BMJ  2008;336:749 (5 April), doi:10.1136/bmj.39505.566701.94

Head to Head

Are there too many female medical graduates? No

¹ Faculty of Biomedical Sciences, University College London, London WC1E 6BT, ² Royal College of Physicians, London

UK universities are now producing more female doctors than male. Brian McKinstry (doi: 10.1136/bmj.39505.491065.94) argues we are risking future staffing problems, but Jane Dacre thinks there is still some way to go before we reach true equality

Medicine needs and wants to attract the best and brightest people, whatever their sex. Some patients prefer to see the same sex doctor as themselves^{1 2}—so we should ideally have equal numbers of men and women.

As the first female dean of Duke University School of Medicine said incredulously, after her appointment had made the headlines on national public radio, "Brilliance and ability are not restricted to certain groups, so it seems logical that if they draw from the widest possible talent pool, the very best institutions will naturally have diversity at all levels."³

Medicine is a caring profession. The attributes of the doctor as documented in the UK General Medical Council’s Good Medical Practice include care, consideration, dignity, and respect.⁴ The Royal College of Physicians working party on medical professionalism has agreed that doctors should be committed to integrity, compassion, altruism, continuous improvement, excellence, and working in partnership.⁵ Although these are characteristics shared by men and women, female doctors in particular engage patients as active partners in care, offer emotional support, and engage in psychological discussion.⁶ Such patient centred care results in better health outcomes.⁷

Under-representation

Women now outnumber men in most medical schools by about 3:2,⁸ but as many of them may want to work flexibly for some of their working life, numbers in the workforce overall are likely to even out.

Despite this increase in female students, there are still few women in some areas, especially clinical academia. The Medical Schools Council report, published in June 2007 showed only 11% of the professorial staff in UK medical schools are women compared with 36% of clinical lecturers. The proportion of women decreases with increasing academic grade. A similar situation exists in the United States, where only 15% of full professors and 11% of department chairs are women.⁹ This is despite several recent studies of leadership that show women are good at empowering others and are good team leaders.¹⁰

Women are also not represented equally across the profession, with specialties requiring more acute and on call responsibilities and more technical skills seeming less attractive.¹¹ Women’s performance in examinations in our medical schools¹² and in the MRCP examination¹³ is now better than that of men, so the reason for this lack of career progression is not explained by lack of academic aptitude. This is a strong argument for ensuring equality of opportunity in medicine, rather than worrying about having too many women.

Recently, a much larger number of women have taken leading roles in the medical royal colleges and other areas of health care. It may just be a matter of time before the overall numbers at the top of the profession reflect the current increase in numbers of women in the medical schools. Although women may take time off to have children, they retire later so stay in the active workforce for longer¹⁴ and therefore have more time to climb the career ladder and to develop their leadership roles. They also gain broad experience of life outside the workplace.

Both men and women make first rate doctors. They should be encouraged into the profession, but in order to welcome women to the more senior positions, it is worth paying attention to the institutional barriers that prevent their progression into leadership positions. These include lack of role models, lack of flexibility of rotas, and low acceptance of career breaks and part time working. Recent work on leadership styles commends a more collaborative approach, with the development of good team working and communication skills.

Embrace flexibility

The shape of the workforce is changing. Projections suggest that there will be too many doctors looking for jobs in the UK in the near future, and unemployment is already a concern for trainees caught up in the recent debacle with the Medical Training Application Service. The health service will soon have to achieve a 48 hour working week to comply with the European Working Time Directive. Rather than focus on the detrimental effect of having too many female graduates, the feminisation of medicine should be welcomed as an opportunity to be creative with workforce planning and to recognise that a more flexible approach is required to deliver good quality patient care at all times of the day and night. This change to a more flexible way of working will be more acceptable to colleagues with domestic and other commitments and is likely to result in more women taking on leadership positions.

Women and men wanting a more flexible career path into medicine should be welcomed. To encourage them to take on the leadership roles that the profession needs. however, some changes need to be considered, including greater availability of flexible on-site child care and easily accessible and funded part time training options. A few small steps would support giant leaps in the development, quality, and leadership of the medical workforce.

---

Competing interests: JD chairs the Royal College of Physicians research project on women in medicine.

References

1. Levinson W, Lurie N. When most doctors are women: what lies ahead? Ann Intern Med 2004;21:471-4.
2. Cooper IA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient centres communication, ratings of care and concordance of patient and physician race. Ann Intern Med 2003;139:907-15.[Abstract/Free Full Text]
3. Andrews NC. Climbing through medicine’s glass ceiling. N Engl J Med 2007;357:1887-91.[Free Full Text]
4. General Medical Council. Good Medical Practice. London: GMC, 2006.
5. Royal College of Physicians. Doctors in society: medical professionalism in a changing world. London: RCP, 2005.
6. Roter DL, Hall JA, Aoki Y. Physician gender effects in medical communication: a meta-analytic review. JAMA 2002;288:756-64.[Abstract/Free Full Text]
7. Greenfield S, Kaplan S, Ware JE. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med 1985;102:520-8.[Abstract/Free Full Text]
8. Medical Schools Council. Women in clinical academia: attracting and developing the medical and dental workforce of the future. London: MSC, 2007.
9. Magrane D, Lang J, Alexander H. Women in US academic medicine: statistics and medical school benchmarking 2004-2005. Washington, DC: Association of American Medical Colleges, 2005.
10. Eagly AH, Johnson BT. Gender and leadership style. A meta-analysis. Psychol Bull 1990;108:233-56.[CrossRef][Web of Science]
11. Federation of Royal Colleges of Physicians. Women in hospital medicine. Career choices and opportunities. London: RCP, 2001.
12. Haq I, Higham J, Morris R, Dacre J. Effect of ethnicity and gender on performance in undergraduate medical examinations. Med Educ 2005;39:1126-8.[CrossRef][Web of Science][Medline]
13. Dewhurst NG, McManus C, Mollon J, Dacre JE, Vale AJ. Performance in the MRCP(UK) examination 2003-4: analysis of pass rates of UK graduates in relation to self-declared ethnicity and gender. BMC Med 2007;5:8.[CrossRef][Medline]
14. Batchelor AJ. Senior women physicians: the question of retirement. N Y State J Med 1990;90:292-4.[Web of Science][Medline]

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