Leadership and Gender Pay Gaps in Medicine by Jane Dacre

Why am I interested in women in leadership? Well, I grew up with three brothers, and no sisters. From an early age, it was clear to me that boys were allowed privileges that were not open to girls, and that the societal expectations on me were different from those on my brothers. I was encouraged to make cakes at the weekend, whilst they did sport; I went shopping with my mother, and my brothers didn’t. Although that was just normal at the time, I grew up with a keen sense of injustice, and wherever I could, I joined in with the boy’s activities… and was proud of my tree climbing ability. My mother was a full-time housewife, and sometimes struggled to fill her day with meaningful activity, so was keen for me to be different. I decided early on that I wanted to be a doctor because I had an interest in all things biological, and liked people, and I really wanted to go to work, so it was a no brainer. My role model was my father, who was a doctor, and I now recognise that as a privilege.  Although fiercely proud, my mother lamented the fact that instead of raising a dutiful daughter, I was more like a boy in her view.

Getting into medical school was tricky, because there were quotas on the number of girls allowed places. There were also challenges around the quality of the science teaching in my girls only school, which focussed more on arts subjects, as they were thought to be more suitable for women. But I made it and found myself again in a minority, surrounded by boys and that became my norm. At the time, I accepted all this and didn’t reflect on, or challenge the status quo. I now look back and see how many barriers I needed to overcome.

My journey into medical school was easy compared to the pioneering women who first broke into the profession. Their break-through was just over 100 years ago, at a time where women’s rights were hotly contested, and the Suffragettes led the way. Impressive trailblazers like Elizabeth Garrett Anderson and her friend Sophia Jex Blake fought to become doctors, against significant opposition, and they got there.

The Lancet Journal at the time in 1878 was quoted as saying

“ A  woman as a doctor is a conceit contradictory to nature, and doomed to end in disappointment to both the physician and the sick”

NHS Digital data now shows that there are more women in medicine than ever before, but they are not represented fully across the specialties, and are not reaching the very top of the profession. Women have made it…..or have they? They are not represented in leadership positions in the same proportion as those working as doctors.

I have found working with Carol Woodhams, who led the research for the Department of Health commissioned independent review into pay gaps in medicine has been a real eye opener. It has shown me that pay gaps are an indirect measure of inequality. A pay gap is defined as the difference in the average hourly pay of women as a percentage of men’s pay. Looking at medicine overall as a professional group, there is a large pay gap of 12- 15%. This suggests that there continues to be inequality in medicine, with women’s average hourly wage being 12- 15% less than men. There are several reasons for this, but one significant factor is the small numbers of women amongst the high earners at the top of the profession. Having children makes the pay gap worse, the so-called motherhood penalty, as does working part time, and working in male dominant specialties.  Men are more likely to apply for and receive Clinical Excellence Award (CEA) payments. These factors all suggest a slower career trajectory for women. Today’s medical careers originated at the time the NHS was founded, just over 70 years ago. This was a time when women doctors were in a minority, and the pay structures were created for men who worked full time over long careers, accruing regular pay uplifts, and not taking breaks during years of service. This structure does not reflect the increase in flexible careers wanted by both men and women in the NHS today.

There is a body of evidence that shows that women are also taken less seriously than men, the  so called Authority Gap. Women, in general are less likely to be appointed to jobs, are more likely to be ignored in meetings, are less likely to be asked to appear on conference panels. This has been highlighted extremely well in the recent book by Mary Ann Sieghart: The Authority Gap.

The NHS is struggling to provide the best quality care for our patients and has workforce shortages wherever we look. NHS Digital data tells us that women make up more than 75% of the NHS workforce. It is time we reduced the inequality towards women and welcomed the increasing diversity of the medical profession. The Gender pay gap review recommendations provide a list of interventions, based on the analysis of a very large data set. If we do what it suggests, the pay gap will reduce, and so will gender inequality in the NHS.

Although the situation is improving slowly, there are still too few women in leadership positions in medicine. Fixing structural barriers, and improving the workplace culture towards women will help women to stay, and begin to be properly valued.

International Women’s Day is a Celebration of Women. The NHS is a very large employer of women. It is time our female colleagues were valued as much as their male colleagues. Making efforts to reduce the gender pay gap demonstrates this value.  This needs to be a joint effort because men and women need each other, and women, in particular need men as allies in the quest for equality in the workplace.

Professor Dame Jane Dacre DBE, MD, FRCP

Jane is the former Director of UCL Medical School and an honorary consultant rheumatologist, at Whittington Health in London. She is Professor of Medical Education at UCL and the President of the Medical Protection Society and a specialist advisor to parliament on the Health and Care Committee. She is the immediate past president of the Royal College of Physicians and was also vice chair of the Academy of Medical Royal Colleges, medical director of MRCPUK examination, academic vice president of the RCP and a GMC council member. Her research is in medical education focussing on assessment and equality.

She was the lead for the Department of Health and Social Care review of the Gender Pay Gap in Medicine, with Professor Carol Woodhams from Surrey University Business School. This review ‘Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England’ was published in December 2020. She now chairs the gender pay gap implementation advisory group.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I am the Chair of the Gender Pay Gap implementation advisory group for the Department of Health and Social Care.



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