Do it #LikeaLadyDoc: Promoting Gender Equality in the NHS Workforce

Science and Technology

In 1865, Elizabeth Garrett Anderson made history as the first women to qualify as a physician and surgeon. Since then, considerable gender equality advancements have been made for workers of the NHS. In 1874, the first medical school in Britain to train women as doctors was founded. Just two years later, a law was passed allowing medical authorities to license all qualified applicants irrespective of gender. Fast-tracking 141 years, one would expect there to be gender equality between workers in the NHS, but is the case?

The report, ‘Women on NHS Boards: 50:50 by 2020’, is the first in-depth analysis of this question and on the surface it looks promising. Currently, the NHS workforce is 77% female and there are 8 medical royal colleges led by women. However, as Clare Marx, President of the Royal College of Surgeons commented, ‘…as I look behind at the medical leadership pipeline, it looks very similar to the one I followed.’ Despite women making up the majority of the workforce, a disproportionately low number of women achieve leading medical positions, termed the ‘leaky pipeline phenomenon’. Currently, just 24.6% of medical directors in the NHS are women and only 34.1% of NHS boards achieve equal employment between women and men. To reach gender equality by 2020 this means NHS boards in England need another 500 women, an additional 125 per year.

Despite women making up the majority of the workforce, a disproportionately low number of women achieve leading medical positions

Another obvious measure of equality is pay, and the statistics show that improvements certainly could be made here too. Data from the Office for National Statistics on median annual gross pay showed that this pay gap is in fact wider than with other employment sectors. In 2006, female doctors earned 24% less than their male colleagues and since 2008, this pay gap has continued to increase with female full-time doctors consistently earning a third less than male doctors. Last year women earned 34% less than their male equivalents, in contrast to the average pay gap of 19% across all employment groups. As a result of these shocking findings, since April of this year, employers in the UK with more than 250 staff, such as NHS trusts, have been required by law to publish gender pay gap and gender bonus gap information on their own website and on a government website. Better late than never, some might say. But they’re in place for a reason – simply, gender inequality still exists in the NHS.

In 2006, female doctors earned 24% less than their male colleagues and since 2008, this pay gap has continued to increase with female full-time doctors consistently earning a third less than male doctors.

Although laws are a step in the right direction, the root of the problem lies in social attitudes. A video campaign lead by the charity ‘Inspiring the Future’ highlighted this perfectly. Their video showed a group of five to seven-year-olds drawing pictures of firefighters, surgeons or fighter pilots. Of the 66 pictures drawn, only five of them were women. This suggests something deep-rooted in the ignorance of society.

As with the legal reforms however, steps are being made to change this. Last year, an article appeared in the Sunday Times entitled ‘The one sex change on the NHS that nobody has been talking about’ which argued that an increasing number of female doctors was an important, but unspoken, factor in the disagreement over changes to antisocial hours proposed in the new junior doctor contracts. A widespread twitter campaign ensued using #LikeALadyDoc, where women shared stories and pictures of themselves and their extraordinary achievements, raising awareness of their tireless contribution to the NHS. Similarly, the cover illustration by Malika Favre for the April edition of The New Yorker magazine this year sparked a viral response. This cover showed four women in surgical masks looking down at an operating table and inspired surgeons from all over the world to replicate this illustration in real life. The mere existence of these campaigns are extremely positive, promoting equality in the NHS workforce with women, people of colour, and other diverse groups. However, they also highlight that this is not a problem of the past but an issue we are still facing now.

Gender inequality is clearly still a problem NHS workers are facing today, despite the 152 years which have lapsed since Elizabeth Garrett Anderson first qualified as a medic. Why it exists and how this can be changed are more interesting questions. After speaking to women working within the NHS, it appears that gender inequality is self-perpetuating. As the majority of medical leaders are men, people are predominantly trained and mentored for these roles by men, thus resulting in more men applying and subsequently selected for higher-ranking positions. Without appropriate changes made to ensure the 2020 target of 50:50 medical workers on NHS boards, it is unlikely any permanent improvements will be observed. It is worth noting however, that not all medical specialities are gender equal and whilst the NHS strives to meet the ’50:50’ goal for boards, this will not be the case for all specialities individually.

Gender inequality is clearly still a problem NHS workers are facing today, despite the 152 years which have lapsed since Elizabeth Garrett Anderson first qualified as a medic.

In order to gain the perspective of a leading female doctor, we have interviewed Dr. Sharona Ben-Heim, a female neurosurgeon based in the US who is an expert in novel cutting-edge surgical epilepsy treatment. When asked what inspired her to become a neurosurgeon, she stated ‘I always knew that I loved studying the brain. Before entering medical school I thought I would become a psychiatrist or a neurologist, and it wasn’t until I entered the clinical wards that I fell in love with surgery. I loved the immediacy of the effect that you can have on people, and I loved working with my hands. Neurosurgery ended up being the natural choice, and now I cant imagine doing anything else.’

We then asked broached the topic of gender equality. We asked if she had experienced any gender inequalities in the NHS throughout her career and what these were. Her answer was insightful and poignant, demonstrating the subtlety but reality of such inequalities. ‘I only spent several months in the NHS and I found it to be quite progressive from a gender equity perspective, especially as compared to neurosurgical programs in the United States.’, she remarks. ‘When visiting an NHS program, for example, I encountered a neurosurgical trainee who had a reduced schedule after returning from a long maternity leave. In the US neurosurgical training programs we don’t have any specific laws governing things like family leave, and as a result it becomes a rather inhospitable environment to men and women trying to start a family. This is unfortunately as our 7 year training program takes place during most people’s reproductive peak. I saw some similarities between US program and the NHS, in that being a female neurosurgeon can be more of a challenge when compared to our male counterparts. The differences are subtle, but real: the way nurses speak to you, the way your colleagues assess your skills. The subtleties are easy to excuse away one by one, but eventually add up.’

‘The subtleties are easy to excuse away one by one, but eventually add up.’

We then asked how this differed to her success in academia, to which she responded, ‘Because there are more women in academia, there are naturally more role models. Others have paved the way and the inequalities are less obvious. In fact, sometimes there are even advantages in that women are sometimes sought after for speaking engagements and committee positions to ‘balance things out.’’

As we assume positive changes are being made to ameliorate any gender differences, we then ask her whether she feels any gender inequalities have diminished more recently. She replies ‘There is no doubt that we have come very far since the first female neurosurgeons entered the field. Hearing their stories about sexual harassment and gross discrimination makes us appreciate how far we have come.’ As someone who has vast expertise in the field and plentiful experience, we then wonder how she feels inequalities may be best combated. On this topic, she remarks ‘I would like to see us continue on the current trend of respecting each other’s differences. I think that the issue of child bearing and rearing will always be a point of potential improvement.’ She then, somewhat surprisingly, continues ‘Ironically, I think that we need to focus more on giving men time off and increase paternity leave in order to ultimately allow women to succeed in the workplace. At present, many European countries are far advanced compared to the US in these matters.’

‘I would like to see us continue on the current trend of respecting each other’s differences’

Our interview was brought to a close with an inspiring message from Dr. Ben-Haim, on the topic of advice she would lend to women wishing to pursue a career in medicine. She stated ‘I would tell women to go into whatever field interests them most. I believe that in making a decision amongst the specialties, you should look at the quality of life of the attendings (consultants) rather than the trainees. I would also tell women the same advice that was given to me by one of my mentors: don’t be passive in anything you do. Don’t let things “happen” to you, but decide what you want in advance and make it happen. You can do whatever you would like to do with regards to marriage, family and lifestyle, but it takes proactivity.’ Although this advice is uplifting, it also strongly demonstrates the pervasive need for women to push harder than their male counterparts to achieve their goals. However, she shows it is indeed possible, as she continues to successfully pave the way for novel techniques in neurosurgery.

Looking to the future, with the majority of workers in the NHS overall being women, the NHS, if anywhere, has the potential to lead the transition to gender equality in the workplace. The NHS is definitely moving in the right direction, with changes being made to tackle the underlying causes. However, there is still some way to go, and whether these changes will be effective remains to be seen.