This is the third blog post of our FemInEM Forward series, featuring blog submissions from the The FIX19 International Attendee Scholarship. The post below is written by Dr. Kaushila Thilakasiri, a registrar in Emergency Medicine in Sri Lanka. She is a visiting lecturer at multiple diploma programs and is involved in teaching at various local acute care and emergency medicine training programs. She is interested in medical education and resuscitation.
A brief account on gender inequity relevant to female emergency medicine physicians in Sri Lanka:
Emergency medicine (EM) is a brand-new specialty in Sri Lanka with the current EM training program starting in 2013 and the first ever EM consultants graduating in 2019. Even after six years, 60% of the EM trainees are still male. As one of the first female trainees in EM in the history of Sri Lanka, I have endured many challenges along the way and have been told by both men and women from the time I decided to pursue emergency medicine that it would be best done by a male and that it is a man’s job. There are only a few other female trainees in EM and no core EM faculty let alone female EM physician role models. Within this context, a particular challenge has been gender inequity. As I progress in my training in the new specialty of EM in Sri Lanka, I gradually noticed how prevalent gender inequity is and how I am experiencing gender inequity more now than ever before in my life. Despite this, there are no pay gaps among doctors based of the same grade irrespective of workplace and gender.
An example of gender inequity that has been incredibly personal for me relates to the professional title of female physicians. Female physicians are expected to express both their marital status and gender when listing their professional title in Sri Lanka. For example, I must specify my written professional title as “Dr. (Mrs.) Kaushila Thilakasiri”. Why is this? Indicating one’s marital status next to your title as a female physician is considered to be ‘respectful’. Male physicians are able to share their professional title alone implying that Dr. associates with a ‘male’ title because men do not need to say “Dr. (Mr)”. In fact, my attempts to use only the title “Dr.” have led to me being mistaken for a male with adverse consequences in both patient care and my career.
This issue with the acceptable professional title for female physicians suggests that the strong patriarchy in Sri Lankan society has infiltrated medicine in a definite way. By exploring the answer to this simple question, I came to realize how unaware most Sri Lankans are with respect to gender inequity, how female physicians silently bare this injustice, and what happens if one tries to change.
Within the ED, it is the norm for female EM physicians to be mistaken for nurses especially when scrubs are worn. With respect to patient care interactions, my male colleagues are always called “Doctor” but I am referred to as “Miss” by patients because, culturally, women may not have earned the title of “Doctor” and “Miss” has sufficed.
As the director of training and development of St. John Ambulance Sri Lanka, I am the first ever female in that position of a 100-year-old organization. The board is all male except me, and its meetings are incredibly challenging. Once, I was humiliated for not declaring my marital status in association with my professional title and was accused to have hidden it deliberately. When I answer calls from EMTs in our ambulance service, they automatically start the conversation assuming that I am a male and never apologies as it is an accepted mistake.
If being a physician is still considered a man’s job in Sri Lankan society and medicine, how will female emergency physicians provide emergency care without discrimination? If my simple use of title is challenged so much, one can only imagine how my viewpoints as an EM specialist would be challenged. As a female EM registrar, I have the extra burden to defend my gender in addition to defending this brand-new specialty. People fear what they don’t know. A female EM trainee in Sri Lanka is two unknown things altogether!
One might say the issue of titles is not worth the fight, but words matter. It highlights the fact that female physicians are treated inferiorly in our society, which limits achieving the full career potential of a female EM physician, ultimately leading to diminished opportunities for patient care and national development.