In 2004, Professor Carol Black, who was then President of the Royal College of Physicians (RCP), asked whether the increasing number of women in medicine might lead to a loss of influence and downgraded professionalism. She called for equal numbers of male and female doctors, rather than more women, to preserve balance and professional status. A review was initiated to look at the likely impact on medicine of the increasing numbers of women in the profession. The result, Women and medicine: the future, a report prepared on behalf of the RCP, was released on June 3. It effectively slays some myths about women in medicine. “The facts that emerge from this research do not suggest an immediate crisis…in medical leadership”, states the report. Concerns about the feminisation, or demasculinisation, of medicine are not substantiated. In fact, with increasing numbers of both women and men entering medicine, the potential for leadership is secure.
The report does not address the position of medicine within society in any detail. It examines the four main areas of a medical career: entry, specialty preferences, modes of working, and advancement and leadership within the profession. In 2007, 57% of places to medical schools in the UK went to women, falling from 62% in 2003, but reflecting an overall steady increase from 24% in 1960. By 2013, it is likely that most general practitioners (GPs) will be women, and, by 2017, most doctors within the NHS will be women.
Of the 60 or so specialties within medicine, most female doctors choose those that offer predictable working hours or greater patient interaction, such as general practice, psychiatry, and paediatrics. Clinical genetics, dermatology, palliative care, and genitourinary medicine have more female than male consultants aged under 45 years, whereas fewer than 25% of these younger consultants are women in the more acute specialties of cardiology, gastroenterology, and renal medicine. 10% of consultants in surgery under 45 years are women.
Most NHS doctors work full time; 15% are on part-time contracts. However, taking into account career breaks and part-time work in the 15 years after graduation, women on average provide 60% of a full-time equivalent role, compared with 80% for men. There is no evidence to support the view that women are more likely than men to leave medicine.
There is also no evidence of lack of progression of women within their medical careers. In 2007, women held the majority of specialist training positions in most medical specialties including general practice. 47% of those achieving consultant positions between 30 and 34 years of age are women compared with 20% of consultants over the age of 55. Given the increase in consultant positions available with the drive to consultant-delivered patient care, the prospects for women and men reaching consultant level are good. In contrast to other professions such as law and accountancy, many medical specialties offer an excellent chance of reaching consultant level, or becoming a principal in general practice, and working part-time.
However, few women are medical directors of NHS trusts or chair professional executive committees on primary care trusts, a woman has yet to become president of a surgical royal college, only 12% of clinical professors are women, and six medical schools had no female professors in 2006. Women remain substantially underrepresented in academic medicine, particularly in senior positions, and in science more generally, in the UK and the USA. Lack of female role models, mentors, and few women on appointment committees have been identified as important barriers to progression in academia, together with insufficient support for flexible working from academic leaders.
Clearly there is room for improvement in ensuring that women reach these most senior appointments in clinical and academic medicine, if that is what they choose to do. Part-time work or career breaks should not be a barrier to career progression, and those on appointment committees must do more to promote different modes of working and refuse to allow discrimination against part-time workers or salaried status GPs.
Delivery of the best possible patient care, by those most motivated to do so, needs careful workforce planning, increased medical school entry, and allowance for specialty choice and flexible working. The impact of the European Working Time Directive on training and career development has yet to be fully appreciated, but undoubtedly more doctors are needed, and there is no reason to change the current merit-based selection process. So long as the total number of doctors continues to increase, providing a larger pool of talent, the medical profession should be secure in the hands of both women and men.
For more information on women in academic medicine in the UK see Women in Academic Medicine: developing equality in governance and management for career progression. April 2008. http://www.bma.org.uk/images/Womenacademicmedicine_tcm41-178228.pdf.
For more on women in science in the USA see http://www.nap.edu/openbook.php?record_id=12062&page=1
The Lancet
The Lancet
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