This year, the MWF Katherine Branson Essay Prize had an outstanding level of entries from medical students across the country. We have chosen to feature all entries on our website as they are all written to a very high standard.
Here are some entries on the essay title:
Women are advancing in the workforce, yet unique challenges are faced by various communities. What are the challenges faced by women of colour and how can we tackle these?
Entry 1: Written by Karen Soh
Title: A Space for Me: Women of Colour in Healthcare
Introduction
Discrimination in the form of racism and sexism is one of the most important issues facing the medical profession. As bias in medicine gains attention in mainstream media, the dual burden of being a woman and a person of colour is one that is yet to be acknowledged by those who do not carry that burden themselves. Women of colour face barriers that others may not have to endure –this essay seeks to validate and recognize the challenges that women face in the medical workforce, and to provide potential solutions to these pressing issues.
Background
The facts and figures don’t lie – the extent of discrimination that women of colour experience is vast and largely understudied. A recent survey from the BMA revealed that 91% of women doctors in the UK experienced any form of sexism at; and nearly half of these women feel like they could not report it. [1] Women are less likely to be promoted, less likely to be leaders and are paid less than men. [2] Racism is an ominous problem that permeates medical practice, training, and research. The adverse effects of racism on communities are well documented and have drawn mass media attention. Unfortunately, doctors report feeling ‘on their own’ when dealing with this discrimination. [3]
However, there is a dearth of research in the field regarding the experiences of women of colour. [4] With women of colour comprising a growing percentage of the medical workforce, there is a pressing urge to quantify the discrimination and draw attention to this. Women of colour are cited to be more likely to leave full-time appointments due to discrimination, institutional roadblocks, and lack of mentorship, amongst many other reasons. [4] The phenomenon of the ‘minority tax’ truly applies and puts immense pressure on doctors who are women of colour; leading to burnout, frustration and poorer career outcomes. [5]
Challenges Faced
At School
The disparity of medical school admissions is truly an isolating and unsupported beginning to a career in medicine. [5] A general lack of diversity and representation through the students, faculty and even curriculum has great detrimental effects on people of colour. [6] Issues of trust pervade, from structural injustices to the hidden curriculum, one must consider how this culture of discrimination can train doctors and improve health outcomes for all. [7]
At Work
Women of colour face many nebulous forms of institutional racism and sexism. Overt and covert workplace discrimination resulting in negative career outcomes and an unwelcoming work environment leads to feelings of isolation, fatigue, and invisibility. Pure bullying from patients and physicians alike, negative stereotypes from aggressiveness to being not assertive and feeling isolation due to lack of diversity and mentorship are additional challenges. [8] There is a clear lack of representation in a clinical and academic environment – even though women of colour are not less qualified than others.
At Home
Even in position of power, women of colour face extensive institutional barriers when trying to change the culture of medicine. Pregnancy and motherhood and wage inequity pose more challenges.
Thinking Solutions
Acknowledge
The persistent racism and sexism that women of colour encounter must be overcome to advance medicine and promote equity. By institutions and those in power acknowledging this discrimination as a deeply rooted issue, we can provide confidence this is a real problem that requires active solutions. This contrasts with current approaches which place the onus on the woman of colour to ‘speak up’; and instead fosters and improves conditions for women of colour and their patients by promoting inclusion across the health sector. By listening to those who are experiencing the discrimination themselves, will we truly understand what is best needed to help.
Support
Support can be provided in mentorship, education, and advocacy – women of colour deserve allies to help navigate this complex world. We need to diversify medical school admissions and faculty to establish a strong presence of women of colour, supporting doctors and addressing the strong overlap in racial and socioeconomic factors. Practical actions include protecting the reproductive rights of women in colour and guaranteeing pay equity.
Empower
By placing more focus on diversity and raising awareness about the value of racial and gender diversity, we can empower women in medicine to feel valued and welcome in this white and male-dominated sphere. From increasing representation on committees to diversity focus groups, education can build resilience, confront discrimination. Through mentorship and encouragement, we can facilitate and guide the empowerment of women to face the challenges of being a female physician.
Conclusion
Every individual should envision a workspace where race is not a barrier to opportunity, and every community can thrive alike. We should promote an environment in medicine where women of colour can be acknowledged, supported, and empowered; and to bring voices of colour and change into the important decisions that affect all communities alike.
References
1. Bm, B.S. BMA: Sexism in Medicine. BMA 2021 [cited 2022 27/1/2022]; Available from: https://www.bma.org.uk/bma-media-centre/bma-survey-finds-that-sexism-is-widespread-in-medicine.
2. Holroyd-Leduc, J.M. and S.E. Straus, #MeToo and the medical profession. Cmaj, 2018. 190(33): p. E972-e973.
3. Vogel, L., Doctors on their own when dealing with racism from patients. Cmaj, 2018. 190(37): p. E1118-e1119.
4. Filut, A., M. Alvarez, and M. Carnes, Discrimination Toward Physicians of Color: A Systematic Review. J Natl Med Assoc, 2020. 112(2): p. 117-140.
5. Campbell, K.M. and J.E. Rodríguez, Addressing the Minority Tax: Perspectives From Two Diversity Leaders on Building Minority Faculty Success in Academic Medicine. Academic Medicine, 2019. 94(12).
6. Wijesekera, T.P., et al., All Other Things Being Equal: Exploring Racial and Gender Disparities in Medical School Honor Society Induction. Acad Med, 2019. 94(4): p. 562-569.
7. Marte, D., Can a Woman of Color Trust Medical Education? Acad Med, 2019. 94(7): p. 928-930.
8. Filut, A., M. Alvarez, and M. Carnes, Discrimination Toward Physicians of Color: A Systematic Review. Journal of the National Medical Association, 2020. 112(2): p. 117-140.
Entry 2 : Written by Evie O'Rouke
In literature and policy, the language we use is important. Women of colour (WOC), or BAME women both hold positive and negative connotations. Whilst these terms can bring an idea of solidarity and shared experience, they also oversimplify the unique cultures, language and society that each group represents. Some choose not to identify with these terms, preferring their own language - we must listen and respect this. Within this essay I have used the specific language given in evidence, to reflect more individual lived experiences.
Data Gap:
My research has exposed how underrepresented intersectional data is, even in the NHS and government. Often statistics state for either women or ethnicity/race, not both. The Equality Challenge Unit provide good guidance on how to create studies that take into account intersectionality highlighting the interdependence of the factors that make up someone’s identity (1). The challenges faced by WOC not only includes the challenges faced by women, or the challenges faced by people of colour, they also contend with their own unique challenges.
Senior Positions:
A big challenge faced by WOC is the disproportionate opportunities for promotion and career growth. Within the NHS, no data is given for WOC, so we infer from the data given of which: 76.7% of the NHS staff are made up by women (2) and 47% of very senior managers are women (3) whilst black and minority ethnicities represent 21% of staff in NHS but only 6.8% are in very senior manager positions (4). I think it’s reasonable to presume that very senior managers are not representative for WOC. This essay will explore those barriers and what can be done to tackle them.
Sickness and Death:
The majority of BAME staff are in lower paid positions within the NHS and have higher job instability. These are frontline roles and during Covid-19, have put BAME people at higher risk of illness and death (5). Racism and discrimination has contributed heavily to this, with PPE inadequately designed. In the NHS, for every 3 white women who have died from covid-related deaths, 5 Asian women have died, and 6 black women (5). Lack of PPE famously caused a huge problem (6, 7). For WOC, the PPE supplied was not fit for purpose, failing to protect the characteristics of different face shapes, in particular Asian women were disadvantaged (8). The masks were designed with white males in mind, the ‘one size fits all’ ethos has failed WOC more than any other group.
Work/life balance:
WOC are faced with lower paid positions, less job security, more unpaid caring responsibilities as well as open and hostile racism and sexism. 12.1% of BME women are in insecure jobs compared to 6.4% white women and 5.5% white men (9). Intersecting racism and sexist discrimination prevents women from being recommended for training or promotions (10) and black women experience ‘double doubt’ whereby their race and gender both cause questions about their competence (11). Furthermore, globally, women maintain most of the caring and unpaid responsibilities within a household; with men enjoying up to an extra 5 hours more leisure time than women (12).This can heavily impact on health and wellbeing. An American study found that 35% of underrepresented women to 22% of underrepresented men experienced burnout (13) whilst higher numbers of BME women in the UK are taking sick leave than men (14).
Racism, Sexism and Discrimination:
Dual racism and sexism create barriers for WOC in every aspect of life. Taking it one step further in intersectionality, this only increases. 45% disabled WOC to 31% able bodied BME women report being denied promotion at work because of discrimination (9). Identifying the unique challenges would promote a happier workplace environment: hijab-wearing women face discrimination because of the physical representation of their faith, with incidents of senior staff banning them from theatre stating unfounded IPC reasons which contradicts current policy. A survey revealed 43% respondents had thought of leaving the NHS because of islamophobia (15) so increasing education to all staff would improve working environments and increase staff retention.
To remove these barriers and encourage WOC, a huge change in our systems is needed. Whilst racism and sexism cannot completely be eliminated, and their roots lie deep in our infrastructure, this makes the fight harder, but infinitely more important. For a start, creating equitable maternal and paternal rights and making higher paid roles more flexible to consider the multiple unpaid responsibilities that women hold and tackling stigma to encourage more men to take paternity pay in the UK. The gender and race pay gap, and the overrepresentation of WOC in lower paid, unstable jobs needs to be corrected by bringing in new policy on anti-racist and anti-sexist.
References:
1. Christoffersen, A. Intersectional approaches to equality research and data. [online] Available at: http://www.ecu.ac.uk/wp-content/uploads/2017/04/Research_and_data_briefing_2_Intersectional_approaches_to_equality_research_and_data.pdf: Equality Challenge Unit; 2017 [Last Accessed 12 February 2022].
2. NHS celebrates the vital role hundreds of thousands of women have played in the pandemic. [online] Available at: https://www.england.nhs.uk/2021/03/nhs-celebrates-the-vital-role-hundreds-of-thousands-of-women-have-played-in-the-pandemic/2021: NHS; 2021 [Last Accessed 12 February 2022].
3. The number of women in Very Senior Manager, Chief Executive or Non-Executive. [online] Available at: https://digital.nhs.uk/data-and-information/find-data-and-publications/supplementary-information/2019-supplementary-information-files/staff-numbers/non-clinical-and-support/the-number-of-women-in-very-senior-manager-chief-executive-or-non-executive-director-roles-in-the-nhs: NHS Hospital and Community Health Services; 2019 [Last Accessed 18 February 2022].
4. 2020 Data Analysis Report for NHS Trusts and Clinical Commissioning Groups. [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2021/02/Workforce-Race-Equality-Standard-2020-report.pdf: NHS; 2020 [Last Accessed 12 February 2022].
5. Saddler, J. Farah, W. Perspectives from the front line: the disproportionate impact of COVID-19 on BME communities. [online] Available at: https://www.nhsconfed.org/publications/perspectives-front-line: NHS Conferderation: BME Leadership Network; 2020 [Last Accessed 12 February 2022].
6. Oliver, D. Lack of PPE betrays NHS clinical staff. BMJ. 2021;372:n438.
7. Chaib, F. Shortage of personal protective equipment endangering health workers worldwide. [online] Available at: https://www.who.int/news/item/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide: World Health Organization; 2020 [Last Accessed 18 February 2022].
8. Chopra, J. Abiakam, N. Kim, H. Metcalf, C. Worsley, P. Cheong, Y. The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis. BMJ Global Health. 2021;6(11):e005537.
9. BME Women and Work. [online] Available at: https://www.tuc.org.uk/research-analysis/reports/bme-women-and-work#.YhuWEADeOzI.link: Trade Union Congress; 2020 [Last Accessed 27 February 2022].
10. d’Arcy, C. Gardiner, L. Just the job–or a working compromise. [online] Available at: https://www.resolutionfoundation.org/app/uploads/2014/05/Just-the-job-or-a-working-compromise-FINAL.pdf: The changing nature of self-employment in the UK London: Resolution Foundation; 2014 [Last Accessed 27 February 2022].
11. Griffin, K. Bennett, J. Harris, J. Analyzing gender differences in black faculty marginalization through a sequential mixed-methods design. New Directions for Institutional Research. 2011;2011(151):45-61.
12. Ferrant, G. Pesando, L. Nowacka, K. Unpaid Care Work: The missing link in the analysis of gender gaps in labour outcomes Available at: https://www.oecd.org/dev/development-gender/Unpaid_care_work.pdf: Organisation for Economic Co-operation and Development; 2014 [Last Accessed 27 February 2022].
13. Lawrence, J. Davis, B. Corbette, T. Hill, E. Williams, D. Reede, J. Racial/Ethnic Differences in Burnout: a Systematic Review. J Racial Ethn Health Disparities. 2022;9(1):257-69.
14. Many UK workplaces still not “Covid-Secure” – TUC poll reveals. [online] Available at: https://www.tuc.org.uk/news/many-uk-workplaces-still-not-covid-secure-tuc-poll-reveals: Trade Union Congress; 2020 [Last Accessed 27 February 2022].
15. Day, A. Exclusive: Muslim Medics Taunted About Bacon And Alcohol – By Their Own NHS Colleagues. [online] Available at: https://www.huffingtonpost.co.uk/entry/islamophobia-nhs-muslim-doctors-institutionalised_uk_5f562e80c5b62b3add43cccb: HuffPost; 2020 [Accessed on 12 February 2022].
Entry 3: Written by Rachel Abeysekera
‘Colour me confused!’ – The disparity in racial equity amongst women in the United Kingdom workforce
As the representation of women in the United Kingdom (UK) labour force grows, indications of mistreatment and discrimination of women from ethnic minorities continues to be a forefront concern. Women from this category may experience structural racism, harassment, underemployment, and job insecurity, many of whom belong to vital front-line services like healthcare. These challenges, heightened by the recent COVID-19 pandemic, impact their economic stability, mental well-being, and career opportunities. Government organisations and employers must act to close the pay and prejudicial gap that these women face every day.
Various reports and surveys conducted in the past few years in the UK have illustrated an alarming trend of discrimination and the unfair treatment of working women of ethnic origin. In an online survey, more than one in three women categorised as Black and Minority Ethnic (BME) reported experiencing racist jokes and being passed over for or denied a promotion (Trades Union Congress, 2020). Furthermore, job security and unemployment rates were consistently lower in women of ethnic minorities compared to white men (Trades Union Congress, 2020). Other challenges these women may face include reports of racism not being taken seriously, physical, sexual, or verbal abuse especially in women with intersecting inequalities, for example women with a disability or who identify as LGBTQ. Furthermore, there are suggestions of increased pay gaps between women from ethnic minority groups when compared to white women. An investigation found the group most impacted by this disadvantage to be Pakistani and Bangladeshi women with gaps of 30% or more (Woodhams et al., 2021).
A special mention of BME individuals including women in the healthcare sector should be discussed, especially due to the extraordinary circumstances the profession has experienced in the past few years. The British Medical Association (BMA) reported in 2020 that while 44% of medical personnel are regarded as BME, 95% of doctors, 71% of nurses and 56% of healthcare support workers who died due to COVID-19 were UK ethnic healthcare personnel (Cook, Kursumovic and Simon, 2020). This alarming trend must be brought to the attention of healthcare organisations so that it can be investigated, and improvements can be made. Additionally, there are findings that doctors from ethnic minorities felt that they have been pressured into treating patients without personal protective equipment more in contrast to their white colleagues (Mahase, 2020).
The statistics and reports illustrate a clear problem that needs to be addressed. To improve the treatment and well-being of women of ethnic minorities in the workplace, we must approach the solution in multiple ways. It is recommended that the government introduce mandatory reporting for ethnic minority pay and provide comparisons of average hourly earnings against white employees, support better leadership and management, and develop guidance for employer action (Chartered Institute of Personnel and Development, 2019). Employers should be actioned to explore any structural and cultural barriers that may lead to workplace inequalities, review recruitment processes to avoid bias and discrimination, develop an inclusive culture and give a voice back to the voiceless by taking complaints seriously and asking for suggestions and feedback (Chartered Institute of Personnel and Development, 2019).
The BMA recommends providing risk assessments for all staff, to prioritise COVID-19 testing and vaccinations for all high-risk personnel, to investigate and mediate any discrimination that may occur and develop a culture where all staff feel empowered to speak out (British Medical Association, 2021). Unfortunately, there tends to be a propensity for female UK ethnic minority professionals to be absent from workplace equality and discrimination research, and instead the focus stays on the understandings of white women, creating bias (Opara, Sealy and Ryan, 2020). Therefore, another approach is to create more inclusive research on this subject.
Racial inequity amongst women in the UK workforce remains a forefront problem. It continuously falls under the radar yet remains a high source of stress and pressure on both the women who experience this prejudice and the system. The government and employers have a duty to work with these women with the aims to highlight their voices and bring awareness and reformation. The treatment of women from ethnic minorities has improved from the past, yet there is still more that needs to be done to create an equitable workforce. We must endeavour to move forward towards this goal and create an inclusive and respectful workplace for all.
References:
British Medical Association (2021) COVID-19: the risk to BAME doctors. Available at: https://www.bma.org.uk/advice-and-support/covid-19/your-health/covid-19-the-risk-to- bame-doctors (Accessed: 16 February 2022).
Chartered Institute of Personnel and Development (2019) Race inclusion in the workplace. Available at: https://www.cipd.co.uk/news-views/viewpoint/race-inclusion-workplace (Accessed: Feb 22, 2022).
Cook, T., Kursumovic, E. and Simon, L. (2020) Exclusive: deaths of NHS staff from covid-19 analysed. Available at: https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19- analysed/7027471.article (Accessed: Feb 22, 2022).
Mahase, E. (2020) 'Covid-19: Ethnic minority doctors feel more pressured and less protected than white colleagues, survey finds', BMJ, 369, pp. m2506. doi: 10.1136/bmj.m2506.
Opara, V., Sealy, R. and Ryan, M.K. (2020) 'The workplace experiences of BAME professional women: Understanding experiences at the intersection', Gender, Work & Organization, 27(6), pp. 1192-1213. doi: 10.1111/gwao.12456.
Trades Union Congress (2020) BME women and work. UK: TUC. Available at: https://www.tuc.org.uk/research-analysis/reports/bme-women-and-work (Accessed: Feb 22, 2022).
Woodhams, C., Dacre, J., Parnerkar, I. and Sharma, M. (2021) 'Pay gaps in medicine and the impact of COVID-19 on doctors' careers', The Lancet (British edition), 397(10269), pp. 79-80. doi: 10.1016/S0140-6736(20)32671-4.
