I volunteered for my university’s open day, talking with prospective students. It was interesting to see almost ten young men approach the Speech Pathology stand to inquire about the course. I remember one prospective student asking me about the role of SPs, and the course content. I related to him a memorable interaction with a client from my acute hospital placement. He was well-informed, correctly inferring that her aphasia was non-fluent – better than your average Year 12 student! However, his mother asked me point-blank: “how many men are in the course?”. I couldn’t lie, out of ~100, there are three, and I am the only local (non-international) student (not that that’s a problem – but it’s an interesting statistic). Also, I am a postgraduate – when my colleagues were in first-year there were two men, one of whom has changed to Audiology. His mother was not impressed. I couldn’t blame her – men like to talk with men on some occasions, and most people would not like the enhanced attention that comes from being the only boy in the room. I tried to sell the positives: the lecturers would always know your name, you would be in high-demand, especially in pediatrics, and since society views men as more competent than women, your career would probably progress faster (this was tongue-in-cheek, but is perhaps true).
I performed a quick ABS search a few months ago, comparing the gender-split in SP to other professions, finding that, in Australia at least, Speech Pathology has perhaps the fifth highest proportion of women. However, when looking at the other side, there are far more professions that have a more extreme gender split favoured towards men (mainly in trades and engineering). It’s nothing new to state that professions that have been historically viewed as feminine (nursing, education, etc.) have large proportions of women, but it is the size of the split in SP that is intriguing.
Here’s a table to compare health practitioners (taken from AHPRA’s Annual Report):
Speech Pathologists aren’t registered with AHPRA, but they would have a similar proportion as the “Nurse and midwife” category.
This week the @wespeechies twitter handle was curated by Adrian Bradley, an Acute clinician from Ireland. He discussed the position of men in the profession, as well as strategies for addressing the gender split.
Is it a problem?
Obviously, there needs to be a benefit to having diversity before we commit to pursuing it. My opinion is that professions with low diversity can lack external credibility. SPs working in all environments face skepticism of their expertise and clinical skills from doctors, teachers, parents, policy-makers (for example see here). Diversity in a profession creates an image separate from the stereotypical associations outsiders may have (the GP as an older man, the nurse as a maternal woman, etc.). SP certainly has an image problem: upon telling a medical intern friend that I was commencing study in SP, he was surprised – his impression was of a lot of petite ladies with high-pitched voices. I have met SPs like this. But the majority that I have met have simply been women – from the country, the city, private schools and public schools. SPs of different ethnicities, some who have completed previous study in medical science, linguistics, psychology, science, education. Some who worked in business and marketing. Certainly beyond the stereotype!
Perhaps one of the issues with the stereotype is socialisation. Through our training, we take on the SP persona, in which our individuality is diminished somewhat. I have been in several settings where I have been told: “we can’t do that here because of X”. X usually involves Other People, who are not SPs (physios, doctors and headmasters are often the culprits here). By enforcing this professional boundary, we lessen diversity.
My ideal professional persona is more consultative than directive. I see myself as someone who has expert knowledge in language, speech, communication and feeding; and who is able to provide expert advice or therapies in consultation with people, their networks (families, friends, colleagues, etc.) in order to help them achieve their goals. To do this, I am more “Team Allied Health” or even “Team Health Care” than “Team Speech”.
Perhaps this comes from belonging to various other groups before entering Speech Pathology (musician, linguist, cooperative director, etc.).
During clinical placements, my gender is seldom mentioned. It was never mentioned on my acute hospital placement, and only once by a nurse on my sub-acute placement (“we’ve never had a male speechie before…”). However, on paediatric placements, whenever I seem to build good rapport with a male client, their parent always says, “it’s because you’re a man.” Perhaps it is, but I’d like to think its because of my skill!
I’ve been told on numerous occasions that clients will seek out a male SP, and that my career will progress faster – “you’ll go straight to management”. While I don’t envisage working solely in clinic for the rest of my career, I’d like to think that any progress I make during in my career would be due to my skill rather than my gender. But how would you know?
This has turned into a rambly sort of post, but these issues are complex and interwoven. The position of women, the position of the profession, and individual factors coalesce – there’s not a simple explanation for the observed phenomena.
Every week, a lot of allied health professionals find themselves in meetings with their colleagues, possibly under the banner of a ‘Multidisciplinary team meeting’. The purpose of these meetings is to better coordinate patient care, and give each professional better input into care in a holistic manner.
As I sat through a few during my hospital placement, I wondered first what the cost of these meetings was. In my head I thought: ten people making (say) $40/hr on average will cost the hospital $200 for a half-hour meeting in wages alone. In other words, teamwork comes with a price-tag – time in meetings is time away from other duties. However, you would assume teamwork to increase productivity by making care more efficient and effective. Also, most would say that teamwork is not an optional-extra that is present ‘in addition’ to ‘normal duties’, but instead is a fundamental part of the role.
Unfortunately, teamwork is not something that people can be forced to do through policy or procedure. People need to ‘opt-in’ to teamwork. Over the past week I’ve been reading “Interprofessional Teamwork for Health and Social Care” (1- whose authors I’ll abbreviate to RLEZ), which has clearly broken down the elements of teamwork, its impact on practice, and the barriers to its implementation.
What is teamwork?
Teamwork is simply not working together. Just because the physio and the speech pathologist might work with one patient, and have similar goals regarding (say) rehab planning doesn’t mean they are part of a team. RLEZ note an early definition of teamwork:
Teams are co-operative groups in that they are called into being to perform a task, a task that cannot be performed by an individual.
This definition would now be viewed as simplistic. The goal of a team is not necessarily to perform a task or tasks: for example, in the emergency department it may be unclear what the tasks are. Also, the definition lacks some key characteristics that RLEZ consider to be essential for teams (p.10):
- Clear team goals [note the difference between goals, which can be broad, and tasks, which are specific]
- Shared team identity
- Shared team commitment
- Role clarity
- Integration between team members
In my thinking, the most important characteristics are interdependence and shared team commitment. The team must want to and need to work together in order to truly be a team.
Teamwork and Practice
RLEZ offer a ‘contingency model’ of teamwork (p.43), where they create a nestled hierarchy of forms of interprofessional practice.
- Teamwork – E.g. intensive care teams, emergency departments – where the goals are clear but the tasks are shared, “unpredictable, urgent and complex”.
- Collaboration – E.g. a general medical ward – where accountability is shared, but the team identity is less strong.
- Coordination – E.g. tasks are coordinated, but not necessarily shared; and team members only communicate to share facts rather than to make decisions
- Networking – E.g. Professional groups, journal clubs, etc.
In my mind, the MDTs that I have witnessed have mainly been ‘Collaboration’. There is little shared responsibility, as decisions are made outside the group, and the group discussions are primarily to action referrals or inform people about patients’ progress in various disciplines.
Unsurprisingly, the most obvious barrier that came from reading the book is what I would characterise as institutional or historical. Most healthcare practice is informed more by past practice than by best practice. It is noted for instance, that doctors enjoy a great deal of power in ‘teams’ as they were the first healthcare profession to institutionalise, and seize the important powers of diagnosis and prescription; which in turn led to higher salaries and respect.
In addition, professions tend to reflect their institutional histories. Speech pathologists may make decisions or act in a certain way, because that’s how they feel speech pathologists should act; rather than having a logical reason for the action. Professions also develop bias against other professions, and fight for ‘space’ in the delivery of patient care. Examples that come to mind are the difficulties SPs had in delivering FEES without the oversight of an ENT; and the fact that only ENT’s can bill Medicare for that procedure.
I’m excited by the new developments in teamwork research, because I believe there is a lot of scope for improving such practices across healthcare, at least in the settings I’ve seen. I also think being made aware of biases and barriers in our own profession can go some way to removing them.
1. Reeves, S., Lewin, S., Epsin, S., Zwarenstein, M. (2010). Interprofessional teamwork for Health and Social Care. Chichester: Wiley-Blackwell.