One of my favourite poems is “The Road Not Taken” by Robert Frost and in summary it is a poem about the choices we are presented with in life. I have often used this poem as a compass when making big decisions, to challenge myself, am I doing something because it is a well-trodden route and therefore feels comfortable?

Throughout my life I have often taken what I feel is the road less travelled. I moved to the UK to pursue a career in public health. I am doing a specialty training programme that is not available to non-medics in Ireland (and across the EU). More recently I became the first non-medical National Medical Director’s (NMD) Clinical Fellow (just call me non-clinical Clinical Fellow for short!).

For me, the journey to an achievement is as satisfying as the achievement. However, more recently I feel my resolve, resilience and self-belief being slowly chipped away, I’m feeling the steep incline of the path ahead.

Since having children I have had a number of realisations; my sense of identity is heavily wrapped up in who I am as a professional (I still proclaim that public health is in my bones!), but I feel I am not the same person I was before having children. It feels like imposter syndrome can crush me and inequality is everywhere!

Women, particularly women with children face significant inequalities in the workplace. Women are more likely to earn less compared with their male counterparts (the gender pay gap) and compared to women in similar roles without children (the motherhood penalty). A gender pay gap report found that 30% of women are in the lowest paid quintile. Once women have children they are unlikely to recover the pay gap generated.

The government furlough scheme was hailed as an intervention to stave off mass unemployment and support those most vulnerable to financial insecurity during the pandemic. However, research has found that the furlough scheme may have exacerbated gender inequalities. Even the best intended policies can have unintended consequences for gender equality.

Although it is increasing, the number of women in very senior or board level positions is significantly lower than men. For example, only a third of FTSE 350 board positions are held by women. Despite women making up 77% of the NHS workforce they continue to be underrepresented at a senior level.

“Women want to be leaders but something is holding them back”. If we put aside the caring responsibilities (for children and older parents), the cost of childcare, and the flexible working policies that can inadvertently pigeon hole women into those part-time roles because the same flexibility is not always there for men… what is holding us back? Women are as ambitious as men, a study by KPMG found that 6 in 10 women aspire to be in a senior leadership role. However, over half of women are more cautious in taking those steps. A piece of research by Harvard Business Review found that women were less comfortable with self-promotion compared with their male colleagues. I have worked alongside some fantastic female leaders, but my observations are that their style of leadership and influence is equally effective but often more subtle.

So how do we move women forward on this road less travelled? This brings me back to my experiences more recently and why the ambition of being a senior leader is just not adding up for me.

As part of the fellowship we have the privilege of speaking with senior leaders in health. I’m blown away by their achievements, but I often I feel my heart sink a little when I hear leaders tell their stories. I cannot identify with these stories and I feel very aware that I am female, non-medical, with young children.

Research by KPMG found that 86% of women feel more encouraged when they see more women in leadership roles. I need to hear from more female leaders, those that have battled the same issues I am facing, share their learning and insight and replenish my self-belief that I can do it too.

In order to make this a well-trodden path for women, we need to recognise the power of role models within organisations. Ensuring female senior leaders are visible and that organisational cultures demonstrate the right behaviours (salary progression policies that address pay gaps, flexible working arrangements for men and women). We need to challenge cultures that reward the loudest voices, recognising that those less likely to self-promote are just as competent as those shouting loudly. We should also recognise that some of our future female leaders may have become disheartened along the way. These may be excellent women that we have worked with for many years, who have held back cautiously.

Programmes like the NMD fellowship are part of this, but we need other initiatives alongside this that exclusively target women. We need mechanisms for talent identification that do not rely on self-promotion. We need to ensure that leadership programmes offer flexible working, do not inadvertently discriminate those working less than full time and ensure gender pay equality.

Here is what I would like to say:

• To the existing female role models, make yourself available to the female talent that exists within your organisation or sector.
• To all senior leaders, be a compassionate leader towards those juggling other commitments, and use your influence to address gender inequality in the workplace.
• To everyone, check your own behaviour, the recruitment and promotion processes – are they inclusive?

As a future leader I need to recognise my role in paving the way for those on the road behind me. Rather than feeling defeated, I need to travel on, to pro-actively reach out to the many female role models to increase my visibility and to hear their stories.

To conclude the poem, collective action will “make all the difference”.

Aideen Dunne

Aideen Dunne is a public health registrar in London and has worked across a diverse range of organisations at a local, regional and national level. Aideen is particularly passionate about the role of wider determinants, such as the physical environment, on health enhancing behaviours and has enjoyed focusing on delivering population health initiatives across complex systems.

Aideen is currently a National Medical Directors Clinical Fellow based in NHS England and Improvement’s Prevention Team. Within her current role Aideen is focusing on tobacco dependency in people with SMI and working with NHS EI Regions and Integrated Care Systems to deliver these services. The fellowship has afforded her excellent opportunities to gain experience within the NHS, and to work alongside some fantastic leaders.

Declaration of interests 

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.