Technical ReportPDF Available

Women doctors: Making a difference. Woman Doctors: Making a difference. Report of the Chair of the National Working Group on Women in Medicine

Authors:
Report of the Chair of the
National Working Group on Women in Medicine
Presented to Sir Liam Donaldson,
Chief Medical Officer
October 2009
Women doctors: making a difference
DH INFORMATION READER BOX
Policy
HR/Workforce
Management
Planning
Clinical
Estates
Commissioning
IM & T
Finance
Social care/Partnership working
Document purpose Policy
Gateway reference 12718
Title Women doctors: making a difference
Author Baroness Deech
Publication date 13 October 2009
Target audience SHA CEs
Circulation list Royal Colleges, Deaneries, PMETB, GMC, BMA,
Equality and Human Rights Commission, ACCEA,
Conference of Postgraduate Medical Deans
Description In August 2008, the Chief Medical Officer asked
Baroness Deech to chair an independent National
Working Group to look at the position of women
in the medical profession. Their report considers
the current situation, reviews existing work and
recommends a programme of action to improve
opportunities for women in medicine.
Cross-reference N/A
Superseded documents N/A
Action required N/A
Timing N/A
Contact details David Winks
CMO Private Office
Room 114, Richmond
79 Whitehall
London SW1A 2NS
020 7210 5853
House
For recipient’s use
1
Contents
Foreword 2
Open letter from the Chair of the National Working Group on Women in Medicine 4
Chapter 1: Executive summary of recommendations 7
Chapter 2: The current situation 11
Chapter 3: Barriers to success 23
Chapter 4: Recommendations and their rationale 36
Annex 1: Recommendations of previous reports 46
Annex 2: Terms of reference of the National Working Group on Women in Medicine 52
Annex 3: Chair of the National Working Group 53
Annex 4: Membership of the National Working Group 54
Annex 5: Evidence collected 66
Glossary 67
References 68
2
Foreword
Since 1997 there has been a radical expansion of the medical workforce in the United Kingdom. As outlined
in the NHS Plan in 2000, this was initially achieved by welcoming qualified doctors from abroad to work
within the NHS. However, it was always the intention that, in the longer term, domestic supply would be
increased through an expansion in the number of places at medical schools within the UK. This expansion is
now complete, and the number of places at medical schools has increased from 5,062 in 1997/98 to 8,148
in 2008/09.1 The first tranche of this new generation of doctors has now entered the medical workforce as
junior doctors.
The number of women entering medical school has increased significantly – from 492 (24.4% of the total
admissions) in 1960/61 to 4,583 (56.2% of the total admissions) in 2008/09.2 This is a remarkable achievement
considering that women were actively prevented from becoming doctors a few decades ago. Despite this
increase in women entering the profession over the last 20 years, few have reached senior leadership
positions. The issues that have traditionally been associated with women in the workplace are going to
become increasingly pronounced for the NHS, and it is of paramount importance that we address them now.
Many of the issues faced by the profession are equally pertinent to other healthcare workers. Indeed, they
are not unique to medicine. However, unlike other professions, the constantly changing nature of practice –
as well as the demands, both physical and emotional, of caring for patients – brings additional concerns for
those responsible for ensuring a stable workforce. If we do not make provisions to ensure that the
workforce is able to meet patient expectations and professional and academic requirements, then the UK
will face a dramatic shortage of working doctors in the future. These doctors are likely to be lost to the
profession when they are at a crucial stage in their careers – a stage when neither the patients they care for,
nor the more junior doctors who rely on them for advice and support, can afford the loss.
In recent years, there has been considerable debate and discussion, and a number of studies have looked
into the issues surrounding women in medicine. These studies have, in the main, focused on the barriers in
particular specialties, such as surgery, or particular work areas, such as academia. I commissioned the
National Working Group on Women in Medicine to review all these reports and to draw out the common
threads in order to recommend a programme of action to improve opportunities for women in every field
of medicine.
The issues raised are not new – nor perhaps are they unexpected. But to tackle them is going to require a
step change in how the medical workforce as a whole behaves. It will require an acceptance of alternative
and differing patterns of working and training for all medical staff, not just women. Wider changes in
society, such as some men choosing to become the primary child carer, mean that the recommendations in
this report are proposed not just to provide opportunity for women but to offer better options to the entire
medical workforce. In my 2006 Annual Report I identified that ‘the problem is not access to medical school
but rather how we ensure that the female medical workforce is able to fulfil its potential once in
employment’. It has become clear during the deliberations of this group that it is not just women who are
affected by these issues. It is my hope, therefore, that this report will address the situation for both men and
women doctors to create a more equitable pattern of work, recognition and reward.
3
I am grateful to have received the report and recommendations of the National Working Group on Women
in Medicine from Baroness Deech, the group’s Chair. I would like to thank Baroness Deech and her working
group colleagues for the effort that they have put into a complex area, the enthusiasm with which they
tackled the challenge and the hard work involved in producing such a comprehensive review.
The report contains a summary of the current situation facing doctors. The recommendations are focused,
and the potential benefits are clear to see. Greater access to mentoring, recognition by the medical Royal
Colleges that time alone does not indicate competence to practise independently, and improved feedback
from the Clinical Excellence Awards scheme are all designed to help every doctor realise their potential.
There are recommendations for additional support with childcare and for improvement in the opportunities
for alternative working patterns. Each will require careful consideration as to how they can best help to
achieve greater gender equity at the senior levels of the medical profession, and, more fundamentally, how
they would ensure that good doctors are not lost to the NHS on account of problems that can and must
be resolved.
I am very pleased to see that this report is a celebration of the successes to date of women in medicine.
In recent years, important steps, such as the NHS Childcare Strategy, have been taken to address the
demands in creating a workforce that meets clinician needs without compromising patient care and,
indeed, expectations. This report is a blueprint for how these pioneering steps can be continued and their
aims achieved.
It will take time to bring about the changes envisaged in the report. As a result, careful monitoring will be
required to ensure that progress occurs and that the drive for implementation is maintained, despite the
many competing priorities that continually challenge the NHS. It is for this reason that I am pleased to
announce that I will hold an annual review meeting to assess the landscape for women in medicine. This
meeting will provide an opportunity to review progress and ensure that additional efforts are made to
guarantee continued success. Women fought long and hard for entry to medicine; it will require continuous
commitment and effort to ensure that they fulfil their potential.
Sir Liam Donaldson
Chief Medical Officer, England
4
Sir Liam Donaldson
Chief Medical Officer, England
Dear Sir Liam
In August 2008 you asked me to chair the National Working Group on Women in Medicine. I was pleased
to accept your offer. This working group developed from the chapter in the 2006 Annual Report of the
Chief Medical Officer, Women in Medicine: Opportunity Blocks. Just over 150 years ago, women had to
fight to be allowed to enter medical schools. Today just over half of new medical graduates are female.
We have had the advantage of reading the Royal College of Physicians’ report of June 2009, Women and
Medicine: The Future,3 which presents a high quality analysis of the relevant data and points out that the
rising number of women doctors needs to be incorporated into the workforce in an effective and productive
manner. Changes in working hours, career expectations and demand are issues that cannot be ignored.
Many of the changes that women need in order to remain in medicine are equally sought by younger male
doctors. These issues are not a problem unique to medicine; however, it is particularly problematic in
medicine, because of patients’ need for 24-hour care. A more user-oriented service is also rightly focusing
on patient demand for continuity in some medical situations. This creates a challenge: more choice for
doctors means less continuity of care for patients. Our aim is to make it more possible for women to work
full time, whilst maximising the advantages of part-time work and training, when need be, along with parity
of esteem for it.
You invited a formidable team of male and female doctors, from a variety of backgrounds, so as to cover
the broad spectrum of issues that gender and medicine create. You asked the Women in Medicine working
group to consider the current situation, review existing work and consult widely, and from this to create a
programme of action to improve opportunities for women in medicine.
As the workforce in medicine changes, new challenges are arising – at medical student level there is a need
to encourage a diversity of applicants. As the workforce becomes more female there is the risk of following
other professions, where rising numbers of women have led to devaluation of the professional status and
sometimes salary levels. The most recent research shows that, with the current level of influx of doctors
from overseas, the gender balance in medicine in the UK is moving towards equity.
With an investment of nearly a quarter of a million pounds in every doctor, male and female, to take them
through to full registration at the end of their Foundation 1 year, it is incumbent on the NHS to adapt to
ensure that these precious resources are not lost but that they stay working for an organisation in which
they feel valued and in which they can achieve their professional ambitions, providing good care for their
Open letter from the Chair of the National
Working Group on Women in Medicine
5
patients. No doctor should be wasted because they cannot find a place in the system that is compatible with
their other roles as a parent and partner, and no doctor should be lost to medicine because of obstacles in
the way of finding the right professional placement. We should make our goal a profession where every
woman and every man goes as far as they wish and as far as their talents permit. The final judgement as to
the success of the implementation of the recommendations of this report will lie in retention of doctors
within the system, both men and women.
Our report traces the obstacles to the full exercise of every doctor’s potential – from the decision at school
to study medicine, through training, work, maternity leave, childcare, progress through the profession,
possibly into positions of leadership and acknowledged excellence, to retirement and pensions – with special
emphasis on the choices and problems that women face, though increasingly in today’s world they are
shared by men. Much of what we describe is not newly discovered. There have been several reports on the
progress of women in medicine in recent years. We asked ourselves why the situation had not changed,
why there was still discontent, and we have surmised that previous reports had focused on the desired
outcomes rather than on the necessary levers of change to achieve them. So our report focuses very much
on the implementation of change. The recommendations are narrow and targeted primarily in three areas:
The first is aimed at improving the existing structures so that there is better advancement to certain
crucial career turning points as well as different ways of working.
The second area is concerned with ensuring that new processes such as revalidation have the flexibility
and capacity to accommodate doctors who may not be conforming to the usual working patterns.
The final area is concerned with providing additional support for the practical realities of caring for a
child or a dependent relative.
The list may seem short, but change will not happen overnight, and to maintain the momentum for
successful implementation will require a commonly agreed set of goals that are achievable regardless of the
shape of broader issues in the healthcare landscape that might be faced in the future. Where possible we
have also tried to ensure that there is a single body accountable for the implementation of each
recommendation so that there is a clear expectation of who will be responsible and accountable.
We have worked closely with colleagues within the Workforce Directorate of the Department of Health,
the Department for Children, Schools and Families, and the Treasury. We have taken evidence from a wide
range of people: academics, trainee and trained clinicians, regulators, patients and NHS managers. All
stakeholders with whom we have engaged have shown understanding of the complexity of these issues,
and commitment to addressing them. There is a clear recognition that, however difficult it is to focus on
these concerns, they must be tackled.
6
I was impressed by the quality and dedication of the women doctors whom I was privileged to meet during
the course of compiling this report. I saw how they made difficult choices in career and family situations,
and I admired their commitment to medicine and their resilience. It was heartening to realise that some
senior men in the medical profession appreciate this too.
I realise that the situation in the UK is not unique. Our extensive examination of the international
experience has shown clear examples of best practice, but no single country has solved this issue to date.
Given the illustrious history of women in medicine in the UK, it is fitting that the UK is seen to lead the way
on this issue at a national level. I therefore commend to you this report of the Women in Medicine working
group and its recommendations.
Baroness Deech
Chair, National Working Group on Women in Medicine
October 2009
I am deeply indebted to Dr Vivian Tang, Dr Claire Lemer and James Ewing for their work on this report.
7
Chapter 1:
Executive summary of recommendations
1.1 Recommendation 1: Improve access to mentoring and career advice
1.1.1 In the next round of contract negotiation there should be an explicit facility for appropriately
trained and skilled doctors (usually consultants) to undertake mentoring or career counselling as
a programmed activity within their job plan.
1.1.2 To facilitate accessing mentoring or career management support, the future commissioners of
medical education should maintain a register of all doctors who are skilled and are willing to
undertake these tasks and make it more accessible to other doctors.
1.2 Recommendation 2: Encouraging women in leadership
1.2.1 Appointments to NHS, academic and clinical committees and boards should be advertised widely
and have a transparent and democratic process rather than simply an appointment by nomination.
1.2.2 Committees should be encouraged to develop their ways of working to enable greater
participation by doctors who are parents or carers.
1.2.3 There should be increased access for women to the committees and boards of major medical
institutions, including the medical schools, postgraduate deaneries, medical Royal Colleges,
NHS trusts and other NHS bodies. The Equality and Human Rights Commission should consider
auditing the appointments process for all such posts at these institutions, as they consider
appropriate, to assess whether sufficient opportunity has been created to increase access for
women to these respective organisations’ committees and boards.
1.3 Recommendation 3: Improve access to part-time working and flexible
training
1.3.1 The postgraduate deaneries should maintain a list of doctors wishing to train part time in a
slot-share arrangement.
1.3.2 NHS Employers should develop guidance for meeting the costs of continuing professional
development, including for those who are working less than full time.
1.3.3 The development of credentialling should be expedited, and there should be full recognition by
the medical Royal Colleges that time alone does not indicate competence to practise
independently.
1.3.4 The aspirational quota for part-time training should be abandoned in favour of a needs-assessed
availability by strategic health authorities (SHAs). The newly formed Centre for Workforce
Intelligence should be commissioned by each SHA to provide this needs assessment on a regional
basis, and provision should be made to meet it.
8
Professor Stephanie Amiel
RD Lawrence Professor of
Diabetic Medicine, the first Chair
in this field
1.4 Recommendation 4: Ensure that the arrangements for revalidation are clear
and explicit
1.4.1 The General Medical Council (GMC) and the appropriate medical Royal Colleges should ensure
that they have a clear set of re-licensing and recertification standards and assessment processes in
place for doctors who have taken time out of training or the profession to return to work.
1.4.2 Responsible officers should coordinate refresher training for those who have taken time out of
training to meet these standards. There should be funding for this within the NHS budget.
1.4.3 Trusts should offer ‘back-to-work’ and ‘taster’ sessions where those who have taken a career
break can shadow working doctors to re-familiarise the doctor with procedures and work patterns,
so that they are confident on return.
1.4.4 The Postgraduate Medical Education and Training Board (PMETB) and the GMC should ensure
that women in non-training grades receive support in applying for entry to the specialist register.
1.5 Recommendation 5: Women should be encouraged to apply for the Clinical
Excellence Awards scheme
1.5.1 The Advisory Committee for Clinical Excellence Awards (ACCEA) should provide greater feedback
to applicants and advice as to where additional development might be necessary.
1.5.2 ACCEA should develop a network of mentors who can be approached for advice. This should be
coordinated with the wider career advice programme.
1.5.3 Selection panels should be gender balanced wherever possible; due consideration should be given
to part time applicants, and ACCEAs processes should be monitored for gender equality.
1.5.4 The same encouragement should be applied to local awards, if any, and monitoring information
from all trusts should be collected centrally for gender analysis.
1.6 Recommendation 6: Ensure that the medical workforce planning apparatus
takes account of the increasing number of women in the medical profession
1.6.1 NHS Medical Education England (NHS MEE) and the Centre for Workforce Intelligence should
ensure that workforce models for the future clearly delineate the effect of a rising number of
women in the workforce so that appropriate advice for the workforce planning apparatus can
be given.
9
1.6.2 For training, NHS MEE should commission the medical Royal Colleges to develop innovative
solutions to these challenges. It is also noted that NHS MEE is conducting a review into the
challenges that are presented by the European Working Time Directive, to improve the quality of
training in reduced training opportunity circumstances, and this should address the particular
issues for women.
1.6.3 The Centre for Workforce Intelligence should approach the GMC to discuss ways of tracking
careers effectively through GMC numbers to allow accurate data to be collected to inform
workforce modelling.
1.7 Recommendation 7: Improve access to childcare
1.7.1 The Conference of Postgraduate Medical Deans of the United Kingdom and the Department of
Health should consider whether the model such as that in place in the North Western Deanery,
which commissions a lead employer for all specialty trainees in the deanery, would be a practical
and desirable model in the new education commissioner/provider landscape. The additional
benefit of better facilitating access to government assistance for maternity benefits and childcare
of this model is clear.
1.7.2 Postgraduate deaneries or their lead employers should plan ahead for the childcare needs of their
trainees and facilitate arrangements between a trainee and the trusts during his or her rotation for
access to childcare provision.
1.7.3 Trusts should appoint a childcare coordinator within their human resources department if they
have not yet done so.
1.7.4 Childcare coordinators should develop internet resources to act as both an information resource
and message boards on local childcare options, including emergency cover.
1.7.5 NHS trusts should engage with local authorities as key employers to ensure that local authorities
fulfil their legal responsibility to ensure that the childcare needs of their population are met. NHS
Employers should begin a programme of work to advise and coordinate NHS trusts to achieve this
and help spread best practice.
1.7.6 NHS Employers should draw up guidance on good practice on what additional provision NHS
trusts should make for childcare allowances for unavoidable unsocial hours of work.
1.7.7 Hospital-based childcare should move to extended opening hours. NHS Employers should host a
conference of childcare coordinators with the objective of identifying how this and the specific
needs of doctors can be achieved.
10
Dame Josephine Barnes
First female president of the
British Medical Association
and leading obstetrician and
gynaecologist
1.7.8 The Department of Health should explore the costs and benefits of doctors (and other
healthworkers in similar circumstances) who are parents paying for full-time or part-time childcare
as a value-for-money solution for enabling doctors to progress their careers. On the basis of this
analysis the Department should submit a case to the Treasury to allow doctors to pay for childcare
from their gross earnings. In addition, it should establish whether any central funding might be
available for childcare assistance. The working group believes that this is fundamental to ensuring
that all doctors can fulfil their potential.
1.7.9 The Centre for Workforce Intelligence should urgently model the effects of greater female
participation in general practice and the potential costs of maternity cover. Contractual changes
should be considered based on this modelling to compensate maternity leave should it be
required.
1.8 Recommendation 8: Improve support for carers
1.8.1 All postgraduate deaneries or their nominated lead employers and NHS trusts should have a lead
person responsible for supporting carers.
1.8.2 The NHS should join Employers for Carers and benefit from the financial advantages conferred
when adopting carer-friendly employment practices. Doctors who are family carers have particular
difficulties with long, unpredictable and inflexible hours of work.
1.9 Recommendation 9: Strenuous efforts should be made to ensure that these
recommendations are enacted through the identification of champions
1.9.1 Trusts should identify a non-executive director to have responsibility at a local level for improving
working patterns, giving advice and handling complaints. The director should work closely with a
lead consultant for workforce planning.
1.9.2 Royal Colleges should follow the example of the Royal College of Psychiatrists and develop
gender equality plans.
11
Chapter 2:
The current situation
2.1 Meeting the future with an increasingly female workforce presents us with a series of challenges;
however, many of these are not unique to medicine. Lessons can be learnt from other professions
that have undergone or are undergoing similar demographic shifts. Evidence from other
professions that have seen similar demographic change, such as teaching or law, suggests that this
workforce change may be accompanied by a decline in the esteem in which the profession is held
and that it is often coupled with a reduction in remuneration, as evidenced by the existence of a
gender pay gap. Research from the Law Society salary survey in 2007 shows that female salaried
partners earned an average of £46,999, whereas their male colleagues earned £80,000.4 In
addition, only 45% of women solicitors of 10 years’ standing in private law practice are partners,
compared with 65% of men.5 A report from the New Zealand Council for Education Research also
raises an important issue: that the mostly female teaching profession may have led to the
profession becoming less attractive to men.6 Evidence also suggests that, with an increasing
number of women, the prestige and income associated with the profession is lowered.7
2.2 In many respects the story of women in medicine in the NHS is a success. In 1948, women
accounted for less than a fifth of the medical workforce; today they account for approximately
41% of the workforce, and that figure is rising. Over the past 10 years, women have been
increasingly competitive and successful in the medical workforce. Within the overall bubble of
expansion of the medical workforce, the total number of women has nearly doubled. With 57%
of medical school entrants now women, the medical profession is likely to be the first previously
male-dominated profession to achieve parity.
2.3 Women with scientific interests seem increasingly keen on medicine. Similarly qualified men
choose other scientific careers, particularly information technology and engineering. The
proportion of workers in science, technology, engineering and mathematics who are women has
barely risen, from 18.4% in 2001 to 18.5% in 2006.8 Furthermore, only 25% of women with
degrees in these subjects are employed in the respective professions.9 In engineering, women
make up only 3% of Modern Apprenticeships.10
2.4 Further up the ladder in medical specialties, the number of women becoming consultants is
increasing in line with the overall rise in the total number of women joining the medical
profession. Nevertheless, whereas at lower grades women account for between 44% and 59%
of the workforce, at consultant level they account for only 28%. An attrition rate between the
grades is evident, which has remained stable (see Figure 1). This is partly due to the function of
time, in that as the pool of women grows so too will the number of women at the more senior
grades, but given that women have represented 50% of medical students since 1991 the impact
should have been greater by now.
12
Dr Elizabeth Blackwell
First female doctor in the United
States
Figure 1: Attrition rates between grades of female doctors as a percentage of the workforce
0
10
20
30
40
50
60
70
Percentage
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Consultants
Registrars
SHO/F2
HO/F1
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.5 One explanation is that in 2007 the mean age of a mother in the UK for all births was 29.3 years,
the age coinciding with the timeframe at which a female junior doctor might be expected to be
reaching the final stages of achieving her Certificate of Completion of Training (CCT). Women
graduating in the early 1990s would therefore be at the stage of their lives where many are taking
career breaks or working part time to care for children. It may thus be that the effect of the 1987
expansion would not be seen for another 5–10 years.11
2.6 However, what does seem to be clear is that despite the global increase in the medical workforce,
some trends present worrying evidence of a series of obstacles in the system for women. These
obstacles seem to be leading women to make decisions regarding their careers that are perhaps
compromises rather than choices. These compromises might well deny the medical profession and
the NHS of valuable talent and skills in more specialist areas because those obstacles, or perceived
obstacles, have not been addressed by those who have the power to address them.
2.7 Looking at the number of additional specialist registrars over the last 10 years, for example, shows
that the number of additional men appointed and the number of additional women appointed is
roughly the same. However, the number of newly appointed consultants in the same period shows
a much greater disparity. The increase in doctors’ numbers has not been evenly distributed
between the sexes at consultant level despite parity having been achieved at the specialist registrar
level (see Figure 2).
13
Figure 2: Comparison of the number of additionally appointed male and female specialist
registrars, 1997–2007
0 2,000 4,000 6,000 8,000 10,000
SpRs
Consultants
Women
Men
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.8 Simultaneously, in the staff and associate specialist (SAS) grades the number of women is
disproportionately high. As of 2007, women who graduated from UK medical schools
outnumbered their male colleagues and, indeed, female international medical graduates (IMGs).
The Royal College of Physicians’ report Women and Medicine: The Future12 explains in paragraph
3.60 how the percentage of women in the UK medical workforce may be affected by the numbers
of IMGs in the NHS workforce.
2.9 In general practice the situation is slightly different. Many women seem to have chosen to move
into the specialty in the last 10 years, and the global rise is almost exclusively female. There are
also far more women GP registrars than men. General practice is in many ways a success story for
women in medicine, with increasing numbers of women choosing this specialty and succeeding.13
However, within this overall story lurks a more complex and less positive one. Currently only 46%
of GPs are partners; of those who are not partners, 76% would like to achieve partnership.
Despite the majority of GPs in partnerships believing that they have a responsibility to make this
happen, 66% of GPs believe it is now more difficult to take on new partners. This is borne out by
the fact that a majority of GP partnerships (69%) have no or only one partner aged under 40.
14
Dame Fiona Caldicott
First female president of the Royal
College of Psychiatrists
Figure 3: Comparison of the total GP and GP registrar population, 1997 and 2007
0
5,000
10,000
15,000
20,000
25,000
30,000
1997 2007
Women
Total GP population GP registrar population
Men
0
500
1,000
1,500
2,000
2,500
3,000
1997 2007
Women Men
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.10 Equally, the number of GP providers has remained the same and the number of GP partners who
are women has increased only slightly (see Figure 4). GP providers include GP partners, single-
handed GPs and GP shareholders.
15
CASE STUDY: A GP PARTNER MANAGING MATERNITY LEAVE
I joined my practice when I was pregnant with my first child. I was in the ‘right place at the
right time’ as I was doing a locum for a GP who then took early retirement, so the practice was
keen to appoint a new partner as soon as possible. There were two partners who were
definitely vital in my success in becoming a partner and going on to have four maternity
leaves. The male senior partner was a delightful man, much loved by patients and colleagues,
and very ‘pro women’. There was one female partner, who had managed two pregnancies in
general practice and was extremely supportive. I started as a half-time partner, doing five
sessions a week and half the on-call commitment. I took four months’ maternity leave for each
baby and made it clear that I would be coming back. At that time, the maternity payment
covered three months of a locum and I paid for the other month. The other two male partners
seemed to have no objections.
It was invaluable having another female partner as role model, as a precedent had been set for
maternity leave. She was always helpful, on any matter however big or small. After the first
maternity leave came and went fairly uneventfully, the partners seemed to manage the next
three without a problem. Since then, our practice has seen at least six more maternity leaves,
in partners, trainees and salaried GPs. I was always upfront from the beginning, saying that my
husband and I wanted to have lots of children, rather than being coy or secretive about it.
The financial barriers were not huge as I was half time and the maximum grant covered a
locum for three months. I was able to feel that I was not a financial burden on the practice.
I managed the inevitable problems of small children being ill by having a nanny and a
husband, who, as an academic, could be fairly flexible with his working hours. Thankfully my
children did not have any special needs, and there were no complications leaving them with a
nanny. In the days of on-call at night, the timing could go wrong if a visit clashed with
breastfeeding, but we seemed to manage. I am grateful to my husband for holding the fort
singlehandedly with four small children on numerous occasions.
My daughter has just finished her first year as a medical student, so what she has seen has not
put her off!
16
Professor Yvonne Carter
Youngest professor of General
Practice and Primary Care in the
United Kingdom when she took
up her post in 1996
Figure 4: Comparison of the gender breakdown of GP providers, 1997 and 2007
Women
Men
0
5,000
10,000
15,000
20,000
25,000
30,000
1997 2007
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.11 For anyone in general practice, being a salaried GP means that employment beyond one year
leads to entitlement to full NHS working rights. To avoid bearing responsibility for this, many such
practices commonly give contracts for just under a year. Short-term contracts such as this are very
disruptive, particularly for those with families. There is additional anecdotal evidence that women
are finding it harder than their male counterparts to obtain even these short-term posts.
2.12 Furthermore, through schemes such as the Retainer Scheme, and indeed for those coming back to
work through the Returners’ Scheme, general practice was attractive for women working less than
full time, as well as to employing practices. With the reduction of funding that both schemes have
seen, these opportunities have dwindled.
2.13 Choosing medicine is, of course, only the first of a number of career choices that are faced during
the course of a medical career. One of the most crucial decisions that will dictate the subsequent
course of a career is that of specialty. Breaking down the hospital consultant specialties by gender
reveals a wide disparity between the various specialties in female participation, ranging from less
than 10% in surgery to over 40% of the workforce in paediatrics, pathology and psychiatry.
1717
Figure 5: Gender divide (percentage) by specialty amongst the hospital consultant workforce, 2007
Female
Male
0 10 20 30 40 50 60 70 80 90 100
Total
Surgery
Radiology
Psychiatry
Public and community health
Pathology
Paediatrics
Obstetrics & gynaecology
General medicine
Clinical oncology
Anaesthetics
Accident and emergency
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.14 For men, strong determinants of career or specialty choice are role models prior to medical school,
and the opportunity for personal and professional success. Women, however, tend to be
influenced more by personal factors such as family obligations, fixed hours and a sense of
altruism.14 This in turn means that different specialties appear attractive to women. Research from
the Royal College of Physicians identified that women tend to opt for the ‘people-oriented’ and
‘plan-able’. Nevertheless, this is not always the case, as can be seen by the high percentage of
women opting for obstetrics and gynaecology. Conversely, men tend to gravitate towards the
more technologically oriented and unpredictable options. For a more detailed explanation, see
Chapter 4 of the Royal College of Physicians’ report Women and Medicine: The Future.15 Whilst
there is no evidence to support the theory that has been raised from time to time that some
specialties are more suited to ‘male’ or ‘female’ attributes, it is true that some specialties seem to
attract proportionately more men than women. This topic could benefit from more research than
the group was able to undertake for this report.
18
Miss Eleanor Davies-Colley
First female fellow of the Royal
College of Surgeons
Figure 6: Female share (percentage) of consultant posts by specialty
(General practice) 44.1
Paediatrics 44.0
Psychiatry 37.7
Public health 48.8
Medical group 25.0
Pathology 38.5
Radiology 31.3
A&E 23.2
Anaesthetics 28.2
Surgical group 8.4
Obstetrics and 32.8
gynaecology
More people oriented
More technology oriented
More
‘plan-able’
More
unpredictable
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
2.15 Surgery is an area of particular concern, given the relatively low percentage of women in such
a large specialty (just 8%). However, looking at the data in a different way, there are as many
women becoming surgical consultants when including obstetrics and gynaecology, where women
represent a third of the specialty. Some caution is therefore required in interpreting the data, and
the reasons for lower numbers of women in surgery are not easily discernible, especially as these
gender differences are not pronounced at the early stages of a medical career. Indeed, evidence
shows that early in their careers, women were as keen on surgery as men; however, men were
more likely to follow this through to succeed in becoming fully qualified surgeons. Conversely,
looking at specialties in the United States that have more women, although only 8% of women
students expressed a preference for paediatrics, a third entered a paediatric residency.16
Accounting for these changing attitudes through the course of a career is not simple.
19
CASE STUDY: A FEMALE SURGICAL CONSULTANT
I work full time as a consultant surgeon. I do not have private practice commitments, which
means I have a huge amount of flexibility (most of my colleagues have 1.5–2 days a week for
their other interests). The new NHS Consultant Contract allows you to negotiate ‘supporting
professional activities’ (eg preparing audits or teaching materials) at home, once the children
are in bed. My clinics start at 9.15am, after I have dropped the children at school. I have four
children. I recommend living close to work, as you can be on-call from home, with teenage
neighbours on standby for childcare if I get called in. I tend to be on-call on Thursdays, so my
husband does the school runs on those days.
My parents and in-laws are very helpful for school holidays. I have to be organised – on-line
supermarkets can deliver groceries in the evenings. The salary is good enough to pay someone
to do ironing and cleaning. My situation as a consultant is better than when I was a trainee,
when the hours were still long. As a trainee I had to cope with travelling, exams, using a
breast-pump to express breast milk when on-call, and having to fit in with a series of different
bosses’ timetables. Hopefully, the European Working Time Directive will make it easier for
women to decide their specialty without worrying about the hours. You can still think and
study when off-duty!
Figure 7: Female and male consultants by specialty as a percentage of total consultant
workforce, 2007
2 4 6 8 10 12 14 16 18
Surgery
Radiology
Psychiatry
Public health and community health
Pathology
Paediatrics
Obstetrics & gynaecology
General medicine
Clinical oncology
Anaesthetics
Accident & emergency
Female
Male
0
Source: The NHS Information Centre for Health and Social Care, NHS Staff 1998–2008 (Medical and Dental)
20
Mrs Linda de Cossart
Past vice-president of the Royal
College of Surgeons England
2.16 The patterns of career choice in specialty training year 1 (ST1) trainees are starting to change.
Firstly, overall percentages of women in all specialties are now considerably higher. At ST1 – apart
from surgery, which as of 2007 was 27% female, and radiology, which is 42% female – all the
specialties are 50% or more female, with the average being 55%. The paradigm is therefore
shifting naturally, slowly towards equilibrium. Women are now better represented in the formerly
male domains of emergency medicine and anaesthetics, which sit firmly within the bracket of
unpredictable working patterns and more technologically oriented fields.17, 18
2.17 If these changes are maintained through specialty training, then the workforce will shift to having
a female majority. However, as has already been observed, this creates the possibility of a large
attrition rate amongst female doctors in the next 5–10 years as choices to favour family are made.
The impact on individual specialties will vary, and it is important to note that the context in which
women are making these choices is also changing and that it is not entirely predictable how this
will affect specialty choice. In particular, the development of credentialling outlined in High
Quality Care for All: NHS next stage review19 may well increase the number of women capable
of performing, for example, a surgical procedure, but it may reduce the number of consultant
surgeons. The effect of a majority female workforce, combined with this more flexible approach
to training and certification, may impinge on efforts to create a more consultant-delivered service.
2.18 In addition to the choice of specialty and whether to take up a training or non-training post, many
women are choosing to work part time. In 2006, 34% of female consultants worked part time
compared with 15% of their male counterparts. In general practice, where part-time work is
perceived to be easier, as many as 49% of female GPs but only 12% of male GPs work part time.
Amongst trainees, part-time working is less easily available, and only 8% of women and 2% of
men are in less than full-time training.
2.19 Academic medicine also reveals some concerning statistics. In 2007, one in five medical schools
had no female professor at all, and only two of the 32 medical schools had a female head. In total,
23.6% of clinical academics are women, whereas women represent 28% of the senior hospital
workforce and 36% of general practice providers.
2.20 Indeed, within the international context the UK is amongst the countries with the worst
representation of women at senior academic level (13% of full clinical professors in the UK are
women, compared with 20% in Finland and Portugal). This may represent an extreme subset of the
issues outlined earlier in this chapter. Those who enter academia take even longer than men to reach
senior levels because academic medicine, with its need for a PhD, is generally worked at concurrently
with clinical medicine, thereby lengthening training. This can pose additional hurdles for women.
2.21 However, there are a number of other considerations that may mean that the broadly positive
vision for medicine in general does not sit neatly with this group. In particular, there is a paucity of
women in academic positions who can act as role models. The limited number of women in
21
positions of authority in medical schools may mean that general trends take longer to reach this
subset. Data from some academic centres show that efforts to create networking opportunities
and to support, encourage and actively progress women, such as those seen in Sheffield University
(the Women’s Network) and Queen’s University Belfast (the Women’s Forum), can dramatically
change these patterns. At Queen’s University, there has been a gender initiative that includes
mentoring. The Women’s Forum meets monthly to examine progress. Since 2000, the
representation of women on the academic council has increased by 58% and as conveners of
appointment panels by 900%. At Sheffield, a women’s academic returner scheme has been in
place since January 2006 that provides financial support to women returning to work. This support
includes funding short-term back-up and a women’s network.
2.22 Similarly, recent changes to the academic career ladder may help to provide a clear career
structure. The introduction of formalised career pathways through the National Institute for Health
Research’s academic clinical fellowships and academic clinical lectureships, with their clear entry
criteria and oversight, may make some of these considerable barriers less imposing.20
2.23 Many of the more subtle barriers that seem to be in the way of the progression of women are
particularly apparent in academic medicine. Women have fewer failed promotion attempts than
men, yet they progress more slowly, implying that women are hesitant to try for promotion and
end up waiting longer than perhaps they need to.
2.24 In 2009, the Medical Schools Council reported that only 13% of professors in the UK are women,
compared with 40% of clinical lecturers. Its survey showed that women often felt they were
passed over for promotion and that male colleagues were given projects that are ‘more
interesting’. Women needed to be more assertive and perceived that having children was
considered a further barrier to promotion.21 Studies have also reported that women are less likely
than men to find an effective mentor.22 This risk aversion is not confined to medicine alone, but it
is clearly a powerful factor within medicine.
2.25 Similarly, the structural barriers remain in academic medicine, such as the difficulties those working
part time have in fulfilling the expectations carried over from full-time work, and the challenges of
finding both the time and money for continuing professional development.23
2.26 This trend appears to be reflected in the composition of medical journal editorial boards. A 2006
survey reported that only 9% of female respondents sat on editorial boards – less than half the
number of male respondents – and only 2% of female respondents had achieved editorship, a
third of the number of their male colleagues.
22
Dr Elizabeth Garrett Anderson
First woman to gain a medical
qualification in the United
Kingdom
2.27 This apparent dearth of women in senior roles is also recognisable at national level. As of June
2008, only three of the 15 medical Royal College and faculty leaders were women. The British
Medical Association (BMA) has never had a female chair of the BMA Council, the executives of its
consultant and senior committees are all male, and only three chairs of its 19 committees are
women, one of these being a co-chair with a man.
2.28 The leadership roles mentioned above are mainly appointed. There is clear evidence that women
are less likely to stand for nomination, and that this stems from self-confidence issues and
difficulty in squeezing additional responsibilities into an already crowded life. However, women
often step into these roles and indeed excel, if they are appointed or stand for election, although
reluctant to do so. Women will often not apply for such positions unless actively recruited and
encouraged; this may be achieved by women’s medical networks publicising vacancies and
nominating them for election.
2.29 The importance of having women in such roles cannot be overestimated. Not only do holders of
these positions help to define the future policy and direction of medicine, but they are powerful
role models for those within medicine and, indeed, a signal to those outside medicine.
2.30 Despite important changes to the mechanisms for providing reward for service to senior doctors
– changes that have made the process more transparent and fair – there has yet to be translation
into gain for women. The Clinical Excellence Awards (CEA) scheme indicates that women may not
be reaching, or at least are not being recognised for, work at senior levels. In 2008, women
accounted for only 16% of applicants to the national award scheme and 17% of the awards
given. Overall, twice as many men as women held a CEA at level 9 or above. Selection panels
should be gender balanced in order to inspire confidence. Application rates for Silver/Gold Clinical
Excellence Awards are lower for females than males (49.5% compared with 55.9%).24 This, too,
may be a facet of time, combined with less than full-time working and career breaks. These
observations regarding national awards apply equally to local awards.
2.31 From these data we can identify trends amongst the female medical workforce:
Women are more likely to work part time.
Women are more likely to enter a staff or associate specialist post.
Women are attracted to some specialties over others.
Women are very underrepresented amongst senior academics.
Women are underrepresented in national leadership roles.
Women are underrepresented in the Clinical Excellence Awards scheme.
23
Chapter 3:
Barriers to success
3.1 Pregnancy and maternity leave
3.1.1 For many women the first time their gender affects their working lives is during pregnancy. In
addition to the physical effects of pregnancy, there are the complications of changing working
practice, both during pregnancy and post-childbirth.
3.1.2 The effects of pregnancy are well studied, and there are good data showing that in clinical areas
where junior doctors work long hours with periods of sleep deprivation and long periods of
alertness there is an increased risk of complications during pregnancy.25 Interestingly, however,
these effects appear to be mitigated if maternity leave and training policies are flexible. There is
therefore a strong case for ensuring that women have access to flexible work and maternity leave
cover, perhaps above and beyond that in other professions.
3.1.3 Maternity leave arrangements are legal requirements, but again the complex and varied
contractual arrangements in place in the NHS mean that this is an area of confusion and anxiety
for women and, indeed, employers. For hospital doctors, the difficulty comes in negotiating their
work patterns towards the latter stages of pregnancy without leaving colleagues to carry the
additional burden. For GPs the situation is even more complex. The employment arrangements
mean that stories of practices not employing females of child-bearing age, or being unable or
unwilling to cover the costs of maternity leave, are a cause of serious concern amongst women
GPs. The situation seems to be worsening rather than improving, despite efforts from many. Those
in substantive academic posts face issues over and above those in the NHS, to do with the length
of service in any one particular higher education institution, as maternity rights do not transfer
with posts. Collaboration between the NHS and the universities over this was recommended in the
Follett report of 2001.
3.1.4 Solutions discussed.
3.1.4.1 The European Working Time Directive will go some way to reducing working hours to a nationally
consistent standard, but it is important that as the directive is implemented the need for flexibility
for pregnant doctors is not lost in the rigidity of the new rotas.
3.1.4.2 Serious discussion between the Royal College of General Practitioners (RCGP), the BMA and the
Workforce Directorate of the Department of Health needs to be initiated so that the concerns of
GPs regarding maternity leave can be understood and managed.
24
Phyllis George
First woman to be elected to the
Council of the Royal College of
Surgeons England
CASE STUDY: A PROFESSOR OF DERMATOLOGY
Many of my colleagues in my small specialty (dermatology) were scandalised when I became
an unmarried mother at the age of 41. It was difficult combining research with being a single
mother and full-time consultant, but the rewards have been great, with a personal chair, a
platinum merit award and a son who believes that women are equal and should work.
3.2 Children
3.2.1 Of all the issues that have been raised, the most widespread area of concern is that of childcare.
A number of individuals and organisations have raised this issue, nationally and internationally, as
a key factor in career decisions faced by parents, irrespective of profession. It is accepted that men
should play an equal part in childcare and there are some indications that this practice is growing
but it has not yet happened, which is why the problems need to be addressed in this report. Our
observations and recommendations apply equally to mothers and fathers. For doctors, the
demands of childcare affect a number of choices, for example choice of specialty, transfer to a
staff or associate specialist grade, retraining, working part time or leaving medicine entirely.
Looking after children is an important phase in life, but it is crucial that decisions made at this time
do not deleteriously affect future careers.
3.2.2 Part of the difficulty concerns the need to balance the developmental needs of children with the
career requirements of parents and the requirement of society to gain value for money, given the
sums spent on training doctors. Balancing doctors’ responsibility to patients against their
responsibility to children is all too often a Hobson’s choice. Anecdotes of a child being left in the
care of a secretary or in the office whilst the needs of a patient are seen to by their doctor-parent
are all too common.
3.2.3 There are a number of types of childcare, each with its own benefits (see table opposite).
3.2.4 No single type of childcare will provide a panacea. Children have different needs as they grow,
and doctors also require different levels and types of support as they progress in their careers.
The problems in obtaining childcare are different at different stages in doctors’ careers, and are
dependent on factors such as the ages of their children and their geographic location. It is
interesting to note that data from North America and Australia indicate that very shortly half of
all physicians will be married to other physicians, making childcare arrangements even more
complex.26
25
Type of childcare Positives Negatives
Nannies and home help
(live-in/live-out)
24-hour support available
One-to-one care
High cost
Unregulated
Employer responsible for
all pre-employment checks/
pay/tax
Nurseries Ofsted registered
Training requirement
Travel costs
Usually fixed hours
Higher child-to-carer ratio
Childminders Safe environment
Fully regulated
Relatively inexpensive
Negotiable hours
Low child-to-carer ratio
Travel costs
Back-up childcare variable
Negotiated hours less flexible
Site of work
Extended school provision Good activity set for older
children
Ofsted registered
Holiday provision
Relatively inexpensive
Provision variable
Travel costs
Usually fixed hours
Relatives One-to-one care
Inexpensive
Dependent on availability
Reliant on goodwill
Au pairs 24-hour support available
Inexpensive
Unregulated
High turnover
Usually untrained
Unsuitable for full-time cover
Babysitters One-to-one care
Inexpensive
Unregulated
Dependent on availability
26
Professor Trisha Greenhalgh
Professor of Primary Care
Health and leading figure in the
philosophical aspects of evidence-
based medicine
CASE STUDY: ALTERNATIVE CHILDCARE
I am a consultant orthopaedic surgeon with four children. My husband is a ‘house husband’.
It was not our intention to have a complete ‘role reversal’, but primary school, with holidays
and 9am to 3pm days, suddenly seemed much less forgiving than nursery hours. My salary is
plenty for a family of six.
The school issue could be worked around differently: two high earners could use private
schools with longer school days; alternatively, the consultant job plan includes on-call duty and
10 hours of ‘supporting work’ in a 40-hour week, so you only have a few fixed early starts and
late finishes each week, for which my friends use breakfast and after-school clubs.
I have recently picked up more managerial roles, which involve a lot of evening meetings or
sudden changes of priority. Traditionally, consultants’ wives were supposed to accept this, but
my husband knows that I have deliberately chosen this extra work and resents it a little for the
reduction in family time. Once the children can cycle themselves home from school, my
husband will be looking to work again. It is a very unusual person who can dedicate their life
to bringing up children, and a role that is still undervalued – I know I could never do this.
3.2.5 For junior doctors many of the problems arise from the rotational nature of their postings, and the
necessity to work unsocial hours, often in changeable working patterns and shift working. For
more senior doctors, the problems arise from the unpredictable nature of their on-call and
emergency demands, and the long hours that are often worked – not infrequently beyond those
paid for.
3.2.6 Whilst it may seem that older children pose fewer childcare concerns than infants and young
children, this is not necessarily the case. Infants and young children require full-time supervision,
whilst those in school require care after school and in the school holidays that, because of the
timings, may be more difficult to achieve at reasonable cost. For younger children the questions
that parents grapple with concern issues such as where best to place children to ensure that they
receive the stimulation necessary for development, whether placement in small or larger groups is
more beneficial, and the site of childcare – home vs. the workplace or somewhere else.
3.2.7 Equally, the concerns of parents are very much affected by location. Living in cities may bring
a wider choice of local childcare options, but the costs may be substantially higher; rural
settings have different issues, such as the restricted availability of childcare and the need to travel
greater distances.
3.2.8 However, all the problems fall broadly into four categories:
information
working practices
27
additional provision of childcare
funding.
Information
3.2.8.1 There appears to be a dearth of easily available information. Knowledge seems to pass by word of
mouth, and although some trusts and local government organisations do have childcare websites,
information is greatly variable. For trainees the problem is particularly acute, because the
rotational working pattern, involving frequent moves, makes it even harder to find information
about local childcare provision within or near the trust where they are working.
3.2.8.2 The information, where it is available, is also not necessarily focused on doctors. Trusts with good
practice have a childcare website and a contact number for the local childcare coordinator.
However, information is very variable and rarely includes the full range of options available.
Working practices
3.2.8.3 One of the key problems with childcare is the unsocial hours worked. The changing patterns of
senior consultants’ work have led to more doctors working shifts. Senior doctors also suffer from
the problem that they may be called on whilst not formally ‘on call’, and the GMC’s Good
Medical Practice requires a doctor to attend when necessary.27 For junior doctors, more hours are
worked outside the normal 9am to 5pm working day, and rotas are now more rigid due to the
introduction of the European Working Time Directive.
3.2.8.4 The higher number of nurses compared with doctors allows for more flexibility in nurses’ rotas
than in doctors’ rotas. This allows nursing rotas to absorb more readily those staff unable to work
unsocial hours because of childcare and caring commitments.
3.2.8.5 Provision of longer hours of childcare is one means to address some of these concerns. It is
important to stress that longer hours would ensure that facilities are more available at the times
required rather than to allow children to be in childcare for longer.
3.2.8.6 As mentioned, these problems are compounded for junior doctors by the rotational nature of
working – namely, that in most instances a trainee’s job changes every four to six months. This
means that, in addition to the physical geographical difference in location, accessing employer-
based support, such as childcare vouchers, can be incredibly difficult. This situation is compounded
by the often short notice at which junior doctors are notified of placements.
Additional provision
3.2.8.7 Available workplace childcare is rarely provided outside normal working hours, and even where it
is available there is rarely a facility to cover all 24 hours. Given increasing moves for doctors at all
levels to work shift patterns, and indeed the increased likelihood of doctors being partnered with
28
Dame Deirdre Hine
First female Chief Medical Officer
in the United Kingdom
fellow doctors, this places a strain on doctors that is not often replicated in other professions.
Similarly, the varied work patterns of doctors make it hard for them to fit into more regimented
routines that demand, for example, children’s attendance on fixed days. If a doctor’s shifts move
from a Monday one week to a Wednesday the next, having a place at nursery on a Monday is not
helpful. Additionally, for junior doctors moving around on rotations, nursery waiting lists often
mean that they cannot obtain what provision is available.
3.2.8.8 GPs face different problems: their workplace may not have childcare provision, and they are often
self-employed. Careful consideration needs to be given to how current provision of childcare can
accommodate their requirements.
Funding
3.2.8.9 There is some assistance available to pay for childcare in the form of vouchers; however, this
provides a maximum of only £1,195 per annum. The case for additional funds or tax relief for
doctors is dependent on clearly expressing that the state requires more from doctors than from
other employees and that this additional work impinges on normal childcare. For example, doctors
work prolonged unsocial hours, which may be unusually rigid or, conversely, unpredictable. Both
of these interfere with simple childcare arrangements, and self-care of children is difficult because
career breaks from medicine are damaging due to the loss of skills and knowledge and limited
return to work schemes. There will be no real progress towards gaining full value from women
doctors until the cost and availability of childcare are addressed. The cost of training alone makes
this worthwhile. Above all other considerations, help with childcare will be in the interests of
continuity of patient care.
3.2.8.10 The costs of childcare are high, the highest of all being employment of a nanny. In addition to the
purely financial cost, there are a number of other issues relating to childcare staff that a potential
employer has to consider:
qualifications
experience
reference checking
Criminal Records Bureau checks
work permits.
29
3.2.9 Solutions discussed.
Information provision
3.2.9.1 Childcare coordinators in each trust obviously have a key role in disseminating information. The
particular challenge is to make that information available as early as possible to trainees who are
moving location, either by linking in through the postgraduate deanery or by inclusion in some
form of welcome pack for new joiners.
3.2.9.2 The Department for Children, Schools and Families has recently published Next Steps for Early
Learning and Childcare, which places a duty upon local government organisations to manage
childcare provision in their area actively. This includes consulting with key employers. It would be
difficult to argue that an NHS acute or primary care trust is not a key employer, and trusts that do
not currently have childcare provision should exploit this new avenue. Raising awareness of this
new duty with trusts will be of key importance. Childcare coordinators in each trust will also have
a key role in advancing the needs of doctors, as well as other healthcare staff, in this new
framework.
Working practices
3.2.9.3 One model that has challenged the constant changes of employer is in the North West, where the
deanery acts as the sole employer for trainees regardless of the trust at which they actually work.
This minimises the disruption caused by having to start again at each new location in accessing
employer-based support.
3.2.9.4 Another proposed solution is ringfencing of crèche places for trainee doctors who are moved.
However, demand is unlikely to be consistent and modelling work would be necessary to ascertain
whether this would be a cost-effective solution.
Additional provision
3.2.9.5 Emergency in-trust childcare is also a possible solution for those instances where it is impossible to
arrange childcare at short notice for limited periods. Anecdotal evidence of children being minded
in a doctor’s office by secretarial or other staff is common. However, such practice is not fair on
either the child or staff members. If trusts had a ‘drop-in’ facility, this would provide a safe
environment not dependent on the goodwill of non-clinical staff. Again, this would need to be
carefully modelled to ensure that it would be cost effective to maintain such a service, and it
would need to be reviewed as the European Working Time Directive alters clinical practice.
Funding
3.2.9.6 A potential solution to the funding problem would be to allow doctors to pay for childcare out of
their gross earnings. This would mean that childcare was treated like the expenses of a small
30
Dr Sophia Jex-Blake
One of the ‘Edinburgh Seven’, the first group of
female medical students at a university in the United
Kingdom. Leading campaigner for medical education
for women and involved in founding two medical
schools for women
business, and that tax was paid on the net amounts remaining after payment of childcare. This
would provide a worthwhile relief from the expense.
3.2.9.7 This represents a significant departure from current government policy and would not produce a
swift resolution. The process for changing this policy is to require the Department of Health to
undertake a detailed business case outlining the benefits of childcare support to doctors and
whether it represents value for money. Additionally, the Department will have to demonstrate that
doctors are a special case, which it is believed they are by virtue of the length and unpredictability
of their working hours. Once the business case has been completed, it will have to be presented
to the Treasury as part of the next Comprehensive Spending Review in order to come into effect
by 2012.
3.2.9.8 The argument might be made – although it would be short-termism – that, in the current financial
climate, the cost to the Treasury and the complexity of the arrangements would have to be fully
explored and proven to show benefit to the NHS if the Treasury were to approve a change. If a
favourable benefit were to be demonstrated, it would not necessarily mean that it would obtain
Treasury endorsement. But the expenditure, small in overall terms, would represent the most
worthwhile protection of the investment made in training women doctors.
3.2.9.9 A second avenue of approach is to ask the Department of Health to make available funding centrally
to assist doctors with childcare. This approach also requires a detailed business case being made by
the Department’s Workforce Directorate and a bid for money in the next Comprehensive Spending
Review round. Again, this would face the challenge of competing with other Department of Health
priorities against a background of a worsening economic picture. Nevertheless, addressing this issue
is the single most productive response called for.*
3.3 Professional barriers
Less than full-time work
3.3.1 The thrust of this report is about enabling full-time work in the interests of patients. But data
clearly show that both men and women increasingly wish to work less than full time, even with
the reduction in hours brought about by the introduction of the European Working Time Directive.
This is particularly true during training, when many doctors start families. Equally, with an ageing
population it may well be problematic later in doctors’ careers too, either in relation to themselves
or as carers for family members. Budgets to allow this have increased but are not keeping pace
with demand. In part, this stems from the additional cost of employing less than full-time workers,
even in job shares. A 2008 survey by the Postgraduate Medical Education and Training Board
(PMETB) showed that almost 22% of female trainees report that they want to train flexibly but
are not doing so.28
* Although they are not within the remit of the working group, these considerations apply equally to all healthcare
workers in similar circumstances.
31
3.3.2 Less than full-time working is also often undervalued. Previously it was felt that this was because
of the supernumerary status of many such doctors, which gave the impression to some that these
doctors were less involved and committed to the institutions housing them. A response to this has
been to follow the model set by the London Deanery of encouraging job shares where possible.
Whilst this has fully integrated doctors into hospital systems, it may have increased rather than
decreased problems for those with children or inflexible time constraints. Furthermore, many work
less than full time in order to care for others, including ageing and infirm parents, partners and
children with long-term conditions or other problems. The effect of this is that these doctors have
limited capacity to take on additional work responsibilities, particularly those spread between
contracted hours. Accordingly, it is often still felt that women in these positions contribute less to
their employers, and this may hamper career progression. A study comparing flexible trainees with
full-time trainees found that the outcomes of training were broadly similar: 92% of flexible
trainees obtained a CCT compared with 90% of full-time trainees, although flexible trainees were
more likely to take part-time consultant posts.29
Re-entering the workforce
3.3.3 It is vital for planning and for the best use of women’s talents that their re-entry into the
profession be at the forefront of arrangements for maternity leave and afterwards. Many women
are choosing to have children at about the age of 30, which is, for a doctor, the latter stage of
completing training and becoming able to practise in their own right. It is vital that women have a
clear and unambiguous mechanism to step off and then get back on the specialist training ladder,
so that the value of the training they have already completed is not lost and that their skills can be
topped up on return to full-time practice. One complication is that maternity is an employment
issue, meaning that an NHS trust will bear the cost of maternity leave, and yet it is the
postgraduate deaneries that coordinate training. Therefore, on returning from maternity leave,
a trainee might not return to the trust through which she was previously rotating. This is not
financially equitable for the employing trust, and it places an additional burden and uncertainty
upon the trainee. Similarly, whilst in the past there has been support for return to work schemes
in general practice, such schemes are now very limited, despite many efforts.
32
Professor Parveen Kumar
Academic gastroenterologist who
started the first Master’s degree
in gastroenterology in England
and co-editor of Kumar and Clark
Clinical Medicine
CASE STUDY: A LETTER ABOUT RE-ENTERING THE WORKFORCE AFTER A CAREER BREAK
Dear Medical Woman’s Federation,
I would be very grateful if you could offer me some advice. I am keen to return to medicine
after a career break of six years. Prior to stopping work to look after my children, I graduated
in 1994 and subsequently spent three years in general medicine and five years in my specialty
(the last year was part time, after my first child arrived). Due to the timing of my pregnancies,
I sat Part I but not Part II of my membership exams. I also had to voluntarily remove my name
from the medical register due to the high cost of fees (unable to be met on a single family
income!). I re-registered last year, but due to my extensive time away from work I now have
to return to an approved practice setting for one year full-time equivalent.
I am currently researching a number of options.
I am considering returning to my former specialty, although I have to start again at the
beginning with my exams, as the system has changed. I am also, of course, somewhat rusty
and would need some sort of refresher training.
I have also looked into public health, although it is apparently not possible for me to enter as
a doctor, as public health training locations are not approved practice settings. I could apply
as a non-medic, although this feels strange as I have a medical qualification, and I can’t help
feeling that I may be put into a difficult position, having a medical qualification, yet not being
allowed to practise as a doctor because I am not in an approved practice setting.
The other difficulty I have is that of fitting my work around childcare. My children will both be
at school from September. Unfortunately, I live in a rural area, with no available after-school
clubs and very limited availability of childminders. I have no family living nearby who can help.
I know that I can apply for flexible training, but I expect that I would be required to work
some full days – due to my lack of childcare, this would prove a challenge!
I know there are no magic answers, but I currently feel very frustrated that my professional
experience and qualifications cannot be used, and would be grateful for any advice as to
where I can go from here. I understand that there used to be a fantastic returners/flexible
scheme run by NHS Professionals, which I believe would have offered the perfect solution,
but this does not seem to be available any longer. Is there any alternative?
Non-training grades
3.3.4 The decision to step off the training ladder and into a staff or associate specialist (SAS) grade post
is made frequently as a solution to balancing the demands of family against work. SAS grades
focus on delivering care, releasing a doctor from the structured pressure of training and, indeed,
the ‘extras’ that are required of a consultant. However, once in an SAS grade post, career
progression becomes much harder because of the lack of that structure. There is a mechanism by
33
which SAS grade doctors can demonstrate that they have obtained similar experience to a doctor
on a specialist training programme and thus demonstrate eligibility to enter the specialist register.
However, the process of constructing a suitable portfolio is time consuming and expensive. In
addition, not all deaneries have structured support for SAS grades. The process has been criticised
as overly bureaucratic, and, when the medical Royal Colleges provide external assessment of
applications, they rely on the goodwill of their senior members to do so on top of their clinical
duties. The Postgraduate Medical Education and Training Board (PMETB) regulates the
equivalence procedures, and its work with the medical Royal Colleges to reduce delays and
improve the process has been recognised.
3.3.5 Part of the problem is, of course, the difficulty in starting any new process. The sheer volume of
applications initially caused extensive delays. Additional problems have been associated with the
quality of applications, and there have been reports of applicants unnecessarily submitting over
1,000 pages of information. Furthermore, once an application has been rejected, there is
insufficient support for that doctor to discover what she needs to do to improve – a void that has
been filled by private tutoring companies, which adds to the expense.
3.3.6 However, for women who have chosen the SAS grade, the problem is deeper than simply
overcoming the process of application. Achieving a Certificate of Eligibility for Specialist
Registration (CESR) gives the impression that the doctor will apply for a consultant post.
The reasons determining the decision to enter the SAS grade post in the first place are likely
to preclude taking up such a post, deterring application at all. There is a large pool of stagnant
talent in the SAS grade as a result.
3.3.7 Solutions discussed.
Less than full-time working
3.3.7.1 Working less than full time, whether to accommodate academic or other responsibilities, also has
potential problems for revalidation. All doctors will be expected to be at the same competence
level irrespective of hours worked. This is important, as the patient would not want similarly
graded doctors with varying competence. However, this requirement means that the onus, cost
and responsibility should not fall on the individual to cover the requirements. Less than full-time
employees should be entitled to the same continuing professional development and appraisal
support as full-time colleagues if they are to be similarly appraised.
Re-entering the workforce
3.3.7.2 With the changes under way in the funding of postgraduate medical education, it would be
extremely beneficial, for both the trainee and the employer, if the fragmentation of responsibility
for maternity leave could be resolved. A single employer for the duration of postgraduate training
34
Professor and Senator Rita Levi-Montalcini
Italian neurologist who, with colleague
Stanley Cohen, received the 1986 Nobel
Prize in Physiology or Medicine for their
discovery of nerve growth factor
would greatly simplify the process and allow for much better long-term workforce planning and
for the flexibility that is required to make it work.
3.3.7.3 In the current mixed economy of run-through and uncoupled specialty training, it will also be
necessary to ensure that women in run-through training posts are not disadvantaged compared
with those in uncoupled training posts who have, theoretically, a greater opportunity to plan
pregnancy during the natural career break between basic and higher specialist training. However,
those in uncoupled training posts will have to re-compete for entry to training, whereas those in
run-through retain their right to re-enter training where they left off. Work is already under way
on the concept of modular credentialling, which should make training more ‘portable’ and ensure
that recognition for achieving competencies is given and appropriately recorded.
3.3.7.4 The introduction of revalidation will also impose new challenges, particularly for more senior
doctors, as both re-licensing and recertification will be required. Under the proposed
arrangements, a long absence from work of over five years could render a doctor unable to
practise. It is vital that, as the implementation of revalidation continues, there is clear and
unambiguous guidance for doctors on how they can register as ‘non-practising’ and on the
requirements, on a sliding scale dependent on the length of absence, to resume practising again.
For a parent of two children it is not inconceivable that a five-year career gap may be necessary.
Provisions for ‘continuation’ training and back-to-work experience will be necessary to assist
parents returning to work to demonstrate that they are up to date and fit to practise. The
postgraduate deaneries, in conjunction with the GMC and the medical Royal Colleges, will play
a key role in this, even for the more senior doctors.
3.4 Psychological barriers
3.4.1 The working group heard convincing evidence that women are not reaching the posts they aspire
to, not because of structural barriers but rather because of internal psychological differences from
their male counterparts. The evidence supports these statements, with women seeming to be
restricted by their tendency to be risk averse, non-self-promoting and not as well networked.
These less tangible personality facets cannot be altered by recommendations, but rather by local
efforts and supportive organisational structures. At the same time, many women told the group
that they were happy with a position that fell short of what they might have aspired to, because
they had achieved a work–life balance that suited them and gave them fulfilling contact with
patients.
3.4.2 Experience at the Harvard Brigham and Women’s Hospital in Boston, Massachusetts, clearly
demonstrates that local action can ameliorate in many ways these more subtle barriers. By creating
an Office for Women’s Careers, which is actively engaged in the promotion of women to senior
positions, they have seen dramatic improvement. Indeed, the number of female professors has
doubled.30, 31
35
3.4.3 Solutions discussed.
3.4.3.1 As trusts and academic institutions coalesce into academic health science centres, there may be
opportunities for similar offices in the UK. However, even without these formal structures, the
mechanisms that they have used to achieve success can be instituted: identifying female role
models who champion local women; providing opportunities to network; mentorship; and active
support of promotions. These aims can be simply translated at a local level:
It is important that every doctor should have her own web page on the trust’s site, in order to
highlight her profile and make herself known, and in order to help her focus on the
achievements that should be recorded.
Prospectuses and information about the trust should feature women who have succeeded,
and they should be put forward as spokeswomen when the trust is publicising its work.
The practice of hanging portraits of doctors in hospitals and surgeries and learned societies should
include those of women, and there should be archives of the achievements of women in the past.
Women should be selected more frequently to deliver named lectures and keynote speeches
at conferences of the BMA and the Royal Colleges, and they should be included in due
proportion on editorial committees.
Committees should meet only at suitable hours, ie not in the early morning or late afternoon
when children need collection from school, nor at night when family duties may prevent
attendance.
Mentors should be trained and there should be trust funding for training. Being a mentor
should be a positive factor in seeking appointments and awards.
A leadership programme such as ‘Springboard’ should be offered to all doctors during their
early career, free of charge.
Women should be encouraged to put themselves forward for awards, locally and by mentors
and women’s networks as well as in the usual ways. Selection committees should have a
gender balance, and proper consideration should be given to part-time applicants.
3.5 The older doctor
3.5.1 Older women doctors often find that they finally have more time to devote to professional duties
once their family duties are behind them. In keeping with new laws relating to age discrimination,
there should be no age limits on applications for posts, prizes and fellowships. Age limits and
criteria such as ‘no more than five years from qualification’ attached to positions are gender
discriminatory, because women are more likely than men to have taken some years off during
their careers for family duties. It should be considered whether there should be inducements to
women doctors to retire at a later age.
36
Chapter 4:
Recommendations and their rationale
Recommendations Nominated lead
4.1 Recommendation 1: Improve access to mentoring and career
advice
4.1.1 In the next round of contract negotiation there should be an explicit
facility for appropriately trained and skilled doctors (usually consultants)
to undertake mentoring or career counselling as a programmed activity
within their job plan.
4.1.2 To facilitate accessing mentoring or career management support, the
future commissioners of medical education should maintain a register of
all doctors who are skilled and are willing to undertake these tasks and
make it more accessible to other doctors.
Department of Health
Workforce Directorate
Dean for Medical
Education
Commissioning
Rationale
Accessing mentoring or career counselling is currently difficult for a number
of reasons. Firstly, these tasks are seen as ‘on the side’ activities, which are
often subsumed by day-to-day clinical concerns. Owing to its informal
nature, doctors are only able to access mentoring or career counselling from
senior colleagues they know on an almost random basis. When combined
with gender issues, this can mean that junior female doctors often gravitate
towards the more heavily female-represented specialties, and mutatis
mutandis for men.
A more coordinated approach is needed to ensure fairer and more equitable
access to mentoring and career counselling so that it is easier for all doctors
to access.
Creating protected time for consultants and GPs to undertake these
activities as part of their job plan would tackle the immediate problem of
supply. Placing a coordination role on the future commissioners of
education would allow a regional single point of access as well as allowing a
strategic view of talent management to be taken. Whilst the commissioners
of education are primarily concerned with doctors in training, it will be
important that this is also available to doctors post-CCT to ensure that
access to career counselling and mentoring can be obtained throughout a
doctor’s career.
3737
Professor Valerie Lund
First professor of rhinology in the
United Kingdom
By providing consultants with the time and space to undertake these tasks,
as well as having a regionally based coordination function, the two key
outcomes would be as follows:
Healthcare provider organisations will be able to supply career
counselling and mentorship to doctors throughout their careers.
Career networks can be developed to enhance talent management and
development programmes further.
As part of the annual workforce planning cycle, healthcare providers should
declare to SHAs how much mentoring and career counselling capacity is
available within their organisation and how many doctors, and at what
grade, have accessed the facility.
4.2
4.2.1
4.2.2
4.2.3
Recommendation 2: Encouraging women in leadership
Appointments to NHS, academic and clinical committees and boards
should be advertised widely and have a transparent and democratic
process rather than simply an appointment by nomination.
Committees should be encouraged to develop their ways of working to
enable greater participation by doctors who are parents or carers.
There should be increased access for women to the committees and
boards of major medical institutions, including the medical schools,
postgraduate deaneries, medical Royal Colleges, NHS trusts and other
NHS bodies. The Equality and Human Rights Commission should
consider auditing the appointments process for all such posts at these
institutions, as they consider appropriate, to assess whether sufficient
opportunity has been created to increase access for women to these
respective organisations’ committees and boards.
Presidents of Royal
Colleges and other
professional
institutions
Presidents of Royal
Colleges and other
professional
institutions
Equality and Human
Rights Commission
38
Rationale
When positions on committees and boards within medical institutions arise,
they should be advertised as widely as possible and women should be
actively encouraged to apply within a framework of an open appointments
procedure.
Committees tend to operate in the early evening, making it difficult for
parents with childcare commitments to attend. A simple solution is to alter
their way of working so that committees meet during the day.
Neither of these proposals can be managed or enforced from the centre.
However, the Equality and Human Rights Commission should audit the
arrangements that medical institutions have in place for committees and
boards and publish the results, using openness as a lever for change.
4.3
4.3.1
4.3.2
4.3.3
4.3.4
Recommendation 3: Improve access to part-time working and
flexible training
The postgraduate deaneries should maintain a list of doctors wishing to
train part time in a slot-share arrangement.
NHS Employers should develop guidance for meeting the costs of
continuing professional development, including for those who are
working less than full time.
The development of credentialling should be expedited, and there
should be full recognition by the medical Royal Colleges that time alone
does not indicate competence to practise independently.
The aspirational quota for part-time training should be abandoned in
favour of a needs-assessed availability by strategic health authorities
(SHAs). The newly formed Centre for Workforce Intelligence should be
commissioned by each SHA to provide this needs assessment on a
regional basis, and provision should be made to meet it.
Deans of postgraduate
deaneries
Trusts
Presidents of Royal
Colleges and other
professional
institutions
Chief executives of
SHAs
39
Professor Averil Mansfield
First female professor of surgery
in the United Kingdom
Rationale
Part-time training and working is perhaps the best solution to balance work
and family. The current part-time arrangements are extremely variable and
largely depend on doctors who wish to work part time having the good
fortune to meet another doctor in the same position. A more coordinated
approach, with the postgraduate deaneries being able to ‘match’ doctors
wishing to work part time, will greatly improve the situation.
The progress of medical education towards modular credentialling is an
important and extremely welcome move. It will facilitate movement in and
out of training, which will be of great benefit to women who are planning
to become mothers.
Current part-time working arrangements are based on an aspirational quota
of availability, which is neither achievable nor realistic. Different workforces
will have different demographics, and the key is to ensure that any demand
for part-time working can be facilitated, so that doctors do not have to
make choices such as changing specialty, moving into the SAS grade or
leaving the profession entirely. By assessing the need in each region, SHAs
will then be able to include planning for part-time training in their annual
workforce planning cycle.
4.4
4.4.1
4.4.2
4.4.3
4.4.4
Recommendation 4: Ensure that the arrangements for
revalidation are clear and explicit
The General Medical Council (GMC) and the appropriate medical Royal
Colleges should ensure that they have a clear set of re-licensing and
recertification standards and assessment processes in place for doctors
who have taken time out of training or the profession to return to work.
Responsible officers should coordinate refresher training for those who
have taken time out of training to meet these standards. There should
be funding for this within the NHS budget.
Trusts should offer ‘back-to-work’ and ‘taster’ sessions where those who
have taken a career break can shadow working doctors to re-familiarise
the doctor with procedures and work patterns, so that they are
confident on return.
The Postgraduate Medical Education and Training Board (PMETB) and
the GMC should ensure that women in non-training grades receive
support in applying for entry to the specialist register.
GMC and presidents
of Royal Colleges and
other professional
institutions
Chief executives (CEs)
of trusts
CEs of trusts
PMETB and GMC
40
Rationale
Revalidation will present a new challenge for doctors who take time out of
work. Whilst a short career break, such as a year, is unlikely to impinge on
the five-yearly revalidation cycle, a longer break may well present
difficulties. It will be important that the GMC and the medical Royal
Colleges have a clearly laid out process for doctors who do take longer
career breaks so that they can re-enter practice safely.
This will need to be supported locally with the appropriate retraining or
supervisory arrangements, so that the GMC, the NHS organisation, patients
and the public can be assured that returning doctors are up to date and fit
to practise.
Doctors who are thinking about returning to work after a career break
should be supported in that decision by the provision of ‘back-to-work’ or
‘taster’ sessions, where they can shadow a working doctor so that they can
refresh their skills and understand the process they will need to undergo in
order to return to work successfully.
4.5
4.5.1
4.5.2
4.5.3
4.5.4
Recommendation 5: Women should be encouraged to apply
for the Clinical Excellence Awards scheme
The Advisory Committee for Clinical Excellence Awards (ACCEA) should
provide greater feedback to applicants and advice as to where additional
development might be necessary.
ACCEA should develop a network of mentors who can be approached
for advice. This should be coordinated with the wider career advice
programme.
Selection panels should be gender balanced wherever possible; due
consideration should be given to part time applicants and ACCEA’s
processes should be monitored for gender equality.
The same encouragement should be applied to local awards, if any, and
monitoring information from all trusts should be collected centrally for
gender analysis.
ACCEA
ACCEA/trusts
ACCEA/trusts
Trusts
41
Miss Clare Marx
First female president of the
British Orthopaedic Association
Rationale
To tackle the underrepresentation of women applying for a Clinical
Excellence Award, more support is needed to provide advice both on how
to make an application and, following a failed application, on where
development is needed. By developing a feedback function that gives a
detailed appraisal of the application as well as anonymised comparator data,
doctors will be able to ascertain where they need to develop their practice.
By combining this with signposting as to where a doctor can find further
advice, doctors will be encouraged to revisit their application instead of
simply giving up, and to improve their practices where necessary, providing
the spur to improvement of the quality of their service. This will benefit all
doctors attempting to obtain a Clinical Excellence Award as well as the
patients they treat. Women are receiving fewer awards than they should;
a gender balance on the panel would inspire more confidence in the result.
4.6
4.6.1
Recommendation 6: Ensure that the medical workforce
planning apparatus takes account of the increasing number of
women in the medical profession
NHS Medical Education England (NHS MEE) and the Centre for
Workforce Intelligence should ensure that workforce models for the
future clearly delineate the effect of a rising number of women in the
workforce so that appropriate advice for the workforce planning
apparatus can be given.
Department of Health
Workforce Directorate
to work with NHS
MEE and the Centre
for Workforce
Intelligence
4.6.2
4.6.3
For training, NHS MEE should commission the medical Royal Colleges to
develop innovative solutions to these challenges. It is noted that NHS
MEE is conducting a review into the challenges that are presented by the
European Working Time Directive, to improve the quality of training in
reduced training opportunity circumstances, and this should address the
particular issues for women.
The Centre for Workforce Intelligence should approach the GMC to
discuss ways of tracking careers effectively through GMC numbers to
allow accurate data to be collected to inform workforce modelling.
NHS MEE
Centre for Workforce
Intelligence
42
Rationale
The expansion of medical school places has brought about a large increase
in the number of women entering the profession. Given the current trends
for women choosing to enter certain specialties or grades, working part
time or taking breaks from their career, it is vital that the workforce
planning apparatus takes into account the effects of more women in the
workforce now and actively manages those changes.
To understand this issue fully, there needs to be an effective tracking
mechanism for doctors’ careers. One potential method is to use the GMC
number to follow a doctor through her career; however, due consideration
needs to be given to the legal limitations imposed by data protection, and
the Centre for Workforce Intelligence should approach the GMC to open
a discussion.
In combination with other factors – such as the European Working Time
Directive, the move towards greater provision of care in the community, the
ageing population and greater patient expectation of access and choice –
the pressures to ensure the right supply are extremely challenging. A
responsive planning system is required, which is capable of identifying
trends and mobilising partners, such as the medical Royal Colleges, to
create innovative ways to equip doctors to meet the demand, including
the development of simulation techniques and e-learning.
4.7
4.7.1
Recommendation 7: Improve access to childcare
The Conference of Postgraduate Medical Deans of the United Kingdom
and the Department of Health should consider whether the model such
as that in place in the North Western Deanery, which commissions a
lead employer for all specialty trainees in the deanery, would be a
practical and desirable model in the new education commissioner/
provider landscape. The additional benefit of better facilitating access to
government assistance for maternity benefits and childcare of this model
is clear.
Conference of
Postgraduate Medical
Deans
4343
Dr Edith Pechey-Phipson
One of the ‘Edinburgh Seven’,
the first group of female medical
students at a university in the
United Kingdom
4.7.2 Postgraduate deaneries or their lead employers should plan ahead for Deans of postgraduate
the childcare needs of their trainees and facilitate arrangements between deaneries or lead
a trainee and the trusts during his or her rotation for access to childcare
provision.
employers
4.7.3 Trusts should appoint a childcare coordinator within their human Trust human resources
resources department if they have not yet done so. departments
4.7.4 Childcare coordinators should develop internet resources to act as both Trust childcare
an information resource and message boards on local childcare options,
including emergency cover.
coordinators
4.7.5 NHS trusts should engage with local authorities as key employers to Trust human resources
ensure that local authorities fulfil their legal responsibility to ensure that departments
the childcare needs of their population are met. NHS Employers should
begin a programme of work to advise and coordinate NHS trusts to
achieve this and help spread best practice.
4.7.6 NHS Employers should draw up guidance on good practice on what Trust human resources
additional provision NHS trusts should make for childcare allowances for
unavoidable unsocial hours of work.
departments
4.7.7 Hospital-based childcare should move to extended opening hours. NHS Trust human resources
Employers should host a conference of childcare coordinators with the departments
objective of identifying how this and the specific needs of doctors can
be achieved.
4.7.8 The Department of Health should explore the costs and benefits of Department of Health
doctors (and other healthworkers in similar circumstances) who are Workforce Directorate
parents paying for full-time or part-time childcare as a value-for-money and Finance
solution for enabling doctors to progress their careers. On the basis of Directorate
this analysis the Department should submit a case to the Treasury to
allow doctors to pay for childcare from their gross earnings. In addition,
it should establish whether any central funding might be available for
childcare assistance. The working group believes that this is fundamental
to ensuring that all doctors can fulfil their potential
4.7.9 The Centre for Workforce Intelligence should urgently model the effects Centre for Workforce
of greater female participation in general practice and the potential costs
of maternity cover. Contractual changes should be considered based on
this modelling to compensate maternity leave should it be required.
Intelligence
44
Rationale
Improving the availability and accessibility of childcare is a key enabler to
ensure that doctors who want to progress their careers are better able to do
so. No single childcare solution will be right for everyone; however, there
are a number of options to position doctors so that they are better able to
exploit the provision that is already available. By altering ways of working
and providing additional funding, there may be further opportunities to
improve the situation.
The primary obstacle for trainees is the rotational pattern of their working
arrangements. By forward planning, the postgraduate deaneries can greatly
reduce the stress of childcare by coordinating a trainee’s needs with the
trust. The single-employer model would also realise the benefits of allowing
trainees to access childcare vouchers much more easily and eliminate the
need to constantly reapply each time they move post.
All doctors who are parents would benefit from easier access to information
and a trust-supported network of parents. Not only would this act as a focal
point for doctors who are parents and allow ad hoc emergency
arrangements to be made more easily and quickly, it would also ensure that
parents are not isolated.
Given the sometimes unpredictable nature of providing healthcare 24 hours
a day and, for consultants, the potential need to attend even when they are
not ‘on call’, childcare provision for extended unsocial hours is essential.
The issue of funding childcare should be investigated fully to establish the
costs and benefits of making essential additional provisions in this area.
4.8
4.8.1
4.8.2
Recommendation 8: Improve support for carers
All postgraduate deaneries or their nominated lead employers and NHS
trusts should have a lead person responsible for supporting carers.
The NHS should join Employers for Carers and benefit from the financial
advantages conferred when adopting carer-friendly employment
practices. Doctors who are family carers have particular difficulties with
long, unpredictable and inflexible hours of work.
Postgraduate
deaneries or lead
employers, NHS
Directorate and NHS
trusts
454545
Professor Dame Julia Polak
One of the longest-living
survivors post-heart and lung
transplant in the United Kingdom
and a leading figure in research
on tissue engineering
Rationale
With an ageing population, the number of doctors acting as carers at some
point in their careers will increase. Whilst as a caring profession medicine
inherently understands the demands of such dual responsibility, it will
require special efforts to ensure that doctors acting as carers are not
disadvantaged. The working group explored the challenges that carers face
and how these demands affect both career patterns and day-to-day life.
The overwhelming sense from the group was that many of these challenges
could be overcome by increased awareness, flexibility and defined routes
for support.
The Work and Families Act 2006 gives to employees who are carers the
right to request flexible working. Employers must seriously consider such
requests and can only refuse for one of the business reasons set out in the
legislation. The NHS should follow the best practice guidelines prepared by
Carers UK.
4.9
4.9.1
4.9.2
Recommendation 9: Strenuous efforts should be made to
ensure that these recommendations are enacted through the
identification of champions
Trusts should identify a non-executive director to have responsibility at a
local level for improving working patterns, giving advice and handling
complaints. The director should work closely with a lead consultant for
workforce planning.
Royal Colleges should follow the example of the Royal College of
Psychiatrists and develop gender equality plans.
CEs of trusts
Presidents of Royal
Colleges and other
professional
institutions
Rationale
Without a designated individual responsible for bringing these
recommendations to board level, there will be limited leverage to effect
change. Similarly, Royal Colleges can provide moral weight and set good
examples by their actions.
46
Annex 1:
Recommendations of previous reports
Report Date Recommendations
Women and 2009 Examine requirements for workforce design:
Medicine:
The Future,
Royal
College of
Physicians
The organisational implications of changing workforce patterns and
preferences with respect to working hours and specialty choices should be
urgently examined so that the effective delivery and continuity of patient
care is not compromised.
Investigate economic implications of changing workforce patterns:
The funding consequences of a potentially substantial increase in part-time
and other forms of flexible working require detailed analysis so that the
level of possible future budgetary commitments can be better understood.
Address critical information gaps:
There exists the need to strengthen the adequacy and accessibility of
cross-sectional and longitudinal data on the working patterns of doctors.
More information and research are needed on entry to the profession.
Strengthen workforce planning and modelling:
The implications of differential working preferences of women and men
over their career lifetimes should be modelled to test sensitivities with
respect to changing average participation rates, the scope for further
extension of part-time options, and the core requirements for continuity of
patient care.
Analysis is needed to investigate the longer-term impact on the balance of
supply and demand across individual specialties and on total service capacity.
Enhance career guidance and feedback:
More guidance should be given to help trainees achieve a sound
assessment of the relative competitiveness of entry to different specialties.
There exists a need to ensure that at later career stages appropriate
counselling and feedback can be offered, especially for women doctors, on
the development of leadership skills, and on the commitments required for
attaining the highest levels within the profession.
4747
Dame Cicely Saunders
Founder of the modern
hospice movement
Report Date Recommendations
Making 2008 Recommendations on attitudes to part-time working:
Part-Time
Work,
Medical
The medical profession needs to promote more positive attitudes to part-
time working through mentors, role models and case studies.
Women’s Royal Colleges, deaneries, the BMA and the GMC need to find effective
Federation ways to consult with those doctors working part time on a wide range
(MWF) of issues.
Recommendations on part-time training posts:
Employers and Royal Colleges should work together to ensure that rota
design can routinely incorporate part-time workers.
Medical directors should support and promote innovative job design.
Deaneries should ensure that training programme directors take
responsibility for leading integration of part-time trainees into training
programmes.
Deaneries and employers should continue to build on the progress of
mainstreaming part-time training.
Employers, deaneries, training programme directors and educational
supervisors should ensure a prompt and sympathetic response to those
trainees who express a desire to train part time.
Junior doctors should be made more aware of sources of information and
support for part-time training at undergraduate and postgraduate level.
Recommendations on part-time career grade posts:
Royal Colleges should issue guidance on part-time career grade posts.
Medical directors should support and promote innovative job design in
order to encourage part-time working for consultants and SAS grade
doctors.
48
Report Date Recommendations
Recommendations on career development for part-time doctors:
Employers, medical directors and deaneries should adopt a formal approach
for the reacquisition of clinical skills after a career break or a period of
extended leave.
The MWF should seek to work with key stakeholders to promote successful
examples of part-time working in the medical profession.
Deaneries, Royal Colleges and the BMA should work with PMETB to use
the national survey of trainees to explore any systematic differences in the
quality of training experienced by those in full-time and part-time posts.
Women in 2007 Students:
Clinical
Academia: More comprehensive information to students
Attracting Mentoring
and
Developing Experience of research early on
the Medical Formal instruction on how to teach
and Dental
Workforce of Flexibility:
the Future, Recognition of need for career breaks
Medical
Schools Recognition of need for flexible working
Council Dedicated tenure tracks for clinical academics
Career tracking through funding bodies
Flexible training reinstated in deaneries
Participation in senior leadership training encouraged
Monitoring by Royal Colleges and medical schools of representation on
panels, boards and faculty positions
49
Dr Fiona Subotsky
Past president of the Medical
Women’s Federation and
consultant child and adolescent
psychiatrist
Report Date Recommendations
Women in 2007 Both the promotions criteria and process need to be made explicit and
Academic transparent to all staff.
Medicine:
Developing
equality in
Appraisal should be an annual process and timed to fit in with the
promotion cycle.
governance Appointments committees should reflect the diversity of staff required
and (eg women and ethnic minority groups).
management
for career Gender monitoring of appointments and promotions should be in place.
progression Equal opportunity and diversity training should be provided.
(Athena
Project), Mentoring for women should be mainstreamed and monitored.
Higher Role models and networking should be recognised and encouraged.
Education
Funding
Council for
Measures of gender equality should be benchmarked against European
targets and exemplars.
England,
Medical
Schools
Council,
Imperial
College
London,
MWF, BMA
50
Report Date Recommendations
Women in
Hospital
Medicine:
Career
choices and
opportunities,
Report of a
working
party of the
Federation of
the Royal
Colleges of
Physicians
2001
More opportunities for part-time consultant posts.
More flexibility in the number of sessions worked over the time an
individual holds a particular consultant post.
More part-time training opportunities.
Increases in job shares.
A flexible training budget should be determined by the percentage of
female graduates and there should be interchange between the training
budgets so as to provide more part-time training posts for all deaneries and
movement between geographic areas.
Training should be competency based.
Appropriate training should be made available to non-consultant grade
post holders so they can apply for consultant positions.
Improved mentoring from medical school through to specialty selection
overseen in the later stages by the appropriate college.
Educational opportunities should be available to those who do not work
standard hours.
The introduction of a hospital retainer scheme similar to that offered in
general practice.
Appropriate support for those who have stepped out of medicine and want
to return.
Adequate childcare places with out-of-hours provision should be available
within the NHS.
Pension rights for part-time workers and those with career breaks should
be reviewed.
Grant allocation should be irrespective of working hours.
Specific part-time academic posts are necessary.
There should be equity of representation of women on academic boards
and grant-awarding bodies.
There should be equal opportunity for nominations for distinction awards.
There should be equal opportunities for women to apply to academic and
senior management posts.
51
Dame Margaret Turner-Warwick
First female president of the Royal
College of Physicians
Report Date Recommendations
Report to the A work–life balance is necessary for all doctors if they are to survive
NHS fruitfully in clinical work today: this need must be recognised by the NHS.
Executive,
Making it
happen:
Professional and personal ambition and the desire to work flexibly are not
incompatible.
Part-time, Most of the leaders of the profession already have a ‘part-time’ clinical
flexible and commitment and combine it with other nationally important work. Other
portfolio reasons to work less than full time in the NHS need to be given comparable
careers in status and respectability.
hospital
medicine A variety of working patterns needs to be facilitated and actively promoted
in the NHS. This would help retain highly skilled staff throughout their
careers, whatever their other commitments. The wider responsibilities and
contributions expected of a consultant need to be recognised when job
plans are organised so that all consultants can participate fully in the clinical
and managerial life of a department.
To enable more flexible working patterns to come about there will need to
be planning and investment of money in different ways of working and a
willingness to change accepted practices whilst maintaining high
professional standards.
Current equal opportunity legislation may make it easier for an individual to
get a job, but by inhibiting discussion of a consultant’s other responsibilities
or needs (disability or chronic illness), may make it less practical to carry it
out. It must become possible to state and openly negotiate these in order
to make successful completion of the job a reality.
The retainer scheme and the possibility of career breaks for hospital doctors
should be enhanced.
Making it possible to move from clinical assistant and SAS grade jobs into
consultant jobs, with appropriate specialist registrar training, would enable
better use of resources.
In order to retain very senior doctors, who now may return to work in their
mid-50s or at 60, the NHS should consider facilitating flexible exit from a
consultant post as well as flexible entry into it.
The culture of medicine is changing with changes in society. With increased
public expectations and greater scrutiny by outside agencies, doctors will
be expected to give more of themselves in their encounters with patients.
52
Annex 2:
Terms of reference of the National Working
Group on Women in Medicine
To review existing work and the most recent reports published on individual aspects of this larger
problem.
To consult the opinions of the medical profession.
Drawing on this work, to recommend a programme of action to improve opportunities for women
in medicine.
53
Annex 3:
Chair of the National Working Group
Baroness Ruth Deech
Ruth Deech taught law at Oxford University and was Principal of St Anne’s College there from 1991 to
2004. From 1994 to 2002 she chaired the Human Fertilisation and Embryology Authority, and from 2002 to
2006 she was a Governor of the BBC. She was the first Independent Adjudicator for Higher Education from
2004 to 2008, and since 2009 she has chaired the Bar Standards Board, the independent regulator of
barristers. She is a fellow of the Royal Society of Medicine. Appointed to a life peerage in 2005, she sits
as a crossbencher.
54
Annex 4:
Membership of the National Working Group
Professor Dame Carol Black
National Director for Health and Work
Besides being a National Director, Dame Carol is also Chair of the Nuffield Trust,
President of the British Lung Foundation and Pro-Chancellor at the University of Bristol.
She is the immediate past President of the Royal College of Physicians and has just
stepped down as Chair of the Academy of Medical Royal Colleges. The internationally
renowned centre she established at the Royal Free Hospital, London, is the major centre
in Europe for clinical care and research on fibrosing connective tissue diseases, in
particular systemic sclerosis.
Since the early 1990s, Dame Carol has worked at board level in a number of
organisations, including the Royal College of Physicians, the Royal Free Hospital
Hampstead NHS Trust, the Health Foundation, the NHS Institute for Innovation and
Improvement and the Imperial College Healthcare Charity. She recently served as Chair
of the UK Health Honours Committee and is now on the main committee for the
Queen’s Awards for Voluntary Service. She is also a member of many national
committees aiming to improve healthcare. She is a Foreign Affiliate of the Institute of
Medicine USA and has been awarded many honorary degrees and fellowships.
Professor Jane Dacre
Professor of Medical Education, leading on Women in Medicine for the
Royal College of Physicians
Jane Dacre is Director of the Division of Medical Education within the Faculty of
Biomedical Sciences at University College London and Vice Dean of its medical school.
She is a consultant physician and rheumatologist at the Whittington Hospital NHS
Trust in London and is a former Academic Vice-President of the Royal College of
Physicians. Professor Dacre took up her first consultant post as a rheumatologist in
1990 and was a lead clinician in the development of the first Clinical Skills Centre in
the UK. She has continued to develop expertise in medical education (redesigning
several clinical examinations) and rheumatology in parallel. Her current academic
interest is in the training and assessment of doctors in general, including fitness to
practise, and rheumatologists in particular. She has been appointed to the new GMC
Council and is a non-executive director of the Whittington Hospital NHS Trust. She is
married with three children.
55
Professor Dame Sally Davies
Director General of Research and Development, Department of Health
Professor Dame Sally Davies is the Director General of Research and Development and
Chief Scientific Adviser for the Department of Health and NHS. As Director General,
she developed the new government research strategy, Best Research for Best Health,
with a budget rising to £1 billion, and is now responsible for implementation of the
National Institute for Health Research (NIHR). She is a board member of the Office of
the Coordination of Health Research and the Medical Research Council and chairs the
UK Clinical Research Collaboration.
She led the UK delegations to the World Health Organization (WHO) Ministerial
Summit in November 2004 and the WHO Forum on Health Research in November
2008. She is a member of the WHO Global Advisory Committee on Health Research
and chaired the Expert Advisory Committee for the development of the WHO research
strategy. She is a member of the International Advisory Committee for A*STAR,
Singapore, and the Caribbean Health Research Council Board, and she advises many
other groups on research strategy and evaluation, including the Australian National
Health and Medical Research Council.
Dr Clarissa Fabre
Medical Women’s Federation
Dr Clarissa Fabre is President Elect of the Medical Women’s Federation. She is a full-
time GP in East Sussex. She initially trained in paediatrics but moved to general practice
after the birth of three children and a career gap of seven years. Her surgery has
changed from being a sleepy single-handed village practice to a three-partner, part-
dispensing, training practice with two registrars and two part-time salaried doctors.
She has been active in medical politics for many years, on the local medical committee
and, for a spell, on the Professional Executive Committee of the local primary care
trust. For the past four years she has represented both East and West Sussex GPs on
the British Medical Association’s General Practitioners Committee.
She joined the Medical Women’s Federation (MWF) when barriers appeared in her
career, with few opportunities for flexible training in paediatrics and geographical
isolation. The most important objective of her involvement in MWF is to ensure that
women doctors are provided with the opportunities to combine a fulfilling family life
with maximum achievement in their professional careers. She is married to a medical
academic, and her two daughters are junior doctors.
56
Ms Helen Fernandes
Women in Surgery
Ms Fernandes is a consultant neurosurgeon (lead paediatric neurosurgeon) at
Addenbrooke’s Hospital, the first female surgeon to be appointed there. She specialises
in the treatment of adult and paediatric patients with brain and spinal problems. She
graduated from Newcastle University, gained her doctorate in 2000 and was awarded
the Louis Alexander Research Fellowship and the Hunterian Professorship from the
Royal College of Surgeons. Prior to her Cambridge appointment she was a Medical
Research Council senior lecturer and honorary consultant neurosurgeon. Helen is a
member of the British Association of Spinal Surgeons, British Cervical Spine Society and
the East Anglian Spinal Society. She is Associate Director of Postgraduate Medical
Education at Addenbrooke’s and Chair of the national body Women in Surgery.
Professor Steve Field
Chair, Royal College of General Practitioners
Professor Field took up the position of RCGP Chair in November 2007 and led the
college through Lord Darzi’s review of the NHS, successfully promoting the RCGP’s
‘federated’ model of patient care – with general practices working together to provide
more services for patients in their local communities – as a workable alternative to
polyclinics, and repositioning general practice at the heart of the NHS. Professor Field is
recognised as a national leader in medical education. As Chair of the RCGP Education
Network, he led the college’s radical review of GP training, which led to the
introduction of the first ever training curriculum for GPs in August 2007.
A practising GP in inner city Birmingham, Professor Field is Honorary Professor of
Medical Education, University of Warwick, and Honorary Professor in the School of
Medicine, University of Birmingham.
He has published many academic papers, reports and books – including a bestselling
publication on the GP curriculum – and has presented papers at academic meetings
around the world. He is a member of the faculty of the Harvard Macy Institute’s
programme for leading innovation in healthcare and education.
He is co-author of the landmark RCGP document The Future Direction of General
Practice: A roadmap, and its follow-up, published in June 2008, Primary Care
Federations: Putting patients first.
57
Dr Patricia Hamilton
Director of Medical Education, Department of Health
Besides being Director of Medical Education at the Department of Health, Dr Hamilton
co-chairs the Modernising Medical Careers England Programme Board. She is
responsible for overseeing the development and delivery of many of the medical
educational projects referred to in A High Quality Workforce, and works closely with
the newly formed Medical Education England.
She is working at the Department of Health on secondment from her post of
consultant and senior lecturer in neonatal paediatrics at St George’s, University of
London. She was previously a medical director at St George’s.
Until recently, she was President of the Royal College of Paediatrics and Child Health,
having previously been Vice President for Training and Assessment. She has chaired
many college committees and working parties, including those developing the
paediatric curriculum and programmes. She was involved in developments in
workplace-based assessments. She was responsible for producing training packages
in child protection and child mental health.
As President of the RCPCH she was a member of the Academy of Medical Royal
Colleges and sat on several of its education and training committees. She was Chair
of the steering group of the Medical Leadership Competency Framework project
completed by the Academy of Medical Royal Colleges and the National Institute for
Innovation and Improvement. She is a board member of the Postgraduate Medical
Education and Training Board, was co-Chair of the London Children’s Clinical Pathways
group and was a member of the leadership group of Lord Darzi’s Next Stage Review of
the NHS.
58
Professor Jacky Hayden
Postgraduate Medical Dean, North Western Deanery
Professor Jacky Hayden has been Dean of Postgraduate Medical Studies for
Manchester University and the North Western Deanery since 1997; prior to this she
was the Director of Postgraduate General Practice Education. She is the Chair of the
English Deans Committee and Vice Chair of the Conference of Postgraduate Medical
Deans, where she leads on the quality agenda, and she is lead dean for psychiatry and
dermatology. She has been a member of the Medical Programme Board since January
2008 and is a member of Medical Education England. Her clinical background is
general practice, and she is a member of the Council of the Royal College of General
Practitioners, a PMETB partner and an associate for the GMC as part of its quality
assurance team. She is an accredited mediator. She has established a range of
innovative activities across the North Western Deanery, including a leadership
programme for young GPs that started over 20 years ago, and an integrated medical
leadership training programme for doctors in training. She is married to a consultant
physician and has two sons.
Dr Anita Holdcroft
Women in Academic Medicine, British Medical Association
Reader in Anaesthesia and Honorary Consultant Anaesthetist, Imperial College
London and Chelsea and Westminster Hospital
Dr Anita Holdcroft, Emeritus Professor of Anaesthesia at Imperial College London,
is a clinician specialising in acute pain medicine, especially in females. She was the
Secretary, then co-Chair, of the International Association for the Study of Pain Special
Interest Group on Sex, Gender and Pain to 2005. She is Past President of the Forum on
Maternity and the Newborn and President of the Section of Anaesthesia at the Royal
Society of Medicine.
Her laboratory and clinical pain research has attracted Medical Research Council and
charitable grants as well as funded studentships and keynote international lectures. As
author and editor she has written books such as Principles and Practice of Obstetric
Anaesthesia and Analgesia, Core Topics in Pain and Crises in Childbirth. Other
publications include chapters on sex and gender differences in pain in Wall and
Melzack’s Textbook of Pain and papers on gender medicine, particularly relating to
women and childbirth.
59
As a spin off from her research she champions academic women’s employment issues
and led the Women in Academic Medicine project funded by the Higher Education
Funding Council for England, the BMA and the Medical Women’s Federation (MWF).
She has co-chaired the BMA Medical Academic Staff Committee and is the MWF
Treasurer. She is married with four daughters.
Professor Sheila Hollins
Immediate Past President, Royal College of Psychiatrists
Professor Hollins was President of the Royal College of Psychiatrists from 2005 to
2008. She is married with four children and two grandchildren, and her eldest
daughter is a consultant psychiatrist. She has an ongoing role as a carer in providing
support to two of her children who have long-term conditions, and the experience of
her son’s learning disability strongly influenced her career direction. She trained part
time in psychiatry, sharing childcare with her husband, a succession of au pairs and
a hospital crèche.
She was in general practice before psychiatry, which influenced her family-based
approach and her interest in co-morbid physical and mental health problems. She
pioneered the involvement of people with learning disabilities as co-researchers and
co-teachers in the medical school, and the dissemination through pictures of best
practice to her patients and their carers. She has been Professor of Psychiatry of
Learning Disability at St George’s, University of London since 1991. Until she retired
from clinical practice in 2006, she had been a consultant psychiatrist in south-west
London for 25 years. She is currently chairing a steering group to develop a Europe-
wide declaration and action plan on behalf of WHO Europe about the health and
social care of children with intellectual disabilities; and she is planning to set up a
spin-out company to further develop Books Beyond Words, her picture-based
technology, to improve communication about health and other topics with people
with learning disabilities.
60
Miss Cathy Lennox
Consultant in orthopaedics and trauma surgery
Miss Lennox’s specialty was traditionally a male specialty but now has increasing
numbers of women coming through the ranks. Apart from an initial problem, back in
the early 1970s when admission policy to medical school limited the number of
women to 10%, she has encountered no major obstructions to her career. A surgical
career in those days required training in general surgery as a pre-fellowship registrar to
obtain the fellowship exam (FRCS) and then to go into higher specialty training. This
involved fierce competition for a place on the much coveted orthopaedic training
rotation. When she started a family she was able to take advantage of the newly
created part-time training scheme, which made it possible to continue her work.
Subsequently, as senior registrar, she did a job share for two years, by joining forces
with another of the very few women in orthopaedic training. After this she became a
full-time consultant. During her consultant years she has been involved in teaching,
advising and mentoring trainees, both male and female. Her strong message has
always been that, with appropriate enthusiasm and dedication, doctors can achieve an
extremely rewarding career in whichever specialty they choose, regardless of gender.
Dr Katie Petty-Saphon
Medical Schools Council
Dr Petty-Saphon is the Executive Director of the Medical and of the Dental Schools
Councils and of the Association of UK University Hospitals. She is a Director of the UK
Clinical Aptitude Test Consortium and sits on the Board for Academic Medicine in
Scotland. Prior to 2003 she had a career in the private sector, founding three successful
companies. She read natural sciences at Cambridge and has a PhD in biochemistry
from the University of Birmingham. She is a former Governor of the University of
Hertfordshire and of primary and secondary schools in Saffron Walden. She is a former
Vice Chair of Princess Alexandra Hospital NHS Trust, having been a non-executive
director there for 10 years. She is a trustee of the Royal Medical Benevolent Fund and
an associate fellow of Newnham College Cambridge, and in 2007 was the Chief
Operating Officer for Sir John Tooke’s independent inquiry into Modernising Medical
Careers. She is married with two children – and 10,000 trees that she planted in 2000.
Apart from two sets of three months’ maternity leave she has always worked full time
– and so has much experience of juggling and multi-tasking.
61
Mr Bernard Ribeiro
Former President of the Royal College of Surgeons of England
Mr Ribeiro qualified at Middlesex Hospital Medical School and was awarded the
fellowship in 1972. In 1979 he was appointed as a consultant general surgeon to
Basildon Hospital, Essex, with a special interest in laparoscopic and gastrointestinal
surgery. He introduced therapeutic laparoscopic surgery to the trust in 1991 with the
aim of establishing an advanced laparoscopic training unit.
He has been a senior examiner in surgery for the University of London and the University
of Oxford and a member of the Court of Examiners of the Royal College of Surgeons.
He is currently an examiner for the new medical school in Brighton. He was Honorary
Secretary and President of the Association of Surgeons of Great Britain and Ireland
(1991–2000), represented the Association of Surgeons on the Senate of Surgery and was
Chair of the Distinction Awards Committee of the association (2000–04). He was elected
to the Council of the Royal College of Surgeons of England in 1998.
He received a CBE for services to medicine in January 2004 and has been made an
honorary fellow of several Royal Colleges and academies. He was President of the
Royal College of Surgeons of England from 2005 to 2008 and was appointed Knight
Bachelor in December 2008.
Dr Joan La Rovere
Director of the Paediatric Cardiac Intensive Care Unit and Consultant Paediatric
Intensivist at the Royal Brompton Hospital, London, and Honorary Senior Lecturer
at Imperial College London
Joan La Rovere is Director of the Paediatric Intensive Care Unit and consultant
intensivist at the Royal Brompton Hospital, where she has been a consultant since
1999, and is an honorary senior lecturer at Imperial College.
Raised in Boston, Massachusetts and educated at Phillips Academy Andover, she
graduated from Harvard University in 1988, followed by an MSc in genetics at St
Andrew’s University, before completing her medical training at Columbia University
College of Physicians and Surgeons in New York, graduating in 1993. Paediatric
residency at Children’s Hospital Boston was followed by a move in 1996 to Great
Ormond Street Hospital in London as a fellow in paediatric intensive care, and
appointment as a consultant at the Royal Brompton Hospital in 1999.
62
Her medical research focuses on outcomes following cardiac surgery and she has
been instrumental in developing lesion-specific care pathways for children of all ages
undergoing cardiac surgery, and the use of databases to detail clinical outcomes.
She sits on the International Multi-Societal Database Committee for Pediatric and
Congenital Heart Disease. In addition to her clinical and managerial role, Dr La Rovere
is the Royal College of Paediatrics and Child Health’s tutor at the Royal Brompton
Hospital and is a member of the Chief Medical Officer for England’s Expert Working
Group on Revalidation and Medical Education. She has organised and spoken at
numerous medical conferences, both nationally and internationally.
Dr La Rovere was elected a member of the Windsor Leadership Trust, an organisation
that brings together top leaders from every sector to reflect on how they use their
influence, decisions and actions to benefit their organisations and wider society. Deeply
involved in issues of healthcare leadership and education, Dr La Rovere also works to
educate the next wave of healthcare professionals by developing medical curricula,
innovating learning programmes and training professionals. She helps to conceptualise
and employ the most cutting-edge technology, including the use of virtual education.
A keen advocate of medical education, Dr La Rovere is a trustee of IMET (International
Medical Education Trust) 2000, a charity aimed at promoting links and cooperation
between the western and developing world, including the development of virtual
medical education. She also sits on the Admissions Committee of Imperial College
Medical School, as well as teaching Imperial College medical students.
Dr La Rovere is co-founder and Vice-President of Virtue Foundation, a public charitable
and non-governmental organisation with special consultative status to the United
Nations. The Foundation’s mission is to increase awareness of prevalent global issues,
to inspire people to action and to render humanitarian assistance through healthcare,
education, and empowerment initiatives. Virtue Foundation undertakes healthcare,
education and empowerment initiatives for women and children in the developing
world.
She is married with one child.
63
Professor Bhupinder Sandhu
Chair of the British Medical Association’s Equal Opportunities Committee and
former Chair of the Medical Women’s Federation
Bhupinder Sandhu is Consultant Paediatrician and Gastroenterologist at the Bristol
Royal Hospital for Children and an honorary professor at the University of Bristol and
the University of the West of England (UWE). She is currently President of the
Commonwealth Association of Paediatric Gastroenterology and Nutrition.
In 2002 she received an Asian Women of Achievement Award from Cherie Blair. She
is being honoured with a Doctor of Science degree by UWE for her ‘outstanding
contribution to public services and exemplary role model for women in science and
medicine’.
Coming from India at the age of 12 in 1963 with little English, she gained a place at
University College London and graduated in 1974. After paediatric appointments at
University College, King’s College Westminster and Great Ormond Street hospitals and
a research fellowship, she obtained a doctorate from the University of London. She
was appointed to the University of Bristol in 1988 and subsequently developed the
Paediatric Gastroenterology Department there. She is a founder member of the British
Society of Paediatric Gastroenterology and Nutrition, hosted its inaugural meeting,
served as its secretary and convener, and recently led on producing national guidelines
on the management of inflammatory bowel disease in children. She has held many
committee and board-level posts in Bristol, and nationally and internationally. She has
served as an external examiner for universities in the UK and abroad. She spearheaded
the Royal College of Paediatrics and Child Health/VSO Fellowship Scheme (described
by Lord Crisp as a beacon of excellent practice) and chaired a European research
working group. She has published extensively, with book chapters and over 80 papers,
and has chaired and spoken at many international meetings, including working with
and advising the World Health Organization.
Her public service roles have included being a foundation board member of the Food
Standards Agency, board member and trustee of VSO, Deputy Chair of the Board of
Governors of UWE, Chair of the BBC West Regional Advisory Council and a chair of
school governors. She currently serves on the governing Council of Bristol Old Vic
Theatre School. She is married with two daughters, both following careers in medicine.
64
Professor Deborah Sharp
Medical Schools Council and Chair of the Council of Heads of Medical Schools’
Committee on Women in Clinical Academia
Professor Sharp is Professor of Primary Health Care and Head of the Academic Unit of
Primary Health Care at the University of Bristol. She was previously lecturer and then
senior lecturer at the United Medical and Dental Schools of Guy’s and St Thomas’ in
the Department of General Practice and Honorary Senior Lecturer at the Institute of
Psychiatry. She obtained one of the first Mental Health Foundation GP Research
Training Fellowships, through which she undertook the work for her PhD on postnatal
depression in a community sample in south London. She took up the foundation Chair
in primary health care in 1994, the first woman to be appointed to a substantive chair
in Bristol, and has built up a world-class department over the last 15 years. The unit
has a very strong research programme, with 70% of its submission rated 3* or 4* in
the 2008 Research Assessment Exercise. They are founder members of the NIHR
School for Primary Care Research.
Professor Sharp is immediate Past Chair of the Society for Academic Primary Care,
represents primary care at the Medical Schools Council, and sat on the GMC Education
Committee and on the Walport Academic Careers Panel. Between 2000 and 2003 she
was Head of School in the Faculty of Medicine at Bristol, and it was during this time
that she became aware of the particular recruitment and retention issues for women
in academic medicine. She is an active member of the Medical Women’s Federation.
In 2006 she chaired the Council of Heads of Medical Schools’ Women in Academic
Medicine Working Party, and has continued both locally and nationally to be involved
in the career possibilities in academic medicine for women at all levels.
Dr Sheila Shribman
National Clinical Director for Children, Young People and Maternity Services
Appointed National Clinical Director for Children, Young People and Maternity at the
Department of Health in December 2005, after 22 years as a consultant paediatrician
with diverse experience in children’s health services, Dr Shribman has held posts in
NHS management, as a medical director for 11 years and as a chief executive. She has
been a senior officer of the Royal College of Paediatrics and Child Health and held
posts in continuing professional development, workforce planning, child protection and
policy areas. Her current clinical interest is in neurodisability. She is married to a GP and
has three young adult children.
65
Miss Susan Ward
Medical Women’s Federation
Sue Ward was elected Vice-President of the Medical Women’s Federation at the spring
meeting in 2005. Her current post is as consultant in obstetrics and gynaecology for
Sherwood Forest Hospitals NHS Foundation Trust. She also holds the post of Associate
Postgraduate Dean at the University of Nottingham, with responsibility for arranging
the Foundation Programme in the Trent region.
A graduate of the University of Nottingham, Miss Ward decided to pursue a career in
obstetrics and gynaecology. In order to broaden her experience, she spent a period as
an anatomy demonstrator and then undertook a surgical SHO rotation during which
time she obtained her FRCS (Edinburgh). She then moved into obstetrics and
gynaecology, obtaining her MRCOG and an MD. She is the college tutor for the
RCOG at King’s Mill. She is an enthusiastic teacher of postgraduates, undergraduates
and paramedical staff both in formal educational settings and on a one-to-one basis in
the operating theatre and clinic.
Despite working full time as an NHS consultant and with all her teaching
responsibilities, she has found the time to build and decorate a new house together
with her husband. She has been widowed and remarried and has two children, one
from each marriage, as well as two cats. One of the most important experiences in her
career was a student elective spent in Africa, and this experience has influenced her
future plans, which are to ‘leave a cohort of well-trained doctors behind her, work in
Africa and then retire disgracefully’.
Dr Jane Youde
Consultant Geriatrician
Dr Jane Youde is a consultant geriatrician at Derby Hospitals NHS Foundation Trust.
She is the Lead Clinician for Medicine for the Elderly in Derby and has a special interest
in falls and syncope. Dr Youde is actively involved in the British Geriatric Society and
holds the posts of Secretary of the Falls Section of the British Geriatric Society and
Secretary for the Trent British Geriatric Society.
66
Annex 5:
Evidence collected
The National Working Group on Women in Medicine met six times between October 2008 and
March 2009. It received oral evidence from 15 stakeholders including:
Lucy Warner – Department of Health Revalidation Support Team
Dr Lucy-Jane Davis – BMA Junior Doctors Committee
Najette Ayadi O’Donnell – BMA Medical Students Committee
Professor Chris McManus – Professor of Psychology and Medical Education, University College London
Julie Cornish – Association of Surgeons in Training
Cathy Williams – PMETB
Dr Sue Shepherd and Professor Jane Dacre – RCP
John James – Department of Health Workforce Leadership Programme
Dr Sarah Thomas – Postgraduate Dean Lead for Flexible Training
Professor Jonathan Montgomery – ACCEA
Dr Clare Gerada – RCGP and Practitioners Health Programme
Elizabeth Kelan – Centre for Women in Business, London Business School
Mike Farrar – North West Strategic Health Authority
Ailsa Donnelly – Patient Partnership Group, RCGP
Dr Sheila Shribman – National Clinical Director for Children, Young People and Maternity
Additionally, the Chair received numerous representations from individual female doctors and met with
groups of doctors from the Oxford Radcliffe Hospitals and the Royal Brompton Hospital.
A subcommittee, chaired by Dr Sheila Shribman, was established to examine the issue of childcare in more
detail. It met twice, in December 2008 and January 2009. NHS Employers, HM Treasury and the
Department for Children, Schools and Families were represented, as well as a junior doctor and mother from
the West Midlands, in addition to Dr La Rovere and Professor Hayden from the main working group.
67
Glossary
ACCEA Advisory Committee for Clinical Excellence Awards
BMA British Medical Association
CCT Certificate of Completion of Training
CEA Clinical Excellence Award
CESR Certificate of Eligibility for Specialist Registration
DCSF Department for Children, Schools and Families
GMC General Medical Council
GP general practitioner
IMG international medical graduate
MWF Medical Women’s Federation
NHS National Health Service
NHS MEE National Health Service Medical Education England
PMETB Postgraduate Medical Education and Training Board
RCGP Royal College of General Practitioners
RCP Royal College of Physicians
SAS staff or specialist grade
SHA strategic health authority
ST1 specialty training year 1
WHO World Health Organization
68
References
1 Higher Education Funding Council for England.
2 Higher Education Funding Council for England.
3 Royal College of Physicians. Women and medicine: The future. London: RCP; June 2009.
4 The Law Society. Earnings and work of private practice solicitors in 2007. London: The Law
Society; February 2008.
5 The Law Society. Women solicitors 2004: Research findings. London: The Law Society; 2004.
6 Wylie C. Trends in feminization of the teaching profession in OECD countries 1980–95.
Geneva: International Labour Office; March 2000.
7 Notzer N, Brown S. The feminization of the medical profession in Israel. Medical Education 1995;
29(5): 377–81.
8 Review May 2004 – April 2008, UK Resource Centre for Women in Science, Engineering and
Technology.
9 Department for Trade and Industry. Maximising Returns to Science, Engineering and Technology
Careers. London: DTI; 2002.
10 Women into Science, Engineering and Construction. www.wisecampaign.org.uk.
11 Office for National Statistics. Birth statistics (FM1 No. 36). Table 1.7b. London: ONS; 2008.
12 Royal College of Physicians. Women and medicine: The future. London: RCP; June 2009.
13 Lambert TW, Evans J, Goldacre MJ. Recruitment of UK-trained doctors into general practice:
findings from national cohort studies. Br J Gen Pract 2002; 52(478): 364–7, 369–72.
14 Levitt C, Candib L, Lent B, Howard M. Women Physicians and Family Medicine Monograph/
Literature Review. www.womenandfamilymedicine.com/files/pdf-documents/wwpwfm_
monograph_01-08-2008.pdf.
15 Royal College of Physicians. Women and medicine: The future. London: RCP; June 2009.
16 Levitt C, Candib L, Lent B, Howard M. Women Physicians and Family Medicine Monograph/
Literature Review. www.womenandfamilymedicine.com/files/pdf-documents/wwpwfm_
monograph_01-08-2008.pdf.
17 Allen I. Women doctors and their careers: what now? BMJ 2005; 331: 569–72.
18 McManus IC, Sproston KA. Women in hospital medicine in the United Kingdom: glass ceiling,
preference, prejudice, or cohort effect? J Epidemiol Community Health 2000; 54: 10–16.
19 Darzi A. High Quality Care for All: NHS next stage review. London: Department of Health; 2008.
69
20 National Institute for Health Research. NIHR Integrated Academic Training. www.nihrtcc.nhs.uk/
intetacatrain.
21 Medical Schools Council. Women in Clinical Academia: Attracting and Developing the Medical
and Dental Workforce of the Future. London: Medical Schools Council; 2007.
22 Mayer AP, Files JA, Ko MG, Blair JE. Academic advancement of women in medicine: do socialized
gender differences have a role in mentoring? Mayo Clin Proc 2008; 83(2): 204–7.
23 Foster SW, McMurray JE, Linzer M, Leavitt JW, Rosenberg M, Carnes M. Results of a
gender-climate and work-environment survey at a Midwestern academic health center.
Acad Med 2000; 75(6): 653–60.
24 Montgomery J, Chair, Advisory Committee on Clinical Excellence Awards. Briefing for National
Working Group on Women in Medicine, 8 January 2009.
25 Grunebaum A, Minkoff H, Blake D. Pregnancy among obstetricians: a comparison of births before,
during and after residency. Am J Obstet Gynecol 1987; 157(1): 79–83.
26 Tesch BJ, Osborne J, Simpson DE, Murray SF, Spiro J. Women physicians in dual-physician
relationships compared with those in other dual-career relationships. Acad Med 1992;
67(8): 542–4.
27 General Medical Council. Good Medical Practice. London: GMC; 2006.
28 Postgraduate Medical Education and Training Board. PMETB surveys reveal trainee doctors’
satisfaction on the increase but demand for flexible training is unmet. PMETB press release,
25 July 2008.
29 Gray SF, Goodyear HM, Jones MJT. Outcomes of flexible training compared to full time
training during the Specialist Registrar Grade in the UK. Med Educ Online 2005.
www.med-ed-online.org/pdf/10000007.pdf.
30 Brigham and Women’s Hospital Office for Women’s Careers.
www.brighamandwomens.org/cfdd/owc/.
31 Nadelson C. A Model for Women’s Career Development: An Office for Women’s Careers.
Presentation at Griffith University, Queensland, August 2006.
Photo credits:
Getty Images
Wellcome Library
Anne-Katrin Purkiss/Wellcome Library (Professor Dame Julia Polak, page 45)
Jeff Stultiens (Dame Margaret Turner-Warwick, page 51)
© Crown copyright 2009
298315 1p 750 October 09 (CWP)
Produced by COI for the Department of Health
If you require further copies of this title visit
www.orderline.dh.gov.uk and quote:
298315/Women doctors: making a difference
Tel: 0300 123 1002
Minicom: 0300 123 1003
(8am to 6pm, Monday to Friday)
www.dh.gov.uk/publications
... Against this backdrop, this study sets out to meet three objectives, of which the first attempts to establish the sex distribution of the cohort of MBChB graduates not entering the SA medical profession, and the second attempts to establish the reasons for attrition of women doctors from the South African medical practice. Taking the aforementioned into consideration, the third objective aims to provide recommendations on the retention 9 The difficulties experienced by women in certain medical specialisms, in academic medicine and in specific work/practice types is widely acknowledged (Tesch, Wood, Helwig & Nattinger, 1995;Deech, 2009). 10 Deech (2009), for instance, notes in her analysis of UK medical student data, an attrition rate of women medical doctors that is higher in comparison to men and that remains fairly constant between junior and consultant level. ...
... The literature on the feminisation of different professions examines the potential impact this might have on the relevant profession (Muzzin et al, 1994;Muzzin et al, 1995;Frize, 1997;O'Keefe, 2000;Riska, 1993Riska, , 2001. The discourse and debate in this area covers a wide range of issues (negative and positive), such as stress, sexual harassment and gender discrimination (CEJA, 1993), changes in values and career plans, structural inequalities, occupational closure (Loudon, 1999, Harden, 2001, Bickel, cited in Searle, 2001, debt and career choices, specialisation preferences and choices, marriage and the family (Dedobbeleer, Contandriopoulos & Desjardins, 1995;Thorne, 2004), working conditions (Darves, 2005;Kotulak, 2005;Davies, 2006) and environment (rural/urban), pregnancy and part-time training 27 , career satisfaction (Barnett, Gareis & Carr, 2005), earnings, and the importance of mentoring (Mobley, Jaret, Marsh & Lim, 1994;Wallace, 2001;Deech, 2009). ...
... In America, the most recent available data at the time of writing (2004) illustrates that medical school classes were 51% female (AMSA, 2005). In the UK, the number of women entering medical school has increased from 24% of total admissions in the 1960s, to about 56% of total admissions in 2008/9 (Deech, 2009). This increase can be attributed, amongst other things, to women's heightened expectations as a result of better education, which is the case in many countries across the globe. ...
Full-text available
Article
ENGLISH ABSTRACT: This dissertation aims to establish the reasons underlying possible gendered attrition trends in the South African medical profession between 1996 and 2005. Noting the international trend of the increasing feminisation of medical education and the profession, the dissertation illustrates that this is also a reality in our national context, and frames this phenomenon as being plagued by difficulties very similar to those encountered in other traditionally male-dominated fields. The particular relevance for further research and debate is illustrated through the noticed discrepancy between women’s representation in enrolment and graduation at medical schools in South Africa, and their representation in the profession itself. The decision to approach this investigation from a feministorganisational perspective was based on the fact that this would not only be a novel, but indeed also an appropriate, research approach to the study of gendered trends in medical education and the profession within the South African context. The research project thus sets out three main objectives relevant to this investigation. Objective 1 aims to establish the sex composition of the cohort of medical graduates that have not entered, or decided to exit, the medical profession. In terms of this objective, findings show an increasing rate of progression of men into the profession, accompanied by a decreasing rate of progression of women into the profession. Objective 2 attempts to establish the reasons behind sex trends in South African medical schools and in the profession. Thus, in an effort to comprehensively investigate the issues underlying attrition, I employ a mixed-methods approach to the primary data collection and analysis. Firstly, the findings show, through a quantitative analysis of the interview data, that this sample of women felt that both institutional and societal factors influenced a women doctor’s propensity to remain in the profession. Secondly, it is established that whether these respondents felt that they had appropriate role models in the profession was the most important factor in terms of their identification with, and propensity to stay in, the profession. Thirdly, it was also found that the respondents felt strongly that the culture of the medical profession impacts negatively on a woman doctor’s propensity to stay in the profession, but similar to the findings of other studies, this does not bring us closer to an understanding of what that culture constitutes. Thus, lastly, through a qualitative analysis of the interview data I find that the respondents clearly recognise the presence of a gendered substructure in medicine in the South African context, and identify some elements of this structure as most commonly linked to attrition. Objective 3, based on the outcomes of the previous objectives, aims to provide recommendations for the retention of medical doctors in general, and women doctors specifically, in the South African context. It concludes that flexibility1 in the medical profession is paramount to the retention of doctors, and women doctors specifically. This is a difficult challenge to overcome, as central values such as the importance of continuity of care in the medical profession would suggest that providing increased flexibility to medical doctors would impact negatively on patient care. However, it appears that there is increasing recognition amongst scholars, policy makers and medical practitioners themselves of the importance of acknowledging alternative work patterns. On the basis of the outcomes of my research, it is clear that the national gender attrition trends are a cause for concern in terms of resourcing the National Health System against the backdrop of a widely acknowledged shortage of doctors in South Africa and elsewhere. If women doctors do not progress effectively into the system, but form the majority of graduates, this is a tragic loss, as well as a waste of resources during training. This aspect also has policy implications, because it appears that the government, in trying to retain doctors, has increasingly turned to measures that are restrictive (compulsory community service, restrictions on foreign doctors), rather than focusing on ways in which to make doctors want to stay. The dissertation thus closes by suggesting two main areas within which these findings and recommendations would be employed most usefully: 1) medical schools/ training/education, and 2) the medical profession/culture. AFRIKAANSE OPSOMMING: Hierdie proefskrif het ten doel om die redes onderliggende aan geslagsverskille in die verlies van vroue uit die Suid-Afrikaanse mediese beroep tussen 1996 en 2005 vas te stel. Die internasionale tendens van die toenemende vervrouliking van mediese opleiding en die mediese beroep wys dat dit ook ‘n realiteit in die Suid-Afrikaanse nasionale konteks is. Hierdie verskynsel word veroorsaak deur probleme soortgelyk aan dié wat in ander, tradisioneel manlik gedomineerde beroepe ondervind word. Die spesifieke relevansie vir verdere navorsing en debat word geïllustreer deur die aangetoonde proporsionele verskil tussen vroue se inskrywing en graduering in mediese skole in Suid-Afrika, en hul verteenwoordiging in die beroep self. Die besluit om hierdie ondersoek uit ‘n feministies-organisatoriese perspektief te benader, is nie net omdat dit ‘n oorspronklike benadering sou wees nie, maar ook gepas vir ‘n studie van geslagstendense in die mediese onderwys en professie binne die Suid- Afrikaans konteks. Die navorsingsprojek bevestig dus drie hoofdoelstellings wat relevant tot hierdie ondersoek is. Doelstelling een probeer om die geslagsamestelling van die kohort van mediese gegradueerdes wat nie tot die beroep toegetree het nie, of dié wat besluit het om die beroep te verlaat, te bepaal. Daar is bevind dat daar ‘n verhoogde koers van vordering van mans tot die beroep is, gepaardgaande met ‘n verlaagde koers van vordering van vroue tot die beroep. Doelstelling twee probeer om die redes onderliggende aan die geslagstendense in die mediese skool en die beroep vas te stel. Dus, om ‘n omvattende ondersoek te doen om uit te vind wat onderliggend aan die verlies is, het ek van ‘n gemengde metode benadering tot data insameling en analise gebruik gemaak. Die resultate van die onderhoud data wys dat hierdie vroue voel dat beide institusionele en sosiale faktore ‘n vroulike dokter se besluit om in die beroep te bly, beïnvloed. Tweedens is daar vasgestel dat geskikte rolmodelle in die beroep die belangrikste faktor is in vroue se identifikasie met die beroep, en hulle besluit om in die beroep te bly. Derdens is gevind dat die respondente baie sterk voel dat die kultuur van die mediese beroep ’n negatiewe impak het op ‘n vroulike dokter se besluit om in die beroep te bly, maar soos ook in ander studies bevind is, bring dit ons nie nader aan ‘n begrip van die aard van die kultuur nie. Ten slotte is daar dus met die onderhoud data gevind dat die respondente duidelik bewus is van die teenwoordigheid van ‘n geslagsubstruktuur in die mediese beroep in Suid-Afrika. Ek identifiseer ook sekere elemente van hierdie struktuur wat bydra tot die verlies van vroulike dokters uit die mediese beroep. Doelstelling drie, gebaseer op die uitkomste van die vorige doelstellings, probeer om aanbevelings te maak vir die behoud van mediese dokters in die algemeen, en vroulike dokters spesifiek. Die gevolgtrekking is dat buigsaamheid in die werkskultuur van die mediese beroep van kardinale belang is vir die behoud van dokters in die algemeen, en vroulike dokters meer spesifiek. Dit is ‘n moeilike uitdaging om te oorkom omdat sentrale waardes, soos die belang van kontinuïteit van versorging in die beroep, persepsies laat ontstaan dat meer buigsaamheid in werksomstandighede ‘n negatiewe impak op die versorging van pasiënte sou hê. Dit blyk egter ook dat daar ‘n toenemende erkenning is deur akademici, beleidsontwerpers en mediese praktisyns self van die belang van alternatiewe werkspatrone. Gebaseer op die resultate van die ondersoek is dit duidelik dat die nasionale geslagsverliestendense ‘n rede tot kommer vir die verskaffing van menslike hulpbronne vir die nasionale gesondheidstelsel is, veral teen die agtergrond van ‘n algemeen erkende tekort aan dokters in Suid-Afrika. As vroulike dokters nie effektief in die stelsel opgeneem word nie, hoewel hulle die meerderheid van gegradueerdes is, is dit ‘n tragiese verlies en vermorsing van hulpbronne wat vir opleiding gebruik is. Dit het ook implikasies vir beleid omdat dit blyk dat die Suid-Afrikaanse regering, in sy pogings om dokters te behou, meermale maatreëls gebruik wat perke stel (verpligte gemeenskapsdiens, beperkings vir buitelandse dokters, ens.), waar hulle eerder behoort te fokus op maniere om dokters in Suid-Afrika te hou. Ten slotte stel die proefskrif twee hoofareas voor waarin hierdie bevindings en aanbevelings aangewend kan word: 1) mediese skole/opleiding/onderwys, en 2) die mediese beroep/kultuur. Thesis (PhD (Political Science))--University of Stellenbosch, 2011.
... In that year, women accounted for 41% of the medical workforce in the UK and it was forecast to become the first traditionally male-dominated profession to achieve gender parity. Moreover, in the decade before 2007, large numbers of women entered into general practice, whereas the number of men in this professional group remained stable (Deech, 2009). Inferring a member of this professional group to be a male is, therefore, a 'dangerous economy' (Goffman, 1977), as the likelihood of the presumption proving erroneous is relatively high. ...
Full-text available
Article
In spite of increasing gender diversity in employment roles, presumptions persist about the gender of people employed in particular occupations. Focusing on healthcare data collected in Australia and the United Kingdom within the past decade, we use Conversation Analysis (CA) to identify how presumptions about gender are displayed within social interaction through the use of gender-specific pronouns. We show how gender-specific pronouns are asymmetrically selected on the basis of a referent’s occupations, with gender-unspecified members of traditionally male occupations (e.g. doctors) referred to with masculine pronouns and gender-unspecified members of traditionally female occupations (e.g. nurses) referred to with feminine pronouns. We also explore ways people avoid making such presumptions. Our analysis therefore reveals a state of flux in contemporary social life, with instances in which gender presumptions persist as well as attempts to employ person references that reflect contemporary social dynamics.
Full-text available
Article
Across academic medicine, including psychiatry, women are underrepresented in senior positions. Various reasons have been put forward, for example the lack of high-ranking female role models or mentors and a reduced rate of career progression for women compared with men. Mentoring has been shown to be a popular and feasible intervention which can improve the success of those perceived as disadvantaged groups (in this case women) by having an important impact on personal development, career guidance and research productivity. Declaration of interest: None.
Full-text available
Article
AND CLIMATE determine how faculty's perceptions of medical school gender climate differ by gender, track, rank, and departmental affiliation. In 1997, a 115-item questionnaire was sent to all University of Wisconsin Medical School faculty to assess their perceptions of mentoring, networking, professional environment, obstacles to a successful academic career, and reasons for considering leaving academic medicine. Using Fisher's exact two-tailed test, the authors assessed gender differences both overall and by track, rank, and departmental cluster. Of the 836 faculty on tenure, clinician-educator, and clinical tracks, 507 (61%) responded. Although equal proportions of men and women had mentors, 24% of the women (compared with 6% of men; p < .001) felt that informal networking excluded faculty based on gender. Women's and men's perceptions differed significantly (p < .001) on 12 of 16 professional environment items (p < .05 on two of these items) and on five of six items regarding obstacles to academic success. While similar percentages of women and men indicated having seriously considered leaving academic medicine, their reasons differed: women cited work-family conflicts (51%), while men cited uncompetitive salaries (59%). These gender differences generally persisted across tracks, ranks, and departmental clusters. The greatest gender differences occurred among clinician-educators, associate professors, and primary care faculty. Women faculty perceived that gender climate created specific, serious obstacles to their professional development. Many of those obstacles (e.g., inconvenient meeting times and lack of child care) are remediable. These data suggest that medical schools can improve the climate and retain and promote women by more inclusive networking, attention to meeting times and child care, and improved professional interactions between men and women faculty.
Full-text available
Article
To assess from official statistics whether there is evidence that the careers of women doctors in hospitals do not progress in the same way as those of men. The proportions of female hospital doctors overall (1963-96), and in the specialties of medicine, surgery, obstetrics and gynaecology, pathology, radiology/radiotherapy, anaesthetics and psychiatry (1974-1996) were examined. Additionally data were examined on career preferences and intentions from pre-registration house officers, final year medical students, and medical school applicants (1966-1991). Data were analysed according to cohort of entry to medical school to assess the extent of disproportionate promotion. The proportion of women in hospital career posts was largely explained by the rapidly increasing proportion of women entering medical school during the past three decades. In general there was little evidence for disproportionate promotion of women in hospital careers, although in surgery, hospital medicine and obstetrics and gynaecology, fewer women seemed to progress beyond the SHO grade, and in anaesthetics there were deficits of women at each career stage. Analyses of career preferences and intentions suggest that disproportionate promotion cannot readily be explained as differential choice by women. Although there is no evidence as such of a "glass ceiling" for women doctors in hospital careers, and the current paucity of women consultants primarily reflects historical trends in the numbers of women entering medical school, there is evidence in some cases of disproportionate promotion that is best interpreted as direct or indirect discrimination.
Article
This study compared the career and domestic responsibilities of women physicians whose domestic partners were physicians (WP-Ps) with those of women physicians whose domestic partners were not physicians (WP-NPs). In 1988 the authors surveyed 602 women physicians in a large midwestern city regarding their career and domestic roles; 390 were physicians in training (students and residents), and 212 were physicians in practice (academic medicine and private practice). Overall, 382 (63%) responded; of the 382, 247 (65%) had domestic partners; of these 247, 91 (37%) were WP-Ps and 156 (63%) were WP-NPs. The WP-Ps were found to be twice as likely as the WP-NPs to interrupt their careers to accommodate their partners' careers. The WP-Ps also assumed significantly more domestic responsibilities and worked fewer hours practicing medicine than did the WP-NPs. The 163 women physicians in training (44-48%-of the WP-Ps and 119-76%-of the WP-NPs) demonstrated a more egalitarian division of labor overall, with no significant differences between the WP-Ps and the WP-NPs. The authors recommend that longitudinal studies be undertaken to determine whether women physicians in training continue this trend as they enter the practice of medicine.
Article
Questionnaires were sent to 1025 female board-certified obstetricians, and information was retrieved about pregnancy outcome. A total of 454 pregnancies, one third of which occurred during residency, were evaluated, and the relationship between pregnancy outcome and residency was assessed. Children of primiparous women who were delivered during or after residency had significantly lower mean birth weights than those who were delivered before residency (p less than 0.001 and p less than 0.005, respectively), whereas birth weights of infants born to multiparous women were not significantly different. The low birth weight rate (less than 2500 gm) was significantly increased during residency (p less than 0.002), and infants born during residency were 7.5 times more likely to be growth retarded than those born outside residency (p less than 0.002). The incidence of other pregnancy complications was not found to be increased during residency. Our data suggest a potentially negative impact of residency on the birth weights of infants born to female obstetricians in training.
Article
Two factors have caused major changes in the gender composition of the Israeli medical profession in recent years: (i) a wave of immigration from the former USSR, which increased the doctor population by approximately 70% and which included a majority of women physicians, and (ii) the entry of more Israeli women into medical school. This report presents the current gender status of the Israeli medical profession, regarding students and physicians, and the choice of medical specialty and academic seniority, and compares gender differences in Israel with those in other countries. Traditional patterns of specialization persist in Israel, with women still concentrated in primary care (family medicine, paediatrics and psychiatry). In addition, women still face obstacles in entering the more prestigious (mainly surgical) specialties. Whilst the number of women in academic medicine has increased over the last decade, women are still concentrated in the lowest echelons of academic medicine. However, the steady trend towards the feminization of medicine will inevitably lead to an increase of women in all areas of the medical profession. Because cross-cultural studies have repeatedly revealed that women doctors have a more humanistic and personalized approach to patient care, a higher ratio of women in the profession should have a qualitative effect in this direction, despite the bureaucratic and fiscal constraints incumbent upon practising doctors. As more women become role models for medical students, their approach will influence the education of the doctors of the future.
Article
In recent years there have been difficulties with recruitment in the United Kingdom (UK) to principalships in general practice. To compare recruitment trends in cohorts defined by year of qualification and to report attitudes of young doctors about the attractiveness of a career in general practice. Cohort studies. UK medical qualifiers in the years 1974, 1977, 1983, 1988, 1993, and 1996. Postal questionnaire surveys conductedfrom 1975 to 1999. Five years after qualification, 23.8% of 1993 qualifiers were in UK general practice, compared with 25.9% and 32.8% of 1988 and 1983 qualifiers respectively. Six per cent of responders in the 1993 cohort were general practitioner (GP) principals, compared with 10% of the 1988 cohort and 20% of the 1983 cohort. Ten years after qualification, 37.7% of 1988 qualifiers and 42.7% of 1983 qualifiers were in UK general practice. Older GPs had lower job satisfaction than their contemporaries in hospital practice, while younger GPs were more satisfied than younger hospital doctors with the time available for leisure. Although young doctors are less inclined to enter general practice nowadays, over haf of the 1996 qualifiers, when surveyed in 1999, actually regarded general practice as a more attractive career than hospital practice. Patterns of entry into and commitment to UK general practice are changing. Fewer young doctors are choosing and entering general practice and early commitment to full-time principalships is falling. The 1996 cohort, however, took an encouragingly positive view of the attractiveness of careers in general practice.
Article
During the past 30 years, women have entered academic medicine in increasingly larger numbers. However, fewer women than men have succeeded in advancing in academic rank.' Despite numerous studies and reports documenting this failure,^"" progress in correcting this problem has been slower than that predicted by even conservative estimates.^ In 1985, 10% of female medical school faculty held the rank of full professor.^ In 2006, 12% of female faculty were full professors.' It has taken more than 20 years for the proportion of female faculty who are full professors to increase 2 percentage points. Among male faculty, 30% have consistently held the rank of full professor over the same 20 years .^ The limited advancement of women in the upper echelons of medicine is not substantially different from that of women in other areas of science, mathematics, and business.'' Our engineering and business colleagues have described similar issues as they search for greater gender equality in their upper ranks.'-* Of female engineering faculty in the United States, 1% are full professors.* In business, the Harvard Business Review has reported that women comprise less than 6% of the uppermost ranks (ie, presidents, executive vice-presidents, chief executive officers, and chief operating officers) of Fortune 500 companies.'" Three years ago, then-Harvard University president Lawrence Summers questioned whether "innate" differences accounted for women's inability to advance in math and science. These statements were made in the context of a discussion about the difficulty of recruiting and retaining women leaders in these fields." Despite being unsubstantiated and negative, such speculation recognizes that the paucity of female faculty with full professorship is not unique to medicine. Within academic medicine, the demands of clinical practice, family obligations, and lack of mentoring have all been identified as factors that have a detrimental effect on
National Clinical Director for Children, Young People and Maternity Additionally, the Chair received numerous representations from individual female doctors and met with groups of doctors from the Oxford Radcliffe Hospitals and the Royal Brompton Hospital
  • Sheila Dr
  • Shribman
Dr Sheila Shribman – National Clinical Director for Children, Young People and Maternity Additionally, the Chair received numerous representations from individual female doctors and met with groups of doctors from the Oxford Radcliffe Hospitals and the Royal Brompton Hospital.
was established to examine the issue of childcare in more detail. It met twice NHS Employers, HM Treasury and the Department for Children, Schools and Families were represented, as well as a junior doctor and mother from the West Midlands
  • A By Dr Sheila
  • Shribman
A subcommittee, chaired by Dr Sheila Shribman, was established to examine the issue of childcare in more detail. It met twice, in December 2008 and January 2009. NHS Employers, HM Treasury and the Department for Children, Schools and Families were represented, as well as a junior doctor and mother from the West Midlands, in addition to Dr La Rovere and Professor Hayden from the main working group. References 1