Women on the rise

MEN were doctors and women were nurses. That’s how the gender split in medicine seemed to present itself for many years. Access to the profession was generally restricted to university graduates and women were historically excluded from such studies. Eventually in the 1900s, after much struggle, they were permitted entry but progress was slow. By the 1960s only 10 per cent of medical graduates were female.

Fast-forward to 2003 and this figure jumps to 61 per cent. It has since fallen slightly but currently sits at a healthy 55 per cent. The predictions are that by 2017 women doctors will outnumber men and the trend has led to some gloomy predictions from critics. But is the rise of women in medicine a bad thing?

Pioneers

A number of key figures in history have helped improve access and equality for women in medicine.

James Miranda Barry, thought to be the world’s first lady doctor, is believed to have disguised herself as a man to gain admission to medical school. She graduated circa 1815 and became an accomplished army surgeon in Canada and South Africa. Only once did she allow herself to be examined, swearing the attending doctor to secrecy.

In 1869, The Edinburgh Seven became the first group of women medical students granted access to a UK university. But while they were allowed to attend classes, they lost their legal bid to be awarded degrees. One of these, the formidable Sophia Jex-Blake, went on to found two medical schools for women – the London School of Medicine for Women in 1874 and its Edinburgh counterpart in 1886. She also opened a women’s hospital in Bruntsfield, Edinburgh.

Current statistics

Although male doctors still form the overall majority, women already dominate certain specialties. According to the Health and Social Care Information Centre, the number of UK female GPs in 2013 reached 20,435, compared with 19,801 male GPs.

Despite this, they continue to be under-represented in senior roles. In 2013, only 41 per cent of GP partners were female, suggesting women find it more difficult (or are less inclined) to reach the top jobs. However, this gender imbalance is small in relation to other professions, such as FTSE 100 company directors and senior judges, where women sometimes make up as little as 10 per cent of positions.

Currently, women are well represented among the presidents of the Royal Colleges, with Professor Jane Dacre (Royal College of Physicians), Miss Clare Marx (Royal College of Surgeons), Dr Maureen Baker (chair of the Royal College of GPs), Professor Caroline McEwen (Royal College of Ophthalmologists), Professor Parveen Kumar (Royal Society of Medicine) and Dr Hilary Cass (Royal College of Paediatrics and Child Health). Dr Suzy Lishman will become president of the Royal College of Pathologists in November 2014.

The criticism

Common criticisms of the so-called feminisation of medicine focus largely on workforce issues and the tendency for women to work part-time, retire earlier and take career breaks along the way. It is argued that this means more money will have to be spent training more doctors to make up for those working less than full time.

In 2004 Professor Dame Carol Black, then President of the Royal College of Physicians, controversially voiced her views. She compared the UK situation to that in Russia, where both medicine and teaching are dominated by women. She said the professions had lost authority and respect and had seen their influence dwindle, something she feared could happen to medicine in the UK.

She also said women often avoided demanding specialties such as surgery or orthopaedics, as well as those requiring evening and weekend work. “What worries me is who is going to be the professor of cardiology in the future?” she said. “Where are we going to find the leaders of British medicine in 20 years’ time?”

In response, Dr Maureen Baker, then secretary of the RCGP, argued that the profession may need to adjust to more flexible working patterns since many women doctors wanted a family.

At the NHS Fife annual health review in 2012 the topic was aired again when staffing issues were blamed on the number of female employees, many of whom work part-time or had taken maternity leave. But Fife Patients’ Association responded by saying: “This is poor human resources management; it just doesn’t seem to connect with the staff”.

Jackson Carlaw, the Scottish Conservative health spokesman, agreed: “Since time began, healthcare has always been made up of predominantly women, so this ‘feminisation’ line is hardly new. Neither is the likelihood of females having children or requiring to work part-time, so this sounds like a hugely dated – and desperate – excuse.”

Ongoing debate

In a Commons debate in June, MP Anne McIntosh said the number of women in the NHS was a “burden”, while fellow MP Anna Soubry described them as a “drain on resources”.

This followed a similarly critical newspaper article in January by oncology surgeon Professor J Merion Thomas. He expressed his concerns about the low numbers of female doctors choosing more demanding specialties, as well as the impact on continuing professional development and patient continuity of the increasing number of part-time doctors.

He recommended that all female medical students read Lean In, a book written by US businesswoman Sheryl Sandberg, which encourages women to commit wholeheartedly to their profession. The Academy of Medical Royal Colleges Council offered a robust defence against the professor’s comments.

They described his arguments as “profoundly mistaken and not evidence based” and refuted his claims that “gender imbalance is already having a negative effect on the NHS”. They rejected the suggestion that women in hospital medicine tended to avoid the more demanding specialties because of a lack of commitment. Gender disparity in some specialties was not, they argued, due to “failings” of women but “wider issues relating to structures, culture and behaviours which need to be addressed by the profession as a whole”.

The Academy added that the changing nature of the medical workforce should be seen as an opportunity rather than a threat and opportunities for flexible working were increasingly being sought by both male and female doctors.

Positive qualities

So, do male and female doctors have different strengths and weaknesses? It’s often suggested that female doctors bring a softer touch to medicine, with better listening skills and greater empathy. A 2011 article on the US website Medscape (Women MDs spend more time with patients: does it matter?) highlighted research that found female doctors on average spend more time with their patients than their male colleagues. It also noted that women were much more likely to engage in “patient-centred” interviewing by “actively enlisting patient input, counselling, and exploring larger life-context issues that affect patients’ conditions.”

Some patients may also be more comfortable discussing their conditions and being examined by females – this can happen in specialties such as obstetrics and gynaecology, and may in some cases even be a religious requirement. That said, it would certainly be overly simplistic to say that all women practise medicine in a way that is distinct from (or indeed superior to) men.

Responding to a new era

The NHS is not an organisation that is known for adapting rapidly, but it’s clear that the evolving workforce will necessitate some changes. In 2009 the Department of Health published Women doctors: making a difference – report of the Chair of the National Working Group on Medicine. It made several recommendations for healthcare services including improving childcare availability, part-time opportunities, careers advice and mentoring, workforce planning and appointment of champions. It has also been suggested that improving access to flexible working for men, including extending paternity cover entitlements, would be another important step towards a more even professional playing field.

Anne Parfitt Rogers is a foundation doctor and editor of FYi

Useful links

• The Medical Women’s Foundation

• Dispelling myths at the RCSEng’s Women in Surgery site

• Women in Psychiatry

• The NHS North West Women in Medicine run an annual conference in England

• For inspiration, look no further than the University College London Leaders in Medicine podcasts

• And the adventurous Dr Quinn