Clare Marx: Outdated career ideals stifle medical women and hurt us all

It was my pleasure to welcome five brilliant women to the GMC’s council this month. 

From ethical leadership to immersive technologies, the expertise they bring with them is testament to the profound impact of women in public life. They’ll fill the seats of five other trailblazing women who have left a wonderful legacy. 

The success and standing of these women is also a sign of how things have moved on. When I qualified as a doctor 43 years ago, such representation seemed like an impossible dream.

I have been extremely fortunate to have had inspirational teachers, mentors, and role models throughout my career, all of them men. But I’ve also seen poorly disguised undermining and sexism masquerading as “joking.” I’ve been in roles where people questioned if I was “strong enough” or “had big enough hands” to be an orthopaedic surgeon. Or when I planned to “leave the playing field to the boys.” Even passing my surgeons exam was met with a degree of disbelief. “Oh my God we’ll have to take you seriously now” was one memorable response.

I thought it would stop as I got more senior, but I think it’s actually become more blatant, even as the medical landscape has become more diverse. 

At a glance, the numbers look good. Women make up a greater proportion of licensed doctors than ever before at 48%, according to this year’s State of medical education and practice in the UK. And in the past few years, there have been higher numbers of female students attending medical school.

But put the profession under a microscope, pay is as good a place to start as anywhere, and you’ll find disparities glaring. 

The Independent Review into Gender Pay Gaps in Medicine in England, chaired by Dame Jane Dacre and published last week, identified a pay gap of 24.4% for hospital doctors, 33.5% for GPs, and 21.4% for clinical academics.

In my specialty, representation is improving at a glacial pace, with the ratio of male to female consultant surgeons still about 8:1.

The pipeline of female talent has never been healthier, so why isn’t this translating into genuine parity in medicine?

It’s complicated, but a few issues come to mind.

For one, society and workplaces are still set up around old-fashioned assumptions and rigid structures. The premise that the mother should be the first contact for the nursery when there is an issue rather than the father, for example.

But this isn’t what the doctors of today say they want—neither men nor women. One in five doctors reduced their hours last year, work/life balance being an important factor for both sexes. Meanwhile, there are signs that doctors also want more flexible training pathways—the number of doctors pausing training after Foundation Year 2 is higher than ever before.

In short, this is still a service model designed for a predominantly male workforce. While there is now no shortage of women in medicine, the workplaces they enter haven’t adapted.

And let’s look at those later in their careers. A BMA survey this year illustrated the issues perfectly. 90% of respondents said symptoms of the menopause had impacted their working lives. But the majority were not receiving any support from their employer to make their symptoms more manageable, running the risk that they would leave the profession altogether. At a time when there is already a shortage of senior doctors, losing this talent would be a profound waste.

Luckily, there is an antidote—enabling fair, inclusive cultures that help everyone to work at the top of their game. 

Today’s doctors have diverse needs, and to get the best out of them training programmes, assessment methods and timings, and the workplace should accommodate those needs. That means listening, showing compassion, being flexible, and being open about balancing the needs of the individuals and the needs of the service.

This is not only in the interests of the doctors themselves, but also their patients. As a recent report for the GMC by Michael West and the late Dame Denise Coia showed, doctors that work in supportive environments deliver better care. Where working environments are inflexible or cliquey, patient care is compromised.

Inequality is insidious. Throughout my career as a surgeon, I’ve seen it take many forms. Sometimes it’s as ostentatious as a sexist slur or a hand on the knee. But most of the time, it creeps quietly into our professional lives, undermining confidence and the care we provide. That’s why combatting inequality of any kind is not a distraction from delivering first class care. It’s an essential part of it. 

Clare Marx became the General Medical Council’s first female Chair in 2019. Prior to this she was Chair of Faculty of Medical Leadership and Management (November 2017-18) and President of the Royal College of Surgeons of England (2014-17).

Competing interests: none declared.