, and then I'll pass the mike on to my colleague, Nathalie Goulet.

Madam Chair and members of the committee, I would like to thank you for your invitation to appear today.

I will introduce you to the Conseil d'intervention pour l'accès des femmes au travail, or CIAFT. Ours is a Quebec organization, made up of groups and individuals who work in the field of women's access to and integration in the labour market. It has been one of the principal defenders of women's rights at work since its creation in 1982. Our organization really believes that women's financial autonomy is primarily based on their access to paid work, on the condition that this work is paid according to its full value. We work to defend, promote and develop services, policies and programs that respond to the specific needs of women at work. We work on reconciling work and family life, pay equity and employment equity. In the last two years, this has become a very important issue for us.

We would now like to talk about women's work in predominantly male occupations. We have 50 members. Essentially, they are women's employability groups, and some work actively on the integration of women into jobs that are predominantly male. Despite 30 years of sustained work by women's groups, the situation regarding women and predominantly male occupations has not changed. Some very specialized occupations have been entered by women, but in the full range of occupations in the labour marked, very little has changed. In our member groups there are significant experiences and important expertise, but they remain scattered and unknown. Many groups are doing grassroots work to integrate women, but their experience is really scattered in geographic terms, and this expertise is not being pooled.

Women's groups must confront the enormous myth that women have achieved equality in the labour market, that when they want to achieve something, they can, no matter the sector or occupation. The success of a certain number of women is overshadowing the precariousness, the low wages and the poor working conditions of many other women. In Quebec, only 16% of women have a university diploma. Many of them go into other less well paid occupations, as we will see later.

For women who try to enter a predominantly male occupation, they remain in precarious situations in terms of integrating into the job and keeping it, when they do not face outright discrimination in hiring. There are really enormous problems of discrimination in hiring for women trying to enter male occupations. The most flagrant case we are working on at present is the construction industry. Women are being trained in a construction trade, but they comprise only 12.% of the construction labour force in Quebec. Even if they are trained, about 5% of the people enrolled in training program are women. There is a pool of women ready to enter this industry, but it is closed to them.

The labour market is still profoundly segregated by sex. There is truly structural segregation of the labour market by sex, despite an increasing level of activity by women and great advances in terms of education. Clearly, in terms of education, women are advancing very rapidly, and educated women are advancing nicely in the labour market. Other women remain concentrated in a limited number of careers.

I have also given you a table. I don't think everyone has it, but it shows segregation in the programs with the highest enrolment, in terms of vocational and technical training. We are talking about college diplomas—in English it would be junior college, technical or vocational training, and we can see the segregation. These are the nine programs with the highest enrolment and they are completely segregated by sex. We have auxiliary nurses, secretaries and bookkeepers, especially bookkeepers. They are the three biggest programs for a large majority of women. Annual earnings are about $28,000, $31,000 and $33,000.

Then we come to men, who become mechanics, electricians, carpenters, cabinetmakers, welders or electrical mechanics.

In those areas, we see that earnings are much higher. Electricians start at $47,000, but it can be much more. There are all sorts of electricians, depending on the industry, and so on.

So there is weak representation of women in the trades, in technical and scientific careers, where terms are more attractive. At the same time, there has been a decrease in funding for training and integrating women into predominantly male trades. The government is withdrawing from this concern somewhat. Not a lot of funds are being spent on this battle, while there are still multiple barriers to access for women and retaining women. We find that there is sometimes also significant resistance in the workplace.

So for all these reasons, the CIAFT has adopted a concerted action strategy in which we try, using that strategy, to create a portrait of the situation. We bring together information. We have held consultations in all regions of Quebec. The regional aspect is extremely important, because women's wages in the regions are much lower than elsewhere, since they don't have access to good jobs in terms of resources. They are really limited to health services and education, or to precarious jobs. So we held broad consultations to get a portrait of the situation. We collected information from everywhere.

We are now in the analysis phase, we are identifying the progress that has been made and possible avenues for action. There will be a mobilization in the fall. We are going to invite everyone back who took part in the process, to get their views on an action plan. We are going to hold mini-summit meetings on the issue, with all the actors.

So this is a huge project with an action plan, because otherwise, initiatives continue to be scattered and the situation doesn't change.

I will now give the floor to my colleague Nathalie Goulet, the director of CIAFT.

[Nathalie Goulet, Director, Conseil d'intervention pour l'accès des femmes au travail]

It's a fine project, isn't it?

For these project, we have felt for some years that there needs to be mobilization on this important issue in Quebec. We need a report card on access to equality programs and the various legislation we have on this subject. Various government departments, partners and companies have to mobilize around this issue. That is why we think there has to be a summit meeting on this issue in Quebec. What we learned in the 2008 consultations is that there has to be action, particularly in relation to vocational and technical training.

Not all women go to university. Three quarters of women do not get a university diploma, and they do not have access to jobs. In fact, half of women in the labour market, out of 520 possible jobs, are concentrated in only 20 occupations and jobs. That is 20 occupations out of 520. That is quite unbelievable.

At CIAFT, we have found that pay equity is one factor of what needs to be done in relation to women in the labour market. Full value for female jobs is an issue we have worked on and continue to work on in Quebec. It is one of the facets. The other facet is employment equity, integrating women into non-traditional occupations. We want to carry that project out and it is very difficult to obtain funding to do that. The CIAFT submitted a three-year project to the Women's Program of Status of Women Canada on that issue. We received a rejection last week.

So for that mobilization, which is both a grassroots mobilization and a political effort to promote, raise awareness and hold a dialogue, we think the federal government and Status of Women Canada has to fund the project.

That concludes our presentation. We will have an opportunity to answer your questions later. Thank you for your attention.

[The Chair, Liberal, Hedy Fry]

Next we have Madame Pageau and Mr. Coles, from the Communications, Energy, and Paperworkers Union of Canada.

Will you be sharing your time?

[Gisèle Pageau, Human Rights Director, Communications, Energy and Paperworkers Union of Canada]

No. I will do the presentation and brother Coles, who is our national representative in the construction industry, will be here to answer your questions, especially more specific questions that I cannot answer.

[The Chair, Liberal, Hedy Fry]

Okay, go ahead.

[Gisèle Pageau]

On behalf of the 150,000 members of the Communications, Energy, and Paperworkers Union of Canada, we thank you for giving us the opportunity to present our views on methods necessary to increase the participation of women in non-traditional occupations.

The CEP brings together workers from almost every occupation in Canada. Our sisters work at a variety of occupations in a multitude of industrial sectors. However, most of our female membership still work in the traditional occupations. The CEP also represents over 5,000 construction workers in Canada. These skilled-trades members are employed in small to large construction projects, mostly in western Canada. Unfortunately, our female construction membership reflects the national average, where only 4% of our construction workers are women, or just over 200 members. Combined, our construction members in Canada earn well over $15 million in wages and benefits each year, of which CEP female construction members only earn $600,000 in the same period.

The CEP finds this crisis in women's participation in non-traditional occupations unacceptable, but we also recognize that we are not any different from any other construction union in Canada in our reflection of structural problems. As many witnesses to this committee have already testified, there is an undeniably thick glass door that blocks women's entry into construction across Canada. This door was not built on the backs of women because of their anatomy and physiology. This barrier is in fact a man-made, institutionalized, artificial block, cemented by generations of discrimination against women. In other words, the CEP does not consider the physical or psychological status as women as relevant to the question of why so few women participate in construction in Canada.

We instead argue that the barriers are formed by poor educational and legislative decisions made by governments, educational institutions, employers, and unions. It is because of this analysis that the CEP is optimistic that this crisis can be reversed reasonably quickly and in time to assist Canada's construction industry with its pending chronic labour shortage. The CEP feels it can be part of the solution, both with our ideas and with our resources. We draw our proposed remedies in part from the excellent and unprecedented study on the crisis recently produced by the construction sector council, which also enjoyed funding from the Government of Canada's sector council program. We understand that this thorough scientific research paper on the participation of women in construction has already been made available to this committee. We respectfully request and recommend your careful review of it.

Our reading of this study makes it clear that two remedies are paramount. The first remedy, which is familiar to this committee, is multi-party targeted entry level trades training programs for female students who have been recruited expressly for the purpose of considering construction as a lifelong occupation. Throughout Canada, many institutions and organizations have engaged in these types of specific programs. In fact, it is exactly what the CEP has done in Saskatchewan. In 2009, the CEP humanity fund participated in a joint venture with the Saskatchewan Institute of Applied Skills and Technology women in trades and technology program. The union's fund contributed $15,000 to the joint program that recruited, oriented, and educated over 20 aboriginal women in the Regina area on the basics of the construction industry.

They learned about the basic skills of the construction trade, the apprenticeship option and responsibility, the economic benefit of the construction industry, and the tricks of the trade they needed to get their boots on the job. After a successful graduation from the six-month classroom exploration of the industry, the CEP immediately dispatched four eager participants to a nearby construction project that we represent. The CEP is walking the talk and has, with our partners, successfully brought women into construction who otherwise would not have participated.

The CEP believes that this committee can and must recommend to Parliament that more similar programs are needed immediately across Canada.

The second CEP remedy to this crisis is more dramatic. We believe that if we are to immediately attract women into construction, the owners or payers of construction projects must demand increased participation of women as a condition of their project.

Owners of construction, from condominium developers to receivers of Government of Canada stimulus moneys, should employ a gender-based hiring quota as a condition of contract for their builders. The CEP has long fought for equity hiring in its construction collective agreement, and we argue it is reasonable for construction project owners to demand it in their service contracts.

Currently, funding agencies place dozens of contract conditions on their construction projects. The CEP proposes that this committee recommend to Parliament that the Government of Canada lead by example and require a condition be added that would increase the participation of women in funded projects.

We urge you to recommend to Parliament that the Government of Canada's construction funding become an agent of change and turn the tide of women's participation in construction.

In conclusion, the CEP recognizes the crisis in construction concerning women's participation. We say the artificial barriers can be removed by aggressive educational opportunities for women, combined with proactive contractual obligations that will compel their hiring.

We thank you.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Madame Pageau.

Now we go to Equal Voice, with Nancy Peckford, who is the executive director, and Giovanna Mingarelli, who is the communications and membership liaison.

Nancy, you weren't here when we talked about the ten-minute presentation, so who is going to be speaking? You will share it?

[Nancy Peckford, Executive Director, Equal Voice]

Yes, we will share it. I will start.

My name is Nancy Peckford, and I am the executive director of Equal Voice. With me is Giovanna Mingarelli, who has joined us as a communications and membership liaison.

For those of you who don't know Equal Voice, we were founded in 2001 and we're a not-for-profit national and multi-partisan organization that advocates for more women in politics. It's self-evident why we are here today. We clearly need more women in politics, and we strive for parity, so our goal is that 50% of all legislatures in the country, from regional to federal, have 50% women and 50% men.

We gave some postcards to the clerk. I hope you have them. That postcard reveals some of the more sobering statistics about why Equal Voice exists. I don't think many of Equal Voice's founders imagined we would still need this sort of organization in order to move forward, but the reality is that representation of women across the country and in many legislatures remains very low. Federally, as you all know, it's hovering at 22%, and has been there for more or less a decade. There has been some stagnation and fluctuation back and forth, but we are in the low twenties.

Gia will say more about that in a moment, but despite the fact that we have such low numbers, Canadians in general consistently say they want more women in Parliament and in legislatures. We did an environics poll during the previous federal election in 2008. It was released last May and it overwhelmingly demonstrated that more than 85% of Canadians were supportive of increased efforts to elect women to our legislatures.

So we do not have a public opinion problem, but we do have a system problem, and that's what Equal Voice works on. I'll tell you a bit about some of our strategies, but I would like Giovanna to give you more of a sense of the numbers as we go forward.

Giovanna.

[Giovanna Mingarelli, Comunications and Membership Liaison, Equal Voice]

Thank you, Nancy.

Thank you for having us here with you today.

I will go over some federal, provincial, and municipal numbers before giving it back to Nancy.

The number of women elected to political office is actually the highest it has been in Canadian history. Since the 2000 election the number of women elected to the House of Commons has increased from 20% to 22.1% of our 308 members of Parliament. The federal cabinet consists of 26.3% women, which is 10 out of 38 ministers, and the number of women appointed to the Senate currently resides at 33.7%, or 35 out of 104 senators.

Taken to the provincial level, women have also seen an increase in political representation. Of 697 provincial seats, 24.9% are held by women, with the strongest presence in Quebec, Ontario, and Manitoba. The number of women elected in the territories remains very low, with 16% representation as of this year.

Municipally, 23% of Canada's mayors and city councillors are women, out of 5,533 mayors and 24,432 councillors.

Whereas the political representation of women has increased, as you've seen, the numbers remain well below the United Nations threshold of what is considered to be a critical mass of 38%. We currently sit in 50th place internationally, behind countries such as Sweden, Germany, Spain, Rwanda, and Afghanistan.

Let's go back to Nancy.

[Nancy Peckford]

Those are some of the statistics that we are all up against collectively in this room and elsewhere. We really appreciate the fact that the status of women committee is doing this kind of work to look very strategically at where women fare overall in Canada.

At the political level, the good news is that in the last election more women ran for office than they had in any other federal election in Canada's history. Between 28% and 29% of the candidates in the last federal election were women. That's good news, and it demonstrates that women are very keen to be involved.

One of the things that Equal Voice tries to challenge is the notion that women don't want to get involved in politics. In fact, the contrary is true. Because of who women are and who they care about and what they care about and how they live in their communities and how they live in their families, they are compelled to get involved. However, the ways in which they get involved and the kinds of doors they bang into or ceilings they may hit obviously make their own intentions and the translation of their interest into formal representation more difficult. Equal Voice has been employing three strategies to date to in fact increase the numbers and to encourage more women to feel equipped to run and also to win.

One of our more interesting projects of late is Experiences. I don't know if all of you know about Experiences. It is a federally funded project. In 2009 it was launched. It's a three-year project that is intended to encourage more women to get involved in the political process. The age range for Experiences is from about 13 to 24 years. What we encourage younger women to do is to hear from women leaders in their high schools and at the post-secondary level. We also encourage young women to sign up for a mentor. Many of you may have been approached to be a mentor so that you can share your experience and insight as someone who is living and breathing politics every day.

The Experiences program is intended to reach women from across the country and to get many of those who may be inclined to think about politics and those who don't to really engage in a more systematic fashion. We're very pleased to have the Experiences program. In my view, it is simply a drop in the bucket. There is so much to be done, but it's a really good start.

Another thing Equal Voice has done is launched the Canada Challenge. Some of you in this room were involved in the Canada Challenge. We've had two, one in 2006 and then another in 2008. The Canada Challenges are designed to invite federal leaders to demonstrate their political leadership so that in anticipation of a federal election they actually commit to working hard to improve the numbers within their own parties in terms of the numbers of women nominees.

We've successfully invited all federal party leaders to do that twice. Once was in 2006. Of course there was lots of anticipation about a federal election then, which ended up being in 2008. We did it again last year, in 2009, in anticipation of a federal election. And all the federal party leaders are now on record saying they want to work hard to improve the numbers of nominees within their own parties.

Finally, in a more recent development, Equal Voice has done a very soft launch of a campaign called “Be Her or Support Her”. That campaign is designed to reach out to the general public and to women in general to either consider running or to support another woman running.

We can talk more about those in the questions and answers.

[The Chair, Liberal, Hedy Fry]

You have two more minutes, and I know you will use it.

[Nancy Peckford]

Okay. Well, in fact I would say that Giovanna has been working very hard on what we've called the “Be Her or Support Her” campaign. It's a campaign that we intend to roll out nationally and more formally in the coming months, but it is really designed to encourage women not only to consider themselves as candidates, but to also think strategically about how they can support another woman in getting elected. We think that's part of the puzzle.

I should say that Equal Voice is very open to women and men. We have had men serving in executive positions in our chapters across the country, and we do believe this is obviously an issue that touches all Canadians. It's a democratic deficit issue, and as a consequence we work collaboratively across the country with as many partners and supporters as we can.

I think I'll leave it there.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now we'll go to Fédération des femmes médecins du Canada. We have Dr. Dollin and Dr. Gartke.

Are you both going to speak?

[Dr. Kathleen Gartke, Past President, Federation of Medical Women of Canada]

I'll actually be doing the majority of the speaking.

Thank you, Madam Chair, for the invitation.

I spent 25 years practising orthopedic surgery, and that's a specialty that fits squarely into the non-traditional category. I've seen and experienced first-hand many of the barriers young women face when they consider surgical careers. Some surgical disciplines remain formidable to women, and they fear certain aspects of these specialties. They have few role models to reassure them.

Still predominantly male enclaves, the old boys network mentality remains disconcerting. Women worry that they're going to have to choose between career and family, or that they will not be able to continue to enjoy the respect of their peers when their family responsibility collides with their practice or forces them to modify it in some way.

I've been approached by a number of female medical students who wanted to discuss these issues. While I have personal solutions, they are very much a one-off sort of thing and not transferable. It's difficult to reassure these women that they can make that kind of unencumbered choice until there are some more general solutions in existence.

If medical school enrolment continues to be an increasingly feminine pursuit, efforts will need to be made to find solutions to these barriers. If we look at the 1970s, less than 25% of medical students were women. This has now reached well over 50%, 60% in some schools, and even as high as 70% in others.

Women have made positive changes to the practice of medicine, and patients have responded positively. There has been an increased interest in work-life issues, something both men and women benefit from.

Women are choosing, however, very specific fields of practice. They're choosing primary care specialities, such as family medicine, obstetrics, gynecology, and pediatrics. If we look at the CIHI statistics over the past 30 years, we see that the percentage of women pursuing specialty training is increasing at the same rate as the percentage of women following family practice. We know that certain specialties, such as obstetrics and gynecology, are attracting a much greater share of women--as a matter of fact 87% of the trainees. So given that these two curves remain parallel, it means that some of the specialties are grossly under-represented. Why is this happening? Is it some inherent characteristic in women, or are there other factors at play?

If we focus on the surgical specialties, we can see that according to CMA data, in 1998, 12% of physicians practising in surgical specialties were women. By 2008, ten years later, this had only increased to 19%, despite the fact that over that time, over 50% of the medical school graduates were female.

In other words, we have to look at the causative factors. It's not simply a pipeline effect. From the Canadian post-MD education registry we know that upwards of 60% of graduates entering specialty training in Canada are women. Most are choosing non-surgical specialties. So we know that 64% of those entering family medicine are women, while only 45% of those entering surgical specialties are women. It's not balanced among the surgical specialties. For example, in obstetrics and gynecology, 87% of the trainees are women, versus only 23% of the trainees in orthopedics.

We have to ask ourselves why this is happening. Why do women not take advantage of the entire spectrum of medicine? We need to make the changes that will allow their skills to be evenly distributed. What factors are at play? What influences a woman in choosing her medical career, her satisfaction, and her advancement? Are these choices unencumbered? We will talk about a couple of these things.

If we look at the U.K. Royal College survey in 2009, we can see that women make career choices partly on the basis of the resulting practice pattern they will be participating in. Women seem to choose more people-oriented or more plannable specialties. We have Canadian statistics, but we don't have uniquely Canadian analysis, which is why we're referring to one from out of the country. In fact, most of the discussion or analysis of these factors come from either the U.K. or the United States. We're a little bit behind in that regard.

If we look at our first-year post-MD trainees, we see that the split mirrors what's going on in the U.K., and I think we can use their conclusions.

So the plannable aspect of medical practice seems to be the dominant factor, and that's not really surprising. Women in and out of medicine shoulder more responsibilities related to their personal or family lives. This must and does affect their choice of career. Women physicians are the primary caregivers for family members, and this is not only true for younger women. We see that 65% of women over 40 have the major responsibility for dependants as well. So work climates must not only support this 65% of women, but also the 44% of men who are responsible.

Medical practice traditionally involves long hours of work. Women physicians work an average of 47 hours per week, versus 52 hours per week for men. However, if that's broken down by dependants, we see an interesting shift. Men who have younger dependants work longer hours, which is the reverse for women who have younger dependants; they work shorter hours. If you look at the group of physicians who don't have dependants, men and women work the same hours.

We have to be careful, because there's been a tendency in the press to relate hours of work to productivity and say that perhaps women bear some responsibility in decreasing productivity. But can we say that a woman who works 47 hours a week is not contributing her share? Does the satisfaction or wellness of a doctor's patients count? Clearly, productivity will need to be measured in different terms.

What is an appropriate work week? Certainly medicine lags behind some other industries. We know that pilots and truck drivers have strict rules as to how much time they should work in a given week. This is really to avoid negative outcomes or errors, which we know increase with fatigue. We know that in Europe some of the unions have put a 46-hour cap on the work week, and Canadian women are working longer than that.

So what is it that women need to allow them to make freer choices? We know that from the end of post-secondary education to the end of specialty training takes at least ten years, and in many cases more. That usually overlaps with when women are looking to have and establish their families. Students tell us they need improved opportunities for different styles of education, with part-time training, job sharing, improved availability and cost of child care, financial support, and importantly a family-friendly culture and elimination of stigmas attached to availing themselves of family-oriented policies. Once these women get out into practice, many of the same things apply. They need many of the same supports. They need organized exit and re-entry strategies if they have to leave for a period of time--again, the family-friendly culture.

Aging is important in Canada. Many medical women find themselves caught in the sandwich generation, with younger dependents and older family members. They really need socially-supported leaves of absence for caregiving, and a family-friendly culture that includes a positive attitude toward caregiving.

For women to be comfortable or to thrive in any of these roles, we need a cultural shift. They need to be confident that they can contribute in a meaningful way and still maintain the respect of their peers. Generation X has brought forward these women's issues--men's issues as well--and none of that generation are willing to put in the kinds of hours that were worked before. That means women's issues are on everybody's agenda, and the response to this will require system and policy changes so that each individual no longer has to navigate this path on their own.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

Now I'm going to begin the question and answer segment. The first round of seven minutes will be for questions and answers, so I would ask everyone to try to be as brief as they possibly can.

I will begin with the Liberals and Michelle Simson.

[Michelle Simson, Liberal, Scarborough Southwest, ON]

Thank you, Madam Chair.

And thank you to all the witnesses. It's been extremely interesting listening to your presentations.

I want to start first by questioning Dr. Gautam. I was fascinated by the fact that you treat specifically physicians.

All our witnesses throughout this study have indicated the same common hurdle, in that women in the sandwich generation are typically caring for aging and ill parents and they still have youngsters or children who require attention. This is one of the biggest factors that tends to affect their careers. I've heard the same thing today, from all of you.

Is there any specific or unique type of stress in being a female physician that other career females--for instance, lawyers or other professions where they work approximately the same number of hours a week--wouldn't have?

[Dr. Mamta Gautam]

Thank you. I appreciate that question.

There are probably more similarities to the stressors and challenges that women face as professionals, throughout all the professions. The one that's unique to medicine is that both men and women in medicine face the fact that this is not how we see ourselves.

We in medicine are caregivers. We're not care receivers, and we don't see ourselves that way. Our personality traits are such that we put everybody else first. We will take care of ourselves, but only when everyone else is well taken care of.

What I see, and why I think the whole issue of physician health is so crucial, is that by the time physicians, including women physicians, come for help, we are probably further down that road than the average person would be.

The very nature of our business, where we spend our whole day taking care of others, means that we are at risk of burnout. But I think we hang in and try to cope. We see reaching out for help as some sense of failure or weakness. A lot of my work has been helping colleagues see that the real weakness or failure is in not getting help when they need it.

[Michelle Simson, Liberal, Scarborough Southwest, ON]

So essentially they're facing the same types of stresses. I wanted to determine if there was something I was missing.

Any of the medical witnesses can answer this question, or you can each give me a short answer.

You've stated that females tend to be drawn toward family medicine and that type of thing. Has the growth in Canada with the walk-in clinics, for lack of a better expression, where it's not a sole practitioner but a group of physicians who get together, in any way alleviated some of the stress or pressure that female physicians are under because of family commitments or that type of thing? Do you have any feedback on that?

[Dr. Anne Doig]

If I may start, I think it's fair to say that any time physicians are able to work in collaborative group settings, whether that's shared practices among the same discipline, or any kind of sharing with other practitioners, clearly there is a less stressful work environment when work can be shared and one knows it's okay to take an afternoon off.

It's okay for me to be in Ottawa this week, because I have 13 other physicians in my group who are carrying my load while I'm away.

I think that group practice, in general, supports that kind of sharing.

[Michelle Simson, Liberal, Scarborough Southwest, ON]

Do you think that is something that was driven by the physicians for that very reason? Or are there other factors that affected it? Is it being driven by the health community without regard for that, or are they concluding that they need to work fewer hours?

As the sole practitioner, you're basically on your own. As you say, the entry-exit strategies are a bit more manageable in a setting like a collaborative clinic.