Cover story: Why women doctors in the NHS are still seeking equality

2017 should see a 50-50 split between men and women doctors for the first time. But for Medical Women’s Federation President Sally Davies the battle for equality is far from over.

The year was 1879. Abroad, British soldiers were fighting Zulu warriors in their infamous battle for dominance in southern Africa.

The same year another battle, little-known and neglected, began at home.

This is the story of women in medicine, which began in earnest on May 6th 1879 when nine female clinicians – almost the entire number qualified at the time – joined together to form the Association of Registered Medical Women (ARMW).

The goal was to fight their corner – and for the interests of female patients – within a society and profession where their voice was sidelined.

Fast forward to 2016 and the number of women entering medical school has consistently outnumbered men for the past 20 years. The gender ratio of qualified doctors is projected to hit 50-50 by 2017, correcting centuries of imbalance.

By any measure it is a stunning turnaround, in no small part due to organisations such as the Medical Women’s Federation, successor to the ARMW and a century old next year.

But there is a problem. While numbers have risen, the leading positions – consultants, clinical and medical directors, and academic posts – remain a male- dominated domain.

Eighty-five per cent of national Clinical Excellence Awards go to men.

MWF president Sally Davies believes the causes of this imbalance are deeply rooted in the culture of medicine.

Securing a new, more flexible working culture, she says, would “make it better for all of us” – men and women doctors alike.

Yet she fears that instead the proposed juniors contract is about to make things worse.

So what would her campaigning forebears make of the situation today? “If you told them that in 2017 50 per cent of all doctors would have been women they’d have been delighted,” she says. “They’d have been amazed.

“But I think they would still be horrified if they saw what was going on.”

Today, says Davies, a lot of the calls the MWF receives are from doctors facing bullying or sexism on the job.

When parenthood is added to the equation, the challenges for women becomes even greater.

Davies had her own eyes opened when she became a mother.

“I was one of these women who thought: ‘I’m never going to need an organisation like that – I’m just as good as my male colleagues’.

“It was only when I had children, worked part-time and fell behind that I realised how pervasive the attitudes are.”

Davies believes that unless these issues are addressed, the imbalance at the top will simply continue. She rejects the idea that the numbers, which mean that today only around 17 per cent of academic medical professors or chairs are women, will simply balance out by themselves.

“The culture of medicine hasn’t changed,” she says. “We still do not welcome flexibility in working patterns.

“You’ve only got to look at the junior doctors’ contract that is supposedly going to be imposed to see that.”

The new contract will likely mean that those working less than full time, many of whom are women with children, will face an even steeper uphill struggle.

One concern is that part-timers will be used increasingly to plug Saturday gaps, putting pressure on childcare commitments and limiting their access to weekday training.

The new pay progression structure devised in the contract will also create more barriers, meaning many part-timers will have to wait years longer to move forward to the next band.

And with “pay protection,” designed by employers to sweeten the pill by applying an income floor to existing junior doctors, scheduled to end in April 2019 there are fears that women taking time out to care for children will be further penalised.

But the impact of the drive for seven-day services isn’t just financial, adds Davies.

“If you are going to be working routinely across seven days, working until late at night, it is very difficult to get childcare. And if you’re both – as 37 per cent of partnerships are – doctors, it’s going to put a lot of stress on the relationship,” she says. “It’s great to have a Monday or a Tuesday off, but you don’t see your family, your partner and your children on more Saturdays or Sundays.

“People are desperate to progress, but it’s made so difficult. So little childcare is provided within the NHS, and there is no flexibility.”

Davies says that the current situation is “equality as equality stands – ie treating everyone the same – but it’s not equity. It’s not giving people the same opportunity.

“Are women not as good as men and therefore not able to progress? No. Are they not interested in progressing further? There’s a little bit of that if you’re trying to juggle family.

“Do women need support, as in someone saying: ‘You really need to go for that’? Possibly they do.

“Is there actually discrimination? Though we don’t want to think it, I think the answer still is Yes. It’s unconscious bias.”

All this matters, says Davies, and not just because of the gender imbalance at the top of medicine. The current culture means men also lose out, especially if they face long-term illness or family demands.

“Rotas are designed by managers, not by doctors. I’m sure that if doctors were actually involved systems would grow up that are much more family friendly, doctor friendly, and more likely to retain doctors.”

She says that changing the culture would just mean employers and policy- makers applying the lessons from some of the world’s most successful businesses.

“If you asked a big company what’s your biggest asset they will say their workforce,” she says. “Where they have made their businesses family friendly they have much better recruitment and retention, increased morale and increased productivity.”

Davies warns that the current trajectory could instead see increasing numbers of women voting with their feet.

But while she acknowledges the difficulties of challenging current attitudes, she detects a ray of hope.

“We know that this current generation coming through are different – the men also would like to work differently. They would also like to work flexibly.

“We’ve just got to do something about it. Because we’ve always done things one way, it doesn’t mean we always have to.”