The findings of the long awaited Dacre review into the gender pay gap in medicine came as no surprise to me.

Nor did confirmation that the gender pay gap in medicine is one of the largest of all professions, with an average hourly pay difference of 18.9 percent for hospital doctors. When age was removed as a factor, and awards and supplements added in, the gap still stood at between 7-10 percent.

I myself set out on a focused and aspirational career path. l was deemed to be a potential leader. I was put forward to represent my organisation internationally and placed onto a regional leadership programme.

I had plans of becoming a medical director or even CEO of an NHS Trust. I made choices that sacrificed relationships and delayed having children to achieve this goal.

All the successful women around me in management or clinical lead positions, especially in surgery and anaesthetics, were single or married with no children and totally committed to their careers, often working excessive hours compared to their male counterparts to “prove” themselves, and counter any possible argument that a woman “wasn’t up for the job” as they were too distracted with family life.

Perversely, some of the worst protagonists of this belief were women, who had themselves made huge personal sacrifices and demanded the same of others.

For me, having married and had children late, life circumstances interjected when I found myself trying to juggle a clinical lead role and aspirations of a board level management position, with being a single mother of two pre-school children and carer for elderly parents—one of whom was terminally ill.

Childcare costs spiralled upwards as I tried to meet the demands of a more-than-full-time job.

Inevitably, with mounting pressure from so many directions, something had to give. Chronic exhaustion, physically and mentally, left me burnt out and resulted in an enforced break. 

My credibility within the NHS as a leader dissolved.

When a period of illness followed, including a cancer diagnosis, becoming less than full time was the only way to achieve a sustainable balance.

My chances of leadership evaporated.

This was never about my income, but about my passion for the health service. Yet the current culture meant that I had to go elsewhere to pursue my aspirations to make a difference and advocate for a better, more sustainable NHS.

The bulk of my story is by no means unique. The Mend the Gap report stated that women overwhelmingly bear the greatest caring burden for children and family members, meaning they are more likely to work less than full time and more likely to choose career options which accommodate this.

This is a significant root of the problem, affecting the chances of securing Clinical Excellence Awards or other supplementary pay, which is compounded by ill-designed salary scales which do not take this phenomenon into account.

But the causes of the medical gender pay gap are multiple and complex. To solve them will require fundamental changes at a national contractual level and through enhanced diversity policies and initiatives that will have to be strengthened and enacted.

Even more importantly, there needs to be fundamental and determined change in culture following years of lip service with no real action.

In 2018, I met with then health minister Stephen Hammond to express concerns around the future recruitment and retention of doctors given the changing nature of the NHS workforce.

The NHS People Plan confirmed the view that the NHS is one of the worst employers, with a pervasive bullying culture and little thought given to the gender pay gap when formulating policy.

In future the medical workforce will no longer be majority male, with women making up 60 percent of current medical students.

Younger doctors, no matter their gender, are increasingly seeking a better work-life balance through reduced hours and portfolio careers.

These trends have to be recognised and embraced to ensure a sustainable medical workforce. They mean the NHS must create meaningful opportunities for flexible working, with creative pathways to advance that do not require full-time working for the full career term, yet still enable the full range of opportunities.

It must also create innovative modes of delivering care based on larger numbers of less than full time doctors, without financial penalty for those who choose to do so.

By doing so the NHS will not just benefit staff, but deliver a more sustainable health service for patients too.

Claudia Paoloni, consultant anaesthetist at Universty Hospital Bristol and President of the Hospital Consultants and Specialists Association.

Competing interests: CP is Director of Calmwater Ltd