Women in medicineBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5144 (Published 10 December 2009) Cite this as: BMJ 2009;339:b5144
Kathy Oxtoby looks at where the struggle for sex equality in the profession has come from and where it’s going
It’s been a long battle, but women within the medical profession now seem closer than ever to being afforded the same career opportunities as their male colleagues.
Just a few years ago women faced numerous obstacles to becoming doctors and to advancing their careers. Now, at a time when a larger percentage of graduates and newly qualified doctors are women rather than men, those barriers appear to be breaking down, allowing more women clinicians to realise their full potential.
But more could be done to improve the career prospects of women doctors, a report by the chief medical officer’s National Working Group on Women in Medicine suggests. Women Doctors: Making a Difference identifies the obstacles that prevent female doctors’ career progression, and sets out how to address them (box).1
Women Doctors: Making a Difference—key recommendations
Improve access to mentoring and career advice
Encourage women in leadership
Improve access to part time working and flexible training
Ensure that the arrangements for revalidation are clear and explicit
Encourage women to apply for the clinical excellence awards’ scheme
Ensure that the medical workforce planning apparatus takes account of the increasing number of women in the medical profession
Improve access to child care
Improve support for carers
Better access to part time working and flexible training could considerably improve the career prospects of women doctors, the report claims. To improve access to part time working, it calls for deaneries to maintain a list of doctors who want to train part time in slot share arrangements, and for strategic health authorities to drop quotas and base provision on needs assessment.
Beryl De Souza, joint honorary secretary of the Medical Women’s Federation, hopes this will “help to overcome perceptions that those in part time work or who are training part time only have a part time commitment to medicine.”
Leading women doctors have also welcomed the report’s recommendation that those involved in medical workforce planning should take into account the increasing number of women in the medical profession and plan for a flexible workforce. Professor Amanda Howe, honorary secretary for the Royal College of General Practitioners, says that now more women are coming into medicine they are being blamed for problems such as a lack of continuity of care. “But the chief medical officer’s report makes it clear that if you know about people’s career needs you should be able to plan for them. So you should be able to prepare for the fact that some of your workforce might have to take a couple of maternity leaves, and avoid wasting women’s potential.”
Childcare provision is another area where the report calls for improvements, urging all trusts to appoint childcare coordinators to expand the information and options available to doctors, and suggesting that they should be allowed to pay for child care from their gross earnings.
This recommendation is particularly valuable, Naomi Brown, a foundation year 1 doctor in Crewe, believes. “Given that clinical work happens 24 hours a day, extending childcare opening hours would be really useful, while funding for child care from gross rather than net earnings could help junior doctors who might be struggling to meet the payments,” she says.
For Professor Jane Dacre, vice dean and director of medical education at University College London Medical School, the report’s recommendation that women should be encouraged into leadership positions is of particular interest. “We know that women are reaching consultant status in unprecedented numbers and are not yet at the pinnacle of their profession,” explains Professor Dacre.
Another factor highlighted is the lack of mentoring and career advice for female doctors. A programmed activity should potentially be made available within the consultant contract for senior doctors to provide mentoring and counselling, it recommends. Helen Fernandes, a consultant neurosurgeon at Addenbrooke’s Hospital, Cambridge, and chair of the national body WinS (Women in Surgery), part of the Royal College of Surgeons of England, hopes this will help to address the “lack of role models” for women doctors, and the “patchy” quality of mentoring and career advice. She says that although some female surgeons might be well supported, others may come across a mentor who will tell them it is impossible to be a surgeon and have a family. “When you’re young and impressionable this can be a very destructive experience,” she says.
Professor Howe hopes that improving the quality of mentoring may also help to overcome some of the glass ceiling issues, such as women not applying for clinical excellence awards or not putting themselves forward for leadership positions.
Professor Howe believes this report could have a genuine impact on women’s career progression in medicine given that the chief medical officer has approved it and that key organisations within the profession are being called upon to take action. But she says “professional bodies, employers, and the trade unions all need to step up” to tackle those obstacles that are impeding women doctors’ progress.
The sheer numbers of women coming into the medical workforce could help ensure the report’s recommendations are realised. “We no longer have hundreds of women graduating—we have thousands. These numbers are going to affect the future workforce and are a wake up call that action has to be taken to help women develop their careers,” says Anita Holdcroft, chair of the BMA’s Medical Academic Staff Committee’s regional services liaison group.
Although having more women in medicine is generally seen as being a positive development, there are some serious concerns. Back in 2004, Professor Carol Black noted that female dominated professions have a tendency to lose their influence. Others agree, pointing out that a female biased population might not be good for doctor politics. Gill Jenkins, a general pracititioner in Bristol, questions whether women doctors “will be politically motivated or whether the managers will take over altogether.”
Sir Bernard Ribeiro, former president of the Royal College of Surgeons, predicts that the large number of women joining the profession—of whom at least 50% will require time out to have a family—combined with restricted working hours under the European Working Time Directive, will result in a drastic shortage of doctors by 2020, making workforce planning a priority.
Dr Holdcroft warns that when women doctors go on maternity leave they are often not replaced, which puts extra pressure on colleagues to deliver services and can create “a culture where people do not want to employ women of childbearing years.”
More women in medicine means some specialties could experience a shortage of doctors. Women practitioners are more likely to gravitate to family friendly disciplines, such as general practice, than to specialties with less predictable hours, such as surgery. Sir Bernard suggests that workforce planners will need to look at ways to attract women to these less appealing disciplines by offering greater job sharing opportunities.
That many women are still drawn to specialties that are more suited to family life is, for some, a sign that obstacles still exist to achieving true equality. A woman who wants to join a specialty but is unable to because it’s not family friendly “is still facing barriers,” says Professor Dacre.
Another barrier, according to the Royal College of Physicians’ report Women and Medicine: The Future, is that women doctors are still not fulfilling their capabilities as medical and academic leaders.2 The report highlights how some women are in the minority on royal college councils and how in 2007, only 12% of all clinical professors on university contracts were women.
The picture for women in academic medicine is not much brighter according to a report from the women in academic medicine project. Published last year, Women in Academic Medicine: Developing Equality in Governance, found that these women face a dominant male “club culture,” misplaced competition, exclusion, and lack of support, and they are still under-represented in the university sector, especially in senior posts.3
Although research indicates many women are still facing obstacles to furthering their careers, others stress that they have not experienced difficulties and are happy with the choices they have made. “If I’d wanted a high powered medical career maybe I would have experienced problems. But I wanted a job in medicine where I could have a family and other interests, so I chose general practice,” says Dr Jenkins.
She believes the choice of whether to prioritise a family or career remains the real issue for women in medicine, because “women still can’t have it all.”
As to the lack of women leaders in medicine, Dr Jenkins says, “You can’t make women interested in medical politics if their priorities are elsewhere.”
Dr Brown believes many women doctors’ career choices are based on personal preferences. “Women are making decisions based around their family life and the fact they want a work-life balance,” she says.
And it’s not only women whose attitudes to medical careers are changing. Professor Selena Gray, former president of the Medical Women’s Federation and director of the Centre for Clinical and Health Services Research School of Health and Social Care, Bristol, says “the idea of sacrificing their whole family life for medicine is increasingly a position that neither men nor women want to take.”
Sir Bernard recalls how years ago there was a saying that summed up a male surgeon’s list of priorities—knife, wife, and life. “Now it’s changed to life, wife, and knife,” he says. With women and men in the profession demanding more from life than solely a career, Sir Bernard says, “We need to create a workplace that makes it easier for people to progress and to support those who have children to be able to work flexibly.”
What is crucial to enhance the quality of all doctors’ working lives is that everyone has the chance to fulfil their potential. As Professor Gray says, “It’s important for people to be able to achieve their ambitions and to be as good as they can be.”
Competing interests: None declared.