Women and medicine: the future

Women in medicine are now reaching consultant status in rapidly increasing numbers. This is a significant achievement for those seeking gender equality in the medical workforce, but raises some issues for the future for those involved in workforce planning and policy. The results of research from the Royal College of Physicians (RCP) suggest that the main area for further policy development should broaden from a focus on the concerns related to barriers to entry or delays to career progression to enabling the larger numbers of women doctors to be incorporated into the workforce in an effective, economical and fair manner that benefits patients. In June 2009, the RCP published Women and medicine: the future.¹ It is the main output of a research project completed by Dr Mary Ann Elston, Emeritus Reader in Medical Sociology, Royal Holloway, University of London. The work has collated information from available data sets, and qualitative seminars to provide the most comprehensive information to date on the evidence base related to women in medicine.

Caring for the sick was seen as women's work until the creation of the medical royal colleges in the time of Henry VIII around 500 years ago. Women were not allowed to enter medical school until 1925, about 400 years later. The problems encountered then are highlighted by the story of Elizabeth Garrett Anderson, who was determined to become a doctor, and quietly took and passed the examination of the Society of Apothecaries to qualify. When the Apothecaries realised that a woman had qualified, they changed the rules to prevent women entering, but too late to stop her and a few other ladies slipping through the net and becoming doctors.

Women have been entering the profession since then but in smaller numbers than men. Since the 1980s, however, there has been a huge change in the demographics and women doctors are likely to outnumber men from 2017. Predictions that the numbers of female doctors will be in excess of 70% look to be unfounded on current trends, as numbers are now levelling off, but the debate about the implications of this change has been aired in the medical press, and is set to continue.^2,3

The RCP research shows that there are clear differences in the distribution of specialties entered by women and men. Although there is a range, women are less well represented in areas where work patterns include an unpredictable pattern of delivery of care, and also an emphasis on the technical aspects of medicine (compare general practice at 44.2% with surgery at 8.4%). Although most doctors still work full time, women are far more likely to work part time. Over a full career, women provide on average 60% of a full-time equivalent, against 80% for men. Women are not, however, more likely than men to leave medicine altogether.

Women are now the majority of entrants to ST1, so, provided they ‘run through’, will be the majority of the consultant workforce over the next decade in all specialties except surgery and radiology. An interesting question about the future leadership of the profession is therefore raised. Currently, although women are very well represented at consultant level, they are less likely than men to reach leadership positions, such as presidents of the medical royal colleges or deans of medical schools. A recent report on women in academic medicine showed only 11% of the professorial staff in the UK's medical schools are women compared with 36% of clinical lecturers.⁴The proportion of women decreases at each increase in academic grade. This is also the case in the USA, where only 15% of full professors and 11% of department chairs are female.⁵One factor influencing the career progression of women in academic medicine and to leadership positions in general is the difficulty they have in taking on extra duties, which may involve out-of-hours work, for example, when childcare is difficult to find or when there are periods of time away from the family presenting work at international conferences. Not making themselves available for these activities may be a career choice for women, but some would call it a barrier.⁶Another complicating factor is the legacy from the lower numbers of women in the profession until the 1980s, which is still working through, resulting in fewer women currently eligible for these prestigious posts.

The questions raised by this research are not easy to answer, and prompt value-laden conclusions depending on what colleagues think of women in the workplace generally. The report has made recommendations, based closely on the results of the research. Most of these are related to improved data collection and workforce planning, with an emphasis on the need for career guidance. There is a need to publicise this work to encourage awareness of the future problems for the men and women in the workforce if the current demographic change is not considered urgently in policy making.

• © 2009 Royal College of Physicians