Medicine—a woman’s world?BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.d8234 (Published 05 January 2012) Cite this as: BMJ 2012;344:d8234
- Maham Khan, Clegg scholar, BMJ
Maham Khan considers whether the rising number of women in UK medicine is leading to “overfeminisation”
Scandal broke out in 2004, when the then president of the Royal College of Physicians in London, Carol Black, was quoted as saying, “We are feminising medicine. It has been a profession dominated by white males. What are we going to have to do to ensure it retains its influence?”1 This sparked headlines of “Women docs weakening medicine” and was further aggravated by a report from the Royal College of Physicians showing that most of the medical workforce will be female by 2017.12
Elizabeth Garrett Anderson was the first woman to graduate as a doctor in Britain, and 2011 marked what would have been her 175th birthday,3 but the press has dubbed the rise in women doctors as “worrying” rather than celebrating her legacy and women doctors’ road to equality.4 Headlines warn the public that a female future is one of “shortages in critical areas”5 and “bad for medicine.”4 In times where gender equality prevails in many personal philosophies, this leaves difficult questions unanswered. Is medicine becoming overfeminised? Is having too many female doctors bad practice?
A pink profession
Looking at the figures shows that the picture is unambiguous. Not only are women doctors to outnumber their male counterparts in the UK by 2017, in general practice this will happen in the next four years.6 Entry data from medical schools show that over the past four decades the number of men entering medicine has doubled whereas the number of women has increased 10-fold.7 This increase means that women are in the majority across UK medical schools, with acceptance rates of 56% women in 2010.8
The number of women at the other end of the professional spectrum is also increasing. Jane Dacre, medical school director at University College London, says, “At the moment 28% of consultants are female. When the 2007 female cohort [of specialty trainees] become consultants, female consultants will be 55% [of the workforce]. So feminisation is a fact. There is a tsunami of women coming through.”
However, she disagrees that medicine is becoming overfeminised, pointing out that the male domination of medicine escaped the headlines for centuries. She said, “For 500 years men have dominated the medical profession, and that has been seen as the status quo, but as soon as there’s a sniff of women dominating the profession there is a crisis. Caring for the sick was taken over by men with the advent of the royal colleges. It became prestigious, and with that the power basis was handed to the men, who decided who could join the colleges and who couldn’t.”
Raising the issue of gender equality, Professor Dacre proposes that the rise of women doctors is bridging the gender divide rather than overfeminising the profession. “Women are becoming consultants, and we are reaching equality in medicine. There are female medical leaders emerging—however, I don’t think we have yet reached an era of overfeminisation. What we are doing is reaching equality. Are we overfeminised in 2011? I think not yet,” she said.
A disruptive innovation
Speaking recently at the Royal Society of Medicine, Jean McEwan, a professor of clinical education and consultant cardiologist, compared the rise of women in medicine to that of a disruptive innovation. She describes a disruptive innovation as a concept or a product that comes into the business market targeting an area underprovided for, at a lower profit margin. Generally, the product begins to take off slowly.9 As the concept evolves it improves rapidly, in time becoming the dominant system.
This novel approach aptly describes some of the complex issues facing women in the workforce. Many studies show that women dominate in specialties such as general practice, paediatrics, and palliative care.810 Using general practice as an example, Professor McEwan explains that this is because “general practice has been underprovided for, therefore the alternative to not having women in general practice was to have nobody. Women have been able to enter the market as there was a great need for women to act as a disruptive force. And these are also areas where workload can be more predictable.”
Professor McEwan says, “Despite the fact we have so many doctors who are women, some branches remain closed or unattractive to women. For example, in my own area of cardiology [and others, such as] gastroenterology, and certainly general surgery, there are very few women who are consultants.” She maintains this is not because of the commonly held belief that women are held back in their careers by taking time out to have a family. She says, “If you look at the numbers of women coming through the profession [over the years], one would expect that somewhere between 25% and 40% of women would be in the higher leadership roles by now, notwithstanding the fact that some of us have to take time out to have our children.”
Part of the reason why women are not reaching higher leadership roles can be explained using her disruptive innovation model, where men are modelled as the “mainstream.” Professor McEwan says, “Unfortunately for us, leadership is mainstream business and disruption will be resisted. Despite improved and increased leadership, prevailing leaders will appoint those like themselves.”
A profession still sexist?
Other prominent professors also agree that women are not reaching the highest positions. Speaking on gender inequalities in surgery, Helen Fernandes, consultant neurosurgeon at Addenbrooke’s Hospital, Cambridge, discussed how at each stage of surgical training the number of women applicants halves. It might not be as simple as men limiting access to the top jobs, however.
Professor Dacre says, “Although women make up the majority of the medical student population they are still under-represented at the top. Some of that is thought to be women not stepping up to the plate and investing in the time and effort it takes to get the top jobs. This might be because they have an evolutionary predetermined view of themselves that they do not want to be leaders. Biodeterminists believe that to be the case.”
Tackling the glass ceiling
Research shows that, unfortunately, a sex pay gap still exists in medicine.11 Anita Holdcroft, emeritus professor of anaesthesia at Imperial College London, is one of the few doctors to have done research in this area. She explains that although some of the discrepancy can be accounted for, up to 5% is unexplained. She says, “Women are obviously working longer hours for less pay than men. Research shows that women often feel uncomfortable in negotiations over pay. But yet they are doing the work. And the percentage of women who apply for clinical excellence awards is less than men. What we want to do is think about how to overcome some of these gender barriers. In other words, how can women become visible?”
Parveen Kumar, president of the Royal Society of Medicine, puts forward the case that some of the onus is on women to make themselves visible. “One of the things about distinction awards, for example, is women just don’t like to apply. They don’t want to be seen as putting themselves forward. By and large the men will push themselves forwards.”
Although we might be diagnosing overfeminisation against a background where sexism is prevalent, one question remains unanswered: why are men becoming an endangered species in medicine?
No longer a profession of mankind
Will Coppola, a senior lecturer at University College London, has tried to tackle this question. He suggests that the problem starts at secondary school: “There is a serious problem with underachievement of boys at school. White working class boys are the lowest achieving out of all groups at GCSE apart from Travellers. [Research] suggests there was a period where men were being disadvantaged in medical school selection.”
He also puts forward the explanation that medicine is becoming a less attractive career option for men for a number of reasons. “[Men are] finding careers in the city, finance, IT [information technology] a more attractive prospect. Loss of status, regulation and control, and decreased autonomy—things many people may feel they identify in medicine as a career—are having a relative impact on career attractiveness to men.” The BMA cohort study of 2006 supports his reasoning. It looked into people’s motivations in studying medicine and found that men place a greater emphasis on status and income than do women.12
To improve male representation, Dr Coppola suggests, “We need to focus on improving boys’ achievements at school—perhaps maintain some of the different features that attract different people. There is no harm doing it where it overlaps with gender, as long as we do not behave discriminatingly or fail to offer equal opportunity.”
Dr Coppola also mentions an important factor in counteracting the dominance of women in medical school: male graduate entry students. He explained that although women outperform at the undergraduate level, men who have done a previous degree are much closer in ability to their female colleagues. He says, “Graduate recruitment is one of the ameliorating factors for men in terms of their disadvantage in applying for medical school.” He warned, however, that impending changes in tuition fees would discourage graduate entry into medicine, effectively reducing the pool of academically able men entering medicine.
Is a female future bad practice?
Despite the fears propagated by the media, more women in the medical profession could lead to safer practice. A review of complaints received by the National Clinical Assessment Service (NCAS) shows that women are less likely to be subject to disciplinary hearings. Over eight years, 490 male doctors were banned from seeing patients, compared with just 79 women.13 Commenting on the study, Rebecca Field from NCAS said that women take a more caring and cautious approach [to patient care].13
Although they might make safer doctors, gender segregation of women into specific specialties could cause problems for patients, particularly in general practice.
Dr Coppola says, “Both men and women show gender preferences, particularly for intimate examinations. The recent evidence shows the male preference for male doctors is stronger than the female preference for females. Interestingly the gender preference in a GP consultation is stronger than with a hospital consultant.”
Whether or not medicine is now overfeminised, underfeminised, or emasculated, one thing to consider, eloquently summarised by Dr Holdcroft is that “medicine is not a profession of gender equality.” However, findings published in a report from the Equality and Human Rights Commission highlight the progress of women in medicine. With the report saying it will take women 55 years to reach equal status with men in the senior judiciary and 73 years for women directors in FTSE 100 companies,14 it seems that in terms of numbers female doctors have made giant leaps for womankind.
From the Student BMJ.
Competing interests: None declared.