Gender, Workforce and the Economics of Women's Health

Happy International Women’s Day!

Today I want to talk about gender. And about medicine. Because in the hospital, my pronoun is doctor.

International Women’s Day is often framed as a celebration of women’s progress. And it absolutely should be.

But for me, the story of gender has never been about division. It has been about people.

I grew up with an unshakeable belief in my own worth because of the people around me. My father loved me unconditionally and believed completely in my capability and potential. My mother taught me to live life with passion and curiosity. Between them, I like to think I inherited the best of both.

So when I reflect on gender today, I do so with gratitude not only for the women in my life, but also for the men who supported me, mentored me and worked beside me.

In medicine, however, gender is not just a personal story. It is a workforce story.

Obstetrics and gynaecology has experienced a profound demographic shift. It is now one of the most feminised specialties in medicine. For many, this represents progress — women choosing to work in women’s health.

But demographics also have consequences.

Australian Bureau of Statistics workforce data demonstrate that earnings between men and women tend to track closely early in their careers before diverging in the early thirties. This divergence is strongly associated with differences in workforce participation, particularly during the years when many women carry the majority of child caregiving responsibilities.

In our specialty, the 2025 NASOG survey found a similar pattern. Many female specialists reduce their clinical hours during the early years of family life and gradually return to full-time work later in their careers. On average, survey showed that it takes fifteen years after fellowship for female specialists to re-enter full-time practice.

These realities are not a criticism of women. They are simply demographic facts that workforce planning must acknowledge.

At the same time, we should ask another question that is rarely discussed: what happens to a profession economically when it becomes feminised?

Are we seeing changes in the way obstetrics and gynaecology is valued?

Across a number of professions, there is evidence that when workforces become predominantly female, the economic value placed on that work can shift over time. Pharmacy, veterinary medicine and several academic disciplines have all experienced periods where feminisation of the workforce coincided with declining remuneration or reduced economic valuation of the profession.

When we examine the Medicare data over the last decade, the economic trend in obstetric care becomes unmistakable.

Using publicly available Medicare data, obstetric benefits nationally have changed dramatically over the last ten years, while patient costs have risen.

Year	Medicare benefits paid (total obstetric services)	Average patient out-of-pocket per service
2010	$121,000,000	$250
2015	$128,000,000	$270
2020	$123,300,000	$290.71
2025	$110,200,000	$339.36

These numbers show something important. Medicare funding for obstetrics is the lowest level in 15 years.

So does the profound demographic change to the specialty invite reflection on whether the value placed on our work by government and the community has shifted?

These questions are particularly relevant following the release this week of the Council of Presidents of Medical Colleges report on ethical billing, which has furthered attention on specialist fees, transparency and the sustainability of medical practice.

The Council of Presidents of Medical Colleges has partnered with government around this discussion. But NASOG has taken a different approach. We believe the starting point must be transparency about the underlying economics of care.

In that context, out-of-pocket costs are not a moral question. They are a structural one.

This is why the conversation around “ethical billing” must include ethical funding.

International Women’s Day is therefore an appropriate moment for reflection.

Gender matters. Workforce participation matters. Economic sustainability matters.

But above all, what matters is that we maintain a profession where every doctor — regardless of gender — can build a safe, sustainable career caring for women and families.

For me personally, gender has never defined my professional identity.

I am a daughter. I am a wife. I am a mother.

But in the hospital, in the consulting room and in the operating theatre — my pronoun is doctor.

These are exactly the conversations we need to have openly as a profession, without fear and without apology.

NASOG will be continuing this discussion at our Insight Series events around the country, including our premier event in Brisbane on 21 March, where we will discuss workforce sustainability, obstetrics and gynaecology economics and the future of specialist practice in Australia.

Alongside these discussions we will also be running an outstanding clinical education program, with CPD points available for attendees.

The event has been designed so colleagues can attend after morning ward rounds, or fly in for the afternoon sessions and dinner. We will make priority parking available for you if you are on call.

We would love to see you there.

And finally, a reminder that NASOG will host its inaugural Practice Management Course in Sydney on 1–2 May. Early-bird tickets close on 1 April, and registrations are filling quickly.

On this International Women’s Day, I celebrate the remarkable women of our profession.

And the remarkable men who stand beside them.

Because the future of medicine will be built as it always has been. Together.

Learn More and Register for the Insight Series