Are women breaking down barriers to leadership roles in medicine?BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5685 (Published 26 September 2013) Cite this as: BMJ 2013;347:f5685
For years, men dominated medicine and women faced numerous obstacles to advancing their careers. Kathy Oxtoby finds those barriers seem to be breaking down, allowing more women clinicians to realise their full potential
Currently, women hold some of the most senior jobs within the profession, including Dame Sally Davies, chief medical officer, Clare Gerada, chairman of the Royal College of General Practitioners, and Sue Bailey, president of the Royal College of Psychiatrists, who was recently named one of Health Service Journal’s “most inspirational women in medicine.”
Gerada says there is “much to celebrate” about the progress women have made to become leaders in recent years. “Women now hold senior posts throughout the medical profession, and compared to industry—where only 3% of women currently head up FTSE companies—medicine is streets ahead,” she says.
But while there are more women in top positions, there is still a long way to go before they achieve equality in terms of having the same senior presence in medicine as their male peers. This is despite the fact that numbers of women outweigh those of men when they start out in medicine: according to the Medical Schools Council, in 2012 around 53% of the 7900 intake to preclinical medicine degree programmes were women.
Of the 14 presidents of medical royal colleges in the United Kingdom, just two are women, and the world of clinical academia remains dominated by men: in 2012 only 28% of clinical academics were women, according to the Medical Schools Council.
Certain specialties, such as surgery, still seem to be male dominated when it comes to taking on senior roles. Scarlett McNally, a consultant orthopaedic surgeon at Eastbourne District General Hospital and chair of Opportunities In Surgery, said in her paper published in February’s Bulletin of the Royal College of Surgeons that the profession is still largely populated by men. “Surgical training: still highly competitive but still very male,” stated that women account for 55% of those at medical school but only 7% of consultant surgeons.
The BMA does not release figures about the numbers of women on its committees, but Rafik Taibjee, chairman of the BMA’s Equality and Diversity Committee, says: “We still have some way to go to ensure women reach the highest positions in the BMA.”
The barriers women face to achieve senior positions in medicine are many and complex, and can be subtle as well as overt. Some specialties, such as surgery, are still dominated by men in senior roles because women don’t see them as being “family friendly.” “Specialties like surgery involve a lot of on-call work and unpredictable hours. Women tend to choose specialties that are more predictable and flexible to fit in with their family life, such as general practice,” says Jane Dacre, director of UCL Medical School and medical director of the MRCP (UK) examination.
Having a family can also impede women’s progress in taking on senior posts in medicine. Often women make the decision to have children and to take time out from medicine during their late 30s—a time when their male peers are taking advantage of opportunities to progress in their careers. And there is still a common perception within the profession that women can’t rise to senior positions while bringing up a family and must choose whether to dedicate their time to their children or to the profession.
“I was told when I was pregnant, by a clinical supervisor, that I ‘needed to sort my life out’—either go on with my career or bring up a family, but that it would not be possible to do both,” says Dacre.
For those women who do have a family, the bulk of childcare still falls to them rather than their partners, so it becomes a challenge to juggle home life while trying to further their career ambitions. “Women are still the ‘homemakers’ and if their child is sick invariably it is the mother that has to pick them up from school,” says Gerada.
Faced with these domestic responsibilities, and a lack of flexible working opportunities, women doctors may be deterred from climbing the career ladder, decide to put their ambitions on hold, or abandon them altogether, while their male colleagues are taking on the top posts in the profession. “It’s hard to be a grant-winning researcher or a top surgeon, and to be a wife and mother, organising the school run,” says Dacre.
Another barrier for women wanting to take on more senior roles is that there is still a “work dominated culture within the profession that favours men, which involves working unsocial hours,” says Beryl De Souza, honorary secretary of the Medical Women’s Federation and a clinical lecturer in plastic surgery at Imperial College London.
This may entail attending meetings or networking events outside typical working hours. “To get to the top of the profession you often have to attend functions outside work. And if you’re working part time this makes it particularly difficult to progress your career,” says Dame Carol Black, principal of Newnham College, Cambridge, expert adviser to the Department of Health on health and work, and chairman of the Nuffield Trust.
Lack of confidence is another barrier for women who want to rise to the top, Dacre suggests. “Men are more prepared to take a risk than women about their competencies to do a job,” she says. “And they will apply for a job when they may have fewer than the necessary attributes the post requires than women, who seem more reluctant to put themselves forward as candidates.”
This lack of confidence may be because women feel intimidated when there is a male dominated senior culture in their workplace. The councils of the medical royal colleges, for example, still consist mainly of men, “which can act as a barrier that prevents women applying for these places,” says De Souza.
Medical academia also continues to be predominantly male, says Sarah Stewart-Brown, professor of public health at Warwick Medical School, University of Warwick. “Medical research tends to be about male thinking—pills, genes, and operations, rather than, say, public health issues, which is thought of as being too fluffy.”
Women wanting to progress in medicine may be uncomfortable about taking advantage of networking opportunities to further their careers as often these are still confined to male oriented areas such as “bars, cricket clubs and the golf course,” says Gerada.
Faced with a boy’s club mentality, women doctors may be reluctant to put themselves forward for senior positions, particularly given the attitude of some male clinicians towards women.
One clinician, who asked not to be named, says: “I’ve heard a doctor say to a female surgeon ‘are you free to make tea love?’ and another say ‘are you free on Monday afternoon to operate or will you be going home to make some cakes?’ While this might have been meant as a joke, it doesn’t come across like that when you’re a woman working with a group of men. We need to get rid of this lads’ environment in medicine.”
These sorts of incidents can undermine women’s confidence to progress, and even those who have progressed experience challenges in what remains a profession where more men have power. “I’m still struck, even in my position, that it’s hard being a short woman among tall men, both metaphorically and literally,” says Gerada.
De Souza says that, for more women to attain senior roles in medicine, it is imperative that there are more diversity programmes, such as the Athena Scientific Women’s Academic Network (SWAN) initiative, which financially rewards universities that recognise women’s careers in areas such as medicine.
To highlight any sex bias towards men gaining senior roles in medicine, medical organisations should be more transparent about the numbers of male and female doctors in these posts “so that any imbalance can be monitored and addressed,” she says.
Dacre would like to see an equal number of men and women on appointment committees to help avoid any bias towards male candidates, which she believes still exists. “When I was academic vice president of the Royal College of Physicians and finishing my term of office there were no women on the ballot paper for my replacement. When I expressed my disappointment to a male colleague he said, ‘Aren’t there enough women already?’” she says.
Ensuring more women have opportunities to further their careers in medicine is not only about sex diversity initiatives and having equal representation on committees. De Souza believes a “change in the work culture” is also needed. “Equality should be a part of everyday working life, and simple steps, such as having meetings during the day rather than early evening when some have family commitments, would help to ensure no one is left out of the loop when important decisions are being made, and that everyone has a voice when concerns are being raised,” she says.
More role models and mentors are crucial to help women get to the top of the profession—an issue that the BMA plans to help deal with this year by celebrating senior female doctors’ achievements through, for example, news stories and web profiles, says Taibjee. Organisations such as the Medical Women’s Federation and the Women in Surgery initiative also offer support for female clinicians wanting to get ahead in medicine.
Ben Challacombe, consultant urological surgeon and honorary senior lecturer at Guy’s and St Thomas’ Hospitals NHS Foundation Trust, King’s College London, agrees that senior women role models and mentors can be “a source of inspiration for young women doctors as they can give advice, talk about their experiences, and encourage them to further their careers.”
Those women who do take time out of medicine to care for their families but are keen to further their careers at a later stage need to “keep their hands in” to ensure they still have a presence within the profession, advises Gerada.
“Don’t let things slip if you want a career in medicine while you’re bringing up your children. Keep up your networks, write an occasional paper, and attend meetings when you can. You have to be out there as you can’t expect to parachute straight back in to medicine after you’ve taken time out—you have to have a presence,” she says.
A positive attitude is essential to ensure women achieve the most from their careers, says Bailey. “I don’t see life as a series of obstacles, but as opportunities. It’s important not to get angst ridden about your sex, but to take those barriers out of your head and turn any adversity into an advantage.”
Of course, not all women working in medicine aspire to leadership roles and women should be able to make choices about their careers without feeling under pressure to achieve high level positions. Consultant ear, nose, and throat surgeon Helena Wilson, who works at the Royal Devon and Exeter Hospital, has three children and currently works part time “because I want to spend time with my family. I don’t have an ambition to be head of the RCS [Royal College of Surgeons], but I don’t feel oppressed either, as this is my choice,” she says.
Some male doctors would also like to have the choice to spend more time with their families but may feel forced to focus solely on their careers. “What I would hope to see in the future is equal support for men who wish to shoulder their share of domestic burdens,” says Neena Modi, professor of neonatal medicine at Imperial College London, vice president for Science and Research of the UK Royal College of Paediatrics and Child Health, and president of the UK Neonatal Society.
For both men and women, carving out a successful career in medicine can be challenging. It requires an ability to make tough decisions and it is hard work. While more needs to be done to support women to get to the top of the profession, once they do achieve that status the rewards are great. As Black says: “As with any profession, no one is going to hand you a top job on a plate. You have to be resilient, and sometimes you will need to make sacrifices. But being a doctor also offers so many possibilities and opportunities for women and men—it’s a glorious career and a privilege to work in.”
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.