Katherine Branson Essay Prize Winner 2019

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- Winner: Amelle Ra, Medical Student, University of Liverpool

“I believe most conscientiously and thoroughly that women as a body are sexually, constitutionally and mentally unfit for the hard-incessant toil, and for the heavy responsibilities of general surgical practice. At the same time, I believe as thoroughly that there is a branch of our profession – midwifery – to which they might be admitted in a subordinate position as a rule.”1

- Dr Bennett, the Lancet, 1870

With the Lancet dedicating an entire issue to ‘Advancing Women in Science, Medicine, and Global Health’2 last month, the prospect of women becoming doctors has drastically (and thankfully) changed since 1870. In the last 200 years, women have leaped from being denied entry to medical schools to making up the majority of medical graduates in the UK.3 This transformation can be largely attributed to the courageous and committed women in medicine who refused to conform within an entirely patriarchal society.4 Pioneers such as Elizabeth Blackwell, Sophia Jex-Blake and Elizabeth Garrett Anderson, despite the oppression they faced, established the London School of Medicine for Women.5 They were also important figures of the Association of Registered Medical Women, which later developed into the Medical Women’s Federation.6 Without doubt, they blazed a trail for women in medicine.

Throughout the 20th and 21st centuries, medical women continued to ascend. For instance, Sheila Sherlock, famously known as ‘the founder of hepatology’ and the UK’s first female Professor of Medicine,7 showed that women can penetrate the glass ceiling. Clare Marx, an advocate for women in surgery, became the first-ever female president of the Royal College of Surgeons and the first woman chair of the General Medical Council.8 And in 2010, Sally Davies became the first female Chief Medical Officer for England.9 Despite such tremendous achievements, medicine is still a man’s world, especially at the top. There remains a 15% gender pay gap10 and in 2017, the best-paid male consultant earned two-and-a-half times that of the female equivalent.11 Equality in our profession has not truly been achieved. I aver that over the next five years, two major issues- the lack of quality flexible working opportunities and the gender imbalance in senior leadership positions- should be the key focus of endeavours to continue women’s success and progress.

Women’s talent and contributions ought to be evenly distributed throughout all fields of medicine. Improving the quality and availability of flexible working, as well as challenging the attached stigma, has the huge potential to attract and retain women in male dominated specialties. Research shows that compared to men, more women choose family-friendly specialties with better work-flexibility and opt for less than full-time training (LTFT).12,13 Undoubtedly, the outdated perception that men should be breadwinners and women child-carers must be challenged. However, when individual women wish to take on childcaring, quality flexible working opportunities, including LTFT, should be available to facilitate their career progression and advancement to leadership positions. Concerningly, LTFT remains disjointed and difficult to arrange.14-16 LTFT doctors often have limited learning opportunities and access to research and auditing.14,15 There is also a widespread stereotype that ‘part-time doctors are part-time committed’, devaluing their role at work.14,17 In a recent survey of 876 LTFT surgeons, over half experienced undermining behaviour from colleagues as a result of undertaking LTFT.14 The medical workforce is becoming feminised and the current issues concerning flexible working must be addressed. Doctors, especially LTFT doctors, require support and encouragement to thrive in their profession.

Another area of concern is that a disproportionate number of females to males continue to hold senior roles in medicine, which fuels the gender pay gap. To become gender balanced, NHS boards in England require another 500 women.18 Only 24% of trust medical directors are female19 despite women having represented 50% of medical students since 1991.4 Only 26% of CCG GP leads are female although there are more female general practitioners than males.19 Very few women represent key medico-political roles. And in academic medicine, the Deech Report found that the number of women in senior positions remains disproportionately low, with only 12% of clinical professors on university contracts being women.4 Having female leaders has shown to shift culture, improve organisational performance, and help organisations to reflect the population they serve.18-22 As the NHS experiences a myriad of difficulties, it is now more essential than ever to form a diverse set of leaders and utilise the wealth of talent that women can offer.

As Henrietta Bowden-Jones asserted: ‘This is a special time for women in medicine in the UK as so many of the Royal Colleges and other organisations have female leaders’.23 To continue our progress and success, over the next five years, we must keep pushing forward by actively tackling the lack of quality flexible working opportunities and women’s under-representation in senior leadership roles. In support of International Women’s Day, we must remember that balance certainly is better for everyone.

References

1. Hilary Bourdillon. Women as Healers: A history of women and medicine. Cambridge: Cambridge University Press, 1988.

2. The Lancet. Advancing Women in Science, Medicine, and Global Health. 9 February 2019. Available: https://www.thelancet.com/journals/lancet/issue/vol393no10171/PIIS0140-6736(19)X0006-9 (accessed 6 March 2019)

3. Department of Health. Women doctors: making a difference. London: Department of Health, 2009.

4. Jefferson L, Bloor K, Maynard A. Women in medicine: historical perspectives and recent trends. Br Med Bull 2015;114:5-15 doi: 10.1093/bmb/ldv007

5. University of Bristol. A short biography of Elizabeth Blackwell. 2019. Available: http://www.bristol.ac.uk/blackwell/about/elizabeth-blackwell/elizabeth-blackwell-biography/ (accessed 6 March 2019)

6. Dorothy Ward, The Medical Women’s Federation and MWIA. 2009. Available: http://www.medicalwomensfederation.org.uk/about-us/medical-women-s-international-association?highlight=WyJkb3JvdGh5Iiwid2FyZCIsImRvcm90aHkgd2FyZ (accessed 6 March 2019)

7. Royal College of Physicians. Women in medicine: Professor Dame Sheila Sherlock. 2017. Available: https://www.rcplondon.ac.uk/news/women-medicine-professor-dame-sheila-sherlock (accessed 6 March 2019)

8. General Medical Council. New Chair of the General Medical Council. 2018. Available: https://www.gmc-uk.org/news/news-archive/new-chair-of-the-general-medical-council (accessed 6 March 2019)

9.Royal College of Physicians. Women in medicine: Sally Davies and Margaret Turner-Warwick. 2017. https://www.rcplondon.ac.uk/projects/outputs/women-medicine-sally-davies-and-margaret-turner-warwick (accessed 6 March 2019)

10. Royal College of Physicians. RCP president Professor Jane Dacre to lead NHS pay gap review. 2018. Available: https://www.rcplondon.ac.uk/news/rcp-president-professor-jane-dacre-lead-nhs-pay-gap-review (accessed 6 March 2019)

11. BBC News. Top women doctors lose out in NHS pay stakes. 2018. Available: https://www.bbc.co.uk/news/health-43077465 (accessed 6 March 2019)

12. Royal College of Physicians. Women and medicine: The Future. 2009. Available: https://www.rcr.ac.uk/sites/default/files/RCP_Women_%20in_%20Medicine_%20Report.pdf (accessed 6 March 2019)

13. British Medical Association. Less than full time guidance. 2015. Available: https://www.bma.org.uk/news/2015/august/less-than-full-time-training-guidance-update (accessed 6 March 2019)

14. Harries R, Gokani V, Smitham P, Fitzgerald J. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6:e010136 doi:10.1136/bmjopen-2015-010136

15. Joint Committee on Surgical Training. Less Than Full Time (LTFT Training in Surgery: JCST Policy Statement. 2017. Available: https://www.jcst.org/jcst-news/2017/09/28/jcst-ltft-taining-statement/ (accessed 6 March 2019)

16. Health Education England. Approaches to Flexible Working- Evidence from the individual specialties. 2017. Available: https://www.hee.nhs.uk/sites/default/files/documents/Appendix%20B%20-%20Medical%20Royal%20Colleges'%20Feedback%20on%20Flexibility_0.pdf  (accessed 6 March 2019)

17. British Medical Association and Medical Women’s Federation. The Pay Gap for Women in Medicine and Academic Medicine. 2009. Available: http://www.medicalwomensfederation.org.uk/images/Daonload_Pay_Gap_Report.pdf (accessed 6 March 2019)

18. NHS Improvement. NHS Women on Boards: 50:50 by 2020. 2017. Available: https://www.nhsemployers.org/-/media/Employers/Publications/NHS-Women-on-Boards-report.pdf (accessed 6 March 2019)

19. The King’s Fund. Advancing women in medicine: how can we move from rhetoric to action? 2015. Available: https://www.kingsfund.org.uk/blog/2015/01/advancing-women-medicine-how-can-we-move-rhetoric-action (accessed 6 March 2019)

20. NHS Clinical Commissioners. Women in clinical commissioning leadership. 2015. Available: http://445oon4dhpii7gjvs2jih81q.wpengine.netdna-cdn.com/wp-content/uploads/2015/12/Women-in-clinical-commissioning-leadership-report2.pdf (accessed 6 March 2019)

21. Shannon G, Jansen M, Williams K, Caceres C. Gender equality in science, medicine, and global health: where are we now and why does it matter? The Lancet 2019;393(10171)560-569 DOI:https://doi.org/10.1016/S0140-6736(18)33135-0

22. Coe I. Feminism is for everybody. The Lancet 2019;393(10171)493 DOI:https://doi.org/10.1016/S0140-6736(19)30239-9

23. Womanthology. Keep pushing forward: Why the Medical Women’s Federation Centenary year is special time that presents a unique opportunity for women in medicine. 2017 Available: http://www.womanthology.co.uk/keep-pushing-forward-medical-womens-federation-centenary-year-special-time-presents-unique-opportunity-women-medicine-dr-henrietta-bowden-jones-psychiatrist/  (accessed 6 March 2019)