By reducing pay gaps, we can reduce inequality in the medical workforce

Women first entered the medical profession just over one hundred years ago and since then the workforce has become increasingly diverse. However, we are concerned that the covid-19 pandemic will reverse the progress that has been made towards workforce equality for women. During lockdown, the societal expectation that women will be predisposed to prioritise family life will damage their career progression.  

In late 2020, we published the outcome of our review of gender pay gaps in medicine in England. It was the largest analysis of public sector administrative data to date and it found that the gender pay gap in medicine is due to an uneven distribution of doctors across the medical workforce, exacerbated by an unsympathetic career structure for women. 

A gender pay gap is different from equal pay and is sometimes misunderstood. It is defined as a difference in the average pay rates for men and women expressed as a percentage of men’s pay. 

In our report we made 41 recommendations across seven themes, reflecting the multiple issues that need to be addressed to mend the gender pay gap in medicine. Some interventions will be difficult to achieve in a health system that struggles with escalating costs and a shortage of doctors. 

Reviewing and modernising the pay structure and reducing the number of incremental salary points would make a big difference, reducing catch-up time for those who have had a break from work or worked reduced hours. 

Increasing the number of doctors is something the medical Royal Colleges and others have been advocating for some time. It would cost money, but would reduce the market forces which risk perpetuating pay gaps in shortage specialties.

There are also several things that everyone can do to make women feel more comfortable in the workplace. For instance, men and women are not equally distributed across the medical specialties.

We can reduce this gender segregation by redesigning career pathways to be less penalising for those that take time away from work and have a positive push to appoint and support more women into specialities where they are under-represented at senior level, like cardiology and surgery.

Data published in our review show that women receive around 20% of clinical excellence awards. We can’t tell if they are less likely to apply for these awards than men, but we know that they are under-represented in the specialties likely to be successful. Women are also less likely to benefit from ad hoc additional payment for work. Why not standardise the payment for these roles rather than having negotiation behind the scenes?

A zero tolerance to the bullying and harassment and micro-aggressions that happen everywhere would go a long way towards supporting women to stay in the workplace.  

As would shared parental leave at consultant level, and a reduction in the stigma associated with flexible and less than full time working.  

Could we not also focus more on the acquisition of competence in medical training rather than time served, which disadvantages those who work less than full time? All of this would make a difference and would help support equality. All doctors would benefit, and so would their patients.

Recent world events have shone the spotlight on the importance of equality, diversity and inclusivity in our clinical workforce. We are concerned that inequality remains a substantial problem for women and minority groups working in the NHS.  Pay gap analysis is a way of documenting this inequality.

Measuring and reducing these gaps is an essential step in highlighting the structural inequality in the NHS that disadvantages female colleagues. If we measure it, we can monitor how well we are doing at reducing it. 

The Department of Health and Social Care are in the process of setting up an implementation group to address this, and to maximise the contribution that female doctors can make to our NHS. Let’s keep measuring and reducing gender pay gaps in Medicine. Let’s mend the gap, it is everybody’s business.

Jane Dacre, UCL Medical School. Twitter: @DacreJane

Carol Woodhams, University of Surrey Business School. Twitter @paygapsmedics

Competing interests: none declared.