If the devil is in the details, let us announce the power of a shrimp.
A few months ago, a particular species of shrimp had a profound impact on world events. This shrimp – the Dublin shrimp, found in relative abundance in the North Atlantic – is so delicate that in Spain wedding guests would have assess the wealth of their hosts by the number of prawns served per participant.
Irish fisherman Patrick Murphy’s modest living depends on his lucrative monthly catch of Dublin prawns. Shrimp fishing is difficult because due to overfishing, the fishing place law limits the number of catches a fisherman can catch in a month.
So when Murphy learned that massive vessels would soon arrive in their waters and disrupt Dublin’s already dwindling prawn numbers, he and his fellow fishermen decided to fight back. They announced that they would sail their tiny craft on the waterways where Russian warships engage in war exercises. Subsequently, the Russian Ambassador to Ireland announced that “as a sign of goodwill”, he movement exercises.
“I’m shocked, really”, later Murphy told CNN. “I didn’t think this little old us…would have an impact on international diplomacy.”
Few outside the Republic of Ireland’s 5 million people could appoint the island nation’s prime minister. But people around the world now know Patrick Murphy, the ordinary Russian resistance fighter. Google the phrase Irish fisherman Russia and you’ll get over a million results in less than a second.
Murphy’s courageous announcement inspired waves of protest. Weeks later, the Irish mirror newspaper reported that the Russian Embassy in Ireland lacked fuel for heating and hot water because Irish oil companies had refused to deliver supplies in response to Russia’s war on Ukraine. Irish unions too protesters rallied at the gates of the embassy, draped in Ukrainian flags, as citizens watch across Dublin attracted participants from the age of 11.
When Russia then invaded Ukraine, fears abounded that troops would invade the country within weeks or sooner. Instead, the steadfast Ukrainians held off the much larger Russian military for six months, backed by a combination of relentless courage and global financial and moral support. It is tempting to pay tribute to Murphy and his colleagues, who organized the first highly visible – and inspiring – citizen resistance.
Right now, the healthcare profession desperately needs an Irish fisherman-style protest against a historically intractable problem: gender pay inequality. Women doctors become the majority. In some specialties, such as obstetrics-gynecology, women represent more than 80% of those in training. The number of women in American medical schools outrun the number of men.
Yet female physicians in the United States earn 75 cents on the dollar earned by their male counterparts, which equates to earning $2 million less than men over a 40-year career. Also worrying, nearly three-quarters of female physicians are retiring less than $1 million savings, compared to 53% of men.
Of course, clinical productivity governs compensation in the United States and female physicians produce less work relative value units (wRVU). Male physicians perform more procedures with higher hourly reimbursement and provide less primary care.
Additionally, other drivers of the gender pay gap include choice of specialty and work-life balance preferences. Research shows that female physicians assume a disproportionate share childcare interruptions, forcing them to take time off work to care for children much more frequently than their male counterparts (42.6% vs. 12.4%).
But these variables do not fully explain the differences. There is a significant pay gap even after adjusting for these and other possible contributing factors.
Moreover, the increase in productivity obviously has a high social cost. Various studies have shown that treatment by female doctors lowers hospital readmission rates and emergency room visits, and that female physicians provide better overall quality of care patients with type 2 diabetes and reduce mortality in patients.
A Canadian study concluded that patients treated by female surgeons had a small but statistically significant decrease in 30-day mortality, length of hospital stay, complications, and readmissions. Other research indicates that patients seek a different (and longer) type of care from female physicians, often talk and disclose more, and expect a more empathetic listen.
Even though the women’s movement has progressed over the past decades, progress in health care compensation still lags behind. Therefore, it is worth considering how Irish fisherman-type activists could help accelerate change.
For starters, Irish fisherman-style activists – women and men alike – could appeal to female doctors to refuse to accept non-clinical, unpaid assignments such as committee service, unless the assignments are not evenly distributed between men and women.
When there is no equal distribution, a woman should ask herself three questions before accepting the assignment: 1) Will I be removed from my clinical responsibilities? 2) Will I make a minimal or no contribution? 3) Can a junior associate or someone else be appointed? If the answer is yes to any of these questions, she should be an Irish fisherman and say no!
Irish fisherman-style campaigners might also suggest holding a monthly ‘unequal doom hour’ in local bars and restaurants and demanding the attendance of male and female doctors. A guest speaker could give an informal presentation on health care wage disparities each time and lead a group discussion on possible solutions. The women present could therefore benefit from a reduction based on their average income compared to the male doctors.
Irish fisherman-style campaigners could further organize the observance of Equal Pay Day, which marks how far women must work in the new year to be paid what men received the year before. On average, American women in all occupations earn 83 cents for every dollar of male income; thus, Equal Pay Day for all women is usually in March.
Equal Pay Day for Minority Women comes even later in the year. For black women, it will be September 21, 2022 (58 cents for every dollar paid to white men). Equal Pay Day for Indigenous Women is November 30, 2022 (50 cents). Latina Equal Pay Day falls on December 8 this year (49 cents).
Healthcare professionals could observe Equal Pay Day by wearing pink in the form of gowns, shirts and blouses, jackets, ties, etc. If nothing else, a collective clothing display serves as a conversation starter and helps educate colleagues.
Finally, Irish fisherman-style activists might demand an objective audit of patient medical records in an assessment of patient complexity and the resulting assessment of clinical burdens between genders. Unfortunately, female physicians are often not given enough credit for probing psychosocial issues and focusing on the whole patient rather than the patient’s primary complaint or a single organ system. The right kind of audits could pave the way for effective solutions.
Voices for equal pay need to be raised not just louder, but more creatively and demonstrably. Supporters don’t need to step down from a Russian or Chinese tank, as happened in Ukraine last winter and in Tiananmen Square in 1989. But we need to innovate visible and viral protests. The times demand it.
None of us should underestimate the potential of strategic and persistent protest. If we’ve learned anything from Irish fishermen, it’s that the role of an object as small as a locomotion-propelled decapod crustacean can be enough to unleash an unstoppable force of change.
Neil Baum, MD, is a New Orleans urologist, company medical director Forward-thinking communicationsassistant professor at Tulane University School of Medicine and author of The Complete Guide to Successful Medical Practice (spring 2015).