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HomemistoryWomen in Eye Health: Finding the Balance

Women in Eye Health: Finding the Balance

The role of women in optometry and ophthalmology is flourishing and this is something to celebrate. While the journey has not always been easy, there has been plenty of support along the way. I asked some of my colleagues – ophthalmologists Drs. Smita Agarwal and Amy Cohn, and optometrist Jessica Chi – to share their experiences as women in eye health. The result is a tribute to the futures of professional women everywhere.

Optometry was not always a female friendly specialty but over the last decade there has been a significant shift in the gender balance. In 1936, when optometrists were first required to be registered, there were just 10 women registered to practice in Victoria.1 Today there are 794 registered female optometrists in Victoria and 2,987 registered female optometrists across the country. There are 2,545 men registered as optometrists in Australia.2

Medicine too is in a state of change. In the late 1800s, women comprised 10 per cent of practicing physicians but this has quadrupled in the last 20 years and today there are currently more women in medicine than in any point in history. In 2016, the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) reported that 21 per cent of registered ophthalmologists and 34 per cent of ophthalmology trainees in Australia were female.

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I was fortunate to have such a strong mentor who believed in me and soon others believed in me also

In an effort to promote gender equality, RANZCO had a stated aim of achieving 35 per cent female representation on all committees by 2017. In 2019, the College will be led by its first female president. It took decades to crack the glass ceiling but it’s finally happened.

Dr. Christolyn Raj

In my career, I have had the good fortune to embrace both disciplines of optometry and ophthalmology. As an optometrist, I was celebrated, together with the five females in my class of 12! Two years later, I found myself in medicine heading towards ophthalmology. My optometry career kept me grounded and funded my time at medical school. My colleagues encouraged me to keep at it, if ophthalmology was my end game.

If in optometry I was celebrated, then in ophthalmology I was embraced and respected. I have never regretted the pathway to my career and given the chance, I doubt I would change it. It has made me the person I am today and filled me with the burning desire to make our disciplines grow closer together.

EARNING TRUST

Gender equality entails the concept that men and women are free to develop their personal abilities and make choices without limitations set by stereotypes, rigid gender roles and prejudices. It means the different behaviours, aspirations, and needs of women and men are considered, valued, and favoured equally. It does not mean women and men have to become the same, but that their rights, responsibilities, and opportunities will not depend on whether they are born male or female.

Indeed, the different personal and professional strengths we bring to our roles, which are influenced by gender, cultural background, and current situation, ensure diversity. Importantly, as a collective profession, this enables us to gain the trust and meet the clinical and emotional needs of our patients.

Ambitious women have led to enormous social and political change throughout history

On my very first day as an ophthalmology registrar I learnt it is a privilege, not a right, to be trusted with the care of an individual’s sight. As women in eye care, we hold a particularly trusted place in society. Perhaps it is our own biases, but the female gender is synonymous with – though not exclusive to – the values people seek in a healthcare provider: empathy, compassion, and ingenuity.

Optometrist Jessica Chi believes these qualities enable us to connect well with patients on an emotional level.

“Recently, two longstanding patients broke down in my consulting room, both stoic, strong men, who were generally positive and upbeat. Men often tear up in my consulting room, but normally because I am shoving contact lenses into their eyes! These men broke down due to personal stresses separate to their ocular problems, and shared their emotions.

Jessica Chi

“While I have often experienced this in my career, these two men in particular, started me thinking. Women have a softness and empathy that makes individuals comfortable in sharing with us… I believe this is the true meaning of feminism. Feminism comes from a desire for equality but also a drive towards mutual respect, and a celebration of the qualities that make us female.”

Ophthalmologist Amy Cohn believes these qualities can sway a patient’s choice of healthcare professional. “I think women can have a different practicing style to men. This may resonate with some patients, while others may prefer a male doctor,” she said.

TRAINING AND MENTORING

There’s no doubt that the support of mentors is integral to a positive experience as a trainee and to the confidence with which you embark on and grow in your career. This is especially true when you’re a woman establishing yourself in what has been a male dominated profession.

As a postgraduate medical student my experience was unusual – I was part of a 40 per cent female year and we all came from very different backgrounds. While some of my female colleagues were told to avoid surgical specialties as they may not be conducive to our lifestyle choices, my experience was different. I was fortunate to be surrounded by mentors who said the very opposite.

Assoc. Prof. Smita Agarwal volunteering in Cambodia

Those mentors, many of them male, advocated for me. They explained the medical profession needed more women in surgery and advised the road ahead would be tough, but mine for the taking. They said women in ophthalmology were a type of ‘technology’ that no amount of investment or funding would ever attain. Without a female perspective, they said our entire medical profession would go backwards.

Amy had a similar experience. “I was training with five men, which wasn’t unusual for surgical specialties at the time. I was wholeheartedly embraced by my male colleagues. As a group we jokingly referred to ourselves as ‘the ladies’ – it was a gentle nod to our group make up, and we became tight knit. It is only upon reflection now that I see how unique our situation was,” she said.

As a woman who had recently migrated to Australia, ophthalmologist Smita Agarwal faced significant challenges in establishing her career. However, they ultimately led to her rapid trajectory as a practice owner. “I came to Australia in the year 2000, recently married. I quickly realised the value of a training position as I struggled to get an accredited traineeship. The road was long and arduous.

“To facilitate my traineeship, my husband and I lived in different cities for nearly four years. At the time, we had a small child – it was heart wrenching to leave him with a baby sitter but I did it because I didn’t want to be thought of as ‘a female trainee with obvious issues’.

“By circumstance rather than choice I started my first solo practice in 2009 in Nowra, New South Wales, another one in late 2009 in Barrack Heights and a third practice in Wollongong in early 2010. There I was, a female migrant who looked younger than her real age, and I suppose for these reasons, during my initial years, I was regularly cross examined by colleagues, referrers and even patients as to where I did my training, whether I had finished it too quickly, and whether I was able to operate. I had to work extra hard to prove myself.

“Looking back I can honestly say I have a lot of satisfaction in doing what I love the most,” Smita told me.

Dr. Amy Cohn operating

Optometrist Jessica Chi said she also had to fight to gain credibility, however the person she had to fight the most was herself.

“After graduating ten years ago, I landed my dream job at a specialty contact lens practice. Patients who were referred to my older, well-established Caucasian male boss were told to see me, a young, female Asian. I felt I had to fight to build my patient database, and I was nervous that people would not want to see me because of my youth and because I was female.

“It soon became apparent that those doubts were more mine than those of my patients. I was fortunate to have such a strong mentor who believed in me and soon others believed in me also. It seemed the hardest person to convince was myself.

“Once I began to speak with confidence, the rest fell into place. I never asked for favours because of my gender, my age or my ethnicity, and I rarely felt subjected to these by anyone but myself,” Jess said.

Amy met her biggest career challenge to date a few years down the track.

“By far and away, it was returning to operating after the birth of my three children. Surgery is a skill and like any skill, if it is not regularly practiced, you can’t expect to be exceptional at it. I had the most wonderful colleague who recognised this difficult period and sat with me, side by side, for my first two lists. She was not yet a mother but could already recognise that if not properly supported during this time, it would be easy for women to lose confidence and give up operating altogether.”

I agree with Amy’s sentiment. During my early years as a consultant, I was faced with some challenging surgical cases. Before I knew it, I had an older, very well experienced surgeon by my side assisting me with the difficult cases. He also taught me the techniques and steps I needed to manage these cases on my own. I still hear his voice in my head every time I sit down to operate.

Sometimes I feel that as women, without meaning to, we doubt our abilities just that much more. We could do well to back ourselves and take on positive feedback… We need to believe in ourselves and in the next generation of females.

WOMEN AND LEADERSHIP

While Amy recognises how far women have come, she says (and we all agree) there is more to be done.

“I’ve never felt disadvantaged as a woman in medicine. It’s been difficult at times, but not insurmountable. At every stage of my career, wonderful mentors, family and friends have surrounded me. I think this has made the journey easier.

“However, it is important to duly recognise the history that has permitted these opportunities that are preset for us today. Forty years ago, I may not have had the same path through medicine or even university. So much change has happened to allow women to forge a surgical path if they desire.

Jessica Chi with Professor Nathan Effron AC

“I think we need to actively ensure we have a balance of genders in ophthalmology. There is plenty of evidence to suggest that work places with gender-diverse leadership outperform those that are male top-heavy. Much has been written about systemic issues that prevent women advancing in the corporate sector. The same reflections are starting to happen in medicine.

“In the right environment, men and women can be equally supportive of each other. The broader question of women’s place in the operating theatre (or any work place) should not be instead of their male colleagues but with them side by side,” said Amy. “I think we need to view ambition in women as a positive and not a detrimental character flaw. Ambitious women have led to enormous social and political change throughout history.”

Jess believes women can be the harshest critics of other women, and it’s time they were more supportive of each other.

“Hillary Clinton recently said when a male succeeds, his popularity increases. When the woman with the male succeeds, she also becomes more popular and liked. But when a woman succeeds, the inverse relationship is seen. Sadly, I find this to be true. I believe the onus is on us as women, just as it is on our male counterparts, to change this attitude for the better.

“The tide is turning. Females today are certainly far more fortunate than those who paved the way for us. We see more and more females sitting in positions of influence. Half of the state presidents of the Cornea and Contact Lens Society are female. The current national president is male, my predecessor and the incoming national president, Margaret Lam, are female. And the trend is continuing among the next generation of optometric colleagues – the Young Optometrists and Early Career Optometrists committees were recently inaugurated and they are still largely led by females.”

BALANCING CAREER AND LIFESTYLE

Without a doubt, child bearing and child rearing affect both women and men in our profession. My female colleagues in particular, tend to embrace the opportunity by managing the choices available to them – for example, they might join a group practice which allows them to share time off, coordinate training with other trainees at the same life stage or buy into a practice, which enables them to choose their own team and suitable hours.

Dr. Christolyn Raj with her business partner Dr. Nima Pakrou

As a junior consultant having just started my own clinical practice, I see it isn’t easy to have a family life and be a great clinician, but what I learn every day from my colleagues is that it isn’t unsurmountable and this gives me hope. The recipe to success appears to be work smart not hard. It is imperative to network, to become a mentor, outsource what you can, and accept assistance.

Working smart is something Smita has become extremely proficient at. “For me as a clinician, teacher, mentor and researcher, my work extends well beyond my clinical practice. However, I still engage with my son’s school, watch him play sport, cook and have dinner most nights at home with my family, which I enjoy the most. I will not say that getting here has been easy but it has been worth the endeavor.”

The goal for today should be to empower both women and men to define their notions of success and to remove any psychological barriers to achieving this

It is certainly hard in the clinical world, however, there is something common to all of our experiences as clinicians, and that is resilience. Resilience acknowledges that the training environment is flawed, but at the same time says we are not in denial about this. Thinking we won’t have to compromise doesn’t enter our minds. Instead, we need to think about how we can make this work for us. There will be obstacles and setbacks of course, and there will be two choices: one may end our career and the other, often the harder one, will see us through a challenging time. This, no doubt, is when our female ingenuity will kick in.

DEVELOPING A POSITIVE CULTURE FOR OUR FUTURE

As professionals in eye health, we believe we can build a culture that is safe and nurturing. However to do so, we need to recognise and value the different behaviours, aspirations and needs of women and men.

As Smita told me, “Women look at success somewhat differently to men. Women in ophthalmology are more likely to say their primary motivation to work is to make the world a better place rather than just gain the tangible benefits personal to them.

Assoc. Prof. Smita Agarwal operating in Cambodia

“The goal for today should be to empower both women and men to define their notions of success and to remove any psychological barriers to achieving this. With the help of each other, within a family as well as within our communities, we can live by example.”

Amy agrees. “Both optometry and ophthalmology provide us with exceptional careers. If we create training programs that appeal to both women and men, the best and the brightest will apply. We have the opportunity to make it the most forward thinking, equitable of all health specialties.”

We do not have to become the same, but we do have to respect each other’s rights, responsibilities and opportunities. By evolving the way we lead, our administration systems, the way we teach and mentor, together, we can influence and optimise outcomes.

It is empowering to be part of the change that we see sweeping through our professions. Let us remain hopeful that the future continues to be bright for us all and proudly set an example for those women who will follow us.

Dr. Christolyn Raj’s sub-speciality interest are in cataract including laser cataract surgery ,retinal vascular disease in particular diabetes and pediatric ophthalmology. She is senior Lecturer at The University of Melbourne and affiliated with the Victorian Diabetes Institute Research group at Monash University . She practices at Sunbury Eye Surgeons Melbourne were she is medical director and also has private rooms at Vision Eye Institute and Melbourne Comprehensive Eye Surgeons. 

Assoc. Prof. Smita Agarwal is a comprehensive ophthalmologist with special interests in refractive cataract surgery, glaucoma, retinal and anterior segment eye diseases. Dr. Agarwal is the Head of Ophthalmology Department at Wollongong and Shellharbour Public Hospitals, a senior lecturer at University of Sydney and University of Wollongong and a Visiting Medical Officer at a number of private hospitals. She sees patients privately at Wollongong Eye Specialists. 

Jessica Chi is the director of Eyetech Optometrists, an independent specialty contact lens practice in Melbourne. She is the current Victorian President of the Cornea and Contact Lens Society, and an invited speaker at meetings throughout Australia and beyond. She is a clinical supervisor at the University of Melbourne, a member of the Optometry Victoria Optometric Sector Advisory Group and a fellow of the Australian College of Optometry and the British Contact Lens Association. Ms. Chi is a regular contributor to mivision. 

Dr. Amy Cohn is a Melbourne based ophthalmologist with special interest in medical retina and cataract surgery. She is a Visiting Medical Officer at RVEEH and Southern Health and a Senior Research Fellow at the Centre for Eye Research Australia. Dr. Cohn sees patients privately in East Melbourne, Footscray, Glen Waverley and Armadale. 

Reference:

  1. www.optometry.org.au/blog-news/2018/3/7/ women-in-optometry/
  2. Optometry Board of Australia Registrant data. Reporting period: 1 April 2018 – 30 June 2018. Available at www.optometryboard.gov.au/About/Statistics.aspx
  3. ABC of Women Worker’s Rights and Gender Equality, ILO, 2000. p. 48.