If the devil lurks among the details, let us herald the power of a shrimp.
A few months ago, one special kind of shrimp exerted a profound impact on world events. This shrimp -- the Dublin prawn, found in relative abundance in the North Atlantic -- holds such delicacy status that in Spain, wedding guests gauge the wealth of their hosts by the number of prawns served per attendee.
Irish fisherman Patrick Murphy's modest living depends on his monthly catch of the lucrative Dublin prawns. Prawn fishing is challenging because due to over-fishing, the law where he fishes limits how many a fisherman can catch in a month.
So, when Murphy learned massive ships would soon arrive in their waters and disturb already declining numbers of Dublin prawns, he and fellow fishermen decided to fight back. They announced they would sail their tiny craft into the paths where Russia's warships engage in wartime exercises. Subsequently, the Russian ambassador to Ireland announced that "as a gesture of goodwill," it would the exercises.
"I'm shocked, really," Murphy later . "I didn't think that little old us...would have an impact on international diplomacy."
Few people outside the Republic of Ireland's 5 million residents could name the island nation's prime minister. But people the world over now know about Patrick Murphy, the common-man Russian resister. Google the phrase Irish fisherman Russia and you'll get more than 1 million results in less than a second.
Murphy's courageous announcement inspired tidal waves of protests. Weeks later, The Irish Mirror newspaper reported that the was running out of fuel for heating and hot water because Irish oil companies refused to deliver supplies in response to Russia's war on Ukraine. Irish trade unions also at the embassy gates, draped in Ukrainian flags, while citizen vigils throughout Dublin as young as 11.
When Russia later invaded Ukraine, fears abounded that troops would overrun the country in weeks or sooner. Instead, the steadfast Ukrainians have held off the far larger Russian army for half a year, buoyed by a combination of relentless grit and global financial and moral support. It's tempting to render some credit to Murphy and colleagues, who staged the first highly visible -- and inspirational -- citizen resistance.
Right now, the healthcare profession desperately needs an Irish-fishermen-style protest against a historically intractable problem: gender pay inequality. Women physicians are becoming the majority. In some specialties, such as ob/gyn, women represent of those in training. The number of women in U.S. medical schools the number of men.
Yet, women physicians in the U.S. earn 75 cents on the dollar earned by male counterparts, equating to earning than men over a 40-year career. As worrisome, nearly three-quarters of women physicians retire with in savings, compared to 53% of men.
Of course, clinical productivity governs compensation in the U.S. And women physicians work relative value units (wRVUs). Male doctors do more procedures with greater per-hour reimbursement, and provide less primary care.
Moreover, other factors in male-female pay disparity include specialty choice and work-life balance preferences. Research shows female physicians take on a of childcare disruptions, requiring them to take off from work to care for children significantly more frequently than male peers (42.6% vs 12.4%).
But these variables do not fully explain the differences. There is a even after adjusting for these and other possible contributing factors.
In addition, increased productivity evidently comes at a high social cost. Various studies have demonstrated that treatment by women doctors hospital readmission rates and emergency department visits, and that female physicians provide an overall better quality of care of and among female patients.
A 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 that patients seek a different (and more time-consuming) kind of care from female doctors, often talking and disclosing more and expecting more empathic listening.
As much as the women's movement has progressed in recent decades, progress in healthcare compensation still lags behind. Therefore, it's worth considering how Irish-fishermen-style activists might help accelerate change.
For starters, Irish-fishermen-style activists -- women and men alike -- could issue the call to women physicians to refuse to accept nonclinical, uncompensated assignments such as committee participation, unless the assignments are equally distributed between males and females.
When there is no equal distribution, a woman should ask three questions before accepting the assignment: 1) Will I be taken away from clinical responsibilities? 2) Will I make minimal or no contribution? 3) Can a junior associate or someone else be assigned? If the answer is yes to any of these questions, she should be an Irish fisherman and say no!
Irish-fishermen-style activists might also suggest hosting a monthly "unequal unhappy hour" at local bars and restaurants and demand attendance by both male and female physicians. A guest speaker could give an informal presentation on healthcare pay disparity each time and lead a group discussion on possible solutions. Women in attendance could correspondingly receive a discount based on their average earnings compared to male physicians.
Irish-fishermen-style activists could additionally organize observance of Equal Pay Day, which marks how far into the new year women must work to be paid what men received the previous year. On average, U.S. women across all professions make 83 cents to a man's dollar of income; thus, Equal Pay Day for all women is .
comes even later in the year. For Black women, it will take place on September 21, 2022 (58 cents for each dollar paid to white men). Native Women's Equal Pay Day will take place on 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 scrubs, shirts and blouses, jackets, ties, and so on. If nothing else, a collective sartorial display serves as a conversation starter and helps raise awareness among colleagues.
Finally, Irish-fisherman-style activists might demand an objective audit of patients' medical records in an evaluation of patient complexity and the resulting assessment of clinical loads among genders. Unfortunately, women physicians often do not receive sufficient credit for probing psychosocial issues and focusing on the whole patient rather than the patient's chief complaint or a single organ system. The right kind of audits could pave the way toward effective solutions.
Voices for pay equality must be raised not just more loudly but in a more creatively demonstrable fashion. Advocates need not stand down a Russian or Chinese tank, as occurred in Ukraine last winter and in Tiananmen Square in 1989. But we must 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 tiny as a locomotion-propelled, decapod crustacean may just be enough to unleash an unstoppable force for change.
Neil Baum, MD, is a urologist in New Orleans, the Corporate Medical Officer of , adjunct professor of the Tulane University School of Medicine, and the author of The Complete Guide to a Successful Medical Practice (Springer 2015).