Do we still need to tackle discrimination against women in medicine?BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1759 (Published 11 April 2017) Cite this as: BMJ 2017;357:j1759
With the proportion of women in medicine reaching 50%, Abi Rimmer looks at whether there is still a need to campaign for gender equality in the profession
Women now make up nearly half of the medical profession. Figures published by the General Medical Council show that 46% of doctors on its list of registered medical practitioners were women.1 Last April, data from the Health and Social Care Information Centre showed that over 50% of qualified GPs in England were women.2
Jane Dacre, president of the Royal College of Physicians, says that despite gaining parity with their male colleagues in terms of numbers, female doctors are still treated differently in the workplace. “There is continued concern about unconscious bias, and there are areas of practice where women continue to be underrepresented,” she says. “In the physician specialties, the main areas of underrepresentation are clinical academia and cardiology.”
The medical workforce would also benefit from gender equality in leadership positions, Dacre says. “The medical royal colleges are well represented by women at the top and as presidents for the moment, but this is not the case for other leadership roles like medical director, or chief executive,” she says. “It is interesting to see that women are coming through in elected positions, but less so in appointed positions. This may be because of unconscious bias, but that is just my opinion.”
In May the Medical Women’s Federation (MWF), which aims to advance the development of women in medicine, will celebrate its centenary. The federation was founded in London in 1879 with nine members. In 1917 articles of association were drawn up and the federation was incorporated as a limited company. The initial membership was 190 and included some of the most distinguished medical women of the time, such as Jane Walker, Ethel Williams, Catherine Chisholm, Florence Barrett, and Louisa Aldrich-Blake.3
Unconscious bias is one of the reasons why organisations like the MWF still need to exist, Dacre believes. “We have had huge success in recruiting women into the workforce, but they have not quite reached parity with the careers of men,” she says. “They still need support and so the MWF will have a role into the future—probably forever.”
Henrietta Bowden-Jones, president-elect of the federation, says that the organisation is acutely aware that it needs to keep focused on the issues that matter to its members. At the moment, those include discrimination against women in the workplace, she says.
“There is discrimination in some areas of medicine but it is seen by trainees to be, at times, difficult to oppose because they fear for their job security if they are thought to be ‘causing trouble’,” she says. “Other members feel that women are squeezed into a tight behavioural path: being assertive and confident is something that they can be criticised and disliked for, however by being less vocal they will be seen to be lacking in confidence and less able.”
Lesley Regan, president of the Royal College of Obstetrics and Gynaecology, says that other issues facing female doctors today include being able to work flexibly and returning to work after maternity leave. “One of the things I want to do during my presidency is be positive and encouraging about getting women to come back into the workforce,” she says. “I’d like to find lots more ways, for when women have finished their maternity leave, of getting them back into the saddle and making them feel confident again.”
Scarlett McNally, consultant orthopaedic surgeon and Royal College of Surgeons council member, also believes that there is still a difference between how men and women are treated. “I fear that some senior medics interpret ‘equality and diversity’ badly,” she says. “They have got the message about equality—that is, not mentioning that there is a difference at a summative assessment. But they do not realise they also have obligations around diversity.
“They don’t realise that if a person is in their organisation already, they have to talk about diversity. They must support them. This means listening. It may mean having difficult discussions about what adjustments are needed to keep the employee working and happy. The MWF and Women in Surgery keep in people’s minds that there is a difference.”
Gender pay gap
In July last year, amidst the dispute over the junior doctors’ contract in England, the health secretary, Jeremy Hunt, announced that he would commission an independent report on how to reduce and eliminate the gender pay gap in the medical profession.4
The Department of Health says that it is working with the BMA and NHS Employers on this report and will shortly be inviting key stakeholders to form a steering committee. The report is expected to be published by the end of the year.
McNally says that there are two areas that need focus to reduce the gender pay gap. “Firstly, there are still assumptions made about what it takes to do a job; additional roles should be advertised with more notice and a fixed tenure,” she says. “Mentoring can help people identify what skills to develop to be ready for a future step.” She says that advertised roles need to be clear about how much time they will take up, whether there is travel involved, and what administrative support is available.
“Secondly there is a confidence issue; I have found that women are sometimes so exhausted by trying to push for minor adjustments to work—such as for less than full time training, flexible hours, or a location near a partner—that they can be poor at negotiating the salary that their work should command.”
Jenny Higham, chair of the Medical Schools Council, says that NHS organisations and universities should correct gender pay gaps where they exist. “Where there is obvious discrimination of course universities and the NHS have to correct for the factors that we have heard about many times, for example that men tend to push more for greater increments, that they have more self confidence.”
Higham says that it is outdated to assume that all women possess the same personality characteristics which contribute to them being paid less. “It is slightly hackneyed and old fashioned to think that all women possess the same innate, stable personality characteristics and all men possess this other set, when in fact the reality is far more blurred. There are some men who are equally trapped, invisible, or don’t progress in their careers.”
She adds, “The public sector now has to look at its pay differentials and correct for them, or at least have a narrative about why they exist. The reasons they exist are multifactorial but I think it’s really welcome that now we have to analyse that and report on it.”