This International Women’s Day comes at a unique and stressful time for all healthcare workers. Many may be thinking of leaving the profession and those who remain will need strong and effective leadership. Never has it been more important for us to encourage the next generation of female leaders. 

Anaesthesia has a proud history of female role models, notably being one of the first Medical Royal Colleges to elect a female leader, Aileen Adams, as far back as 1985. However, Jane Dacre’s recent review of the gender pay gap in medicine highlighted that although women make up a significant proportion of the medical workforce, they are still under-represented in leadership positions.

There are multiple reasons for this. But importantly, since the majority of those working less than full time in medicine are women, they inevitably take longer to reach the point where they might take on these roles. The structure of medical careers has not changed to keep pace with the change in workforce demographics and is still based around the expectation of full time working over a long career. 

Looked at objectively, this is a very outdated employment model that cannot possibly allow the current workforce to reach its full potential. In addition, there are still barriers to job sharing or less than full time working in leadership positions. Add to this a culture that allows far too much bullying and micro-aggression against those perceived to be under-performing against current benchmarks, and it is obvious why women are generally not progressing as far or as fast as men.

Globally, and beyond medicine, women have been affected more than men by job losses during the pandemic. This is due to the fact that women are over-represented in the professions most at risk, such as retail and hospitality. There is no doubt however that school closures and lack of availability of childcare will have had an effect. As key workers, women in medicine have been less affected by these pressures, but they still tend to take on most of the childcare responsibilities. Medical training can seem to some to be designed to disadvantage women. The important career-moulding years of specialty training often coincide with the time at which people will start a family. Women taking take time out for maternity leave may well return part time to balance childcare responsibilities. This inevitably means they take longer to complete their training, or even give up on the idea altogether.

It is clearly possible to have a fulfilling career without going through a full training programme. The issue is that people take this route through necessity rather than choice. It is a sad fact that there is still a legacy of those working less than full time being regarded as less dedicated to the profession, and therefore less worthy of progression and promotion, than their full time colleagues, even though the opposite is often the case.

One way to overcome the gender pay gap and work towards equality in medicine would be to promote more flexible working for men, making it a normal expectation that they would also have periods of working less than full time during their careers. While this would allow domestic responsibilities to be shared more equitably, there is no real reason why less than full time working should not be adopted for any number of reasons, both professional and personal. 

This fits with the current drive to make training more flexible and to allow people to step on and off the training pathway while still ultimately heading for a Certificate of Completion of Training in their chosen specialty, if that is what they wish to do. In the wake of the pandemic the improved work-life balance inherent in working flexibly may be very attractive. Encouragingly there are growing numbers of role models and mentors of all genders, who have either taken less conventional career pathways themselves, or who have seen the benefits that can accrue in doing so, and will help others aiming to do the same. 

Cultural change is notoriously difficult, but during the pandemic we have seen that when there is a pressing need, leaders will emerge and will drive effective change. The recommendations from Jane Dacre’s review encompass things such as changes in pay scales to reduce the impact of less than full time working, reduction in the assessment burden during training, improved careers guidance in medical school and a zero-tolerance approach to bullying and harassment in the workplace. While these are designed to address the gender pay gap, they will do so by attacking some of the root causes and will therefore have benefits beyond pay. This should lead to a more inclusive and nurturing workplace that would ultimately help to improve patient safety.

In celebrating International Women’s Day, let’s look forward to a time when we will all be valued for what we can bring to a role rather than for who we happen to be.

Fiona Donald, Vice President of the Royal College of Anaesthetists.

Competing interests: none declared.