SAS Conference Bursary Report by Dr Tamsin Holland Brown
Time to fix the gender pay gap in medicine- Prof Carol Woodhams
The motherhood penalty is a structural and systemic disadvantage that disproportionately affects women in medicine, particularly in the NHS. It arises because caring responsibilities — including motherhood — are unequally borne by women, who "choose" to adapt their careers for work-life balance, flexibility, and family responsibilities. This results in a complex, compounding disadvantage often referred to as the motherhood gap. In medicine, this manifests in uniquely pronounced ways due to the rigid, hierarchical, and inflexible nature of training and career structures.
Training pathways in medicine are often lengthy, inflexible, and geographically disruptive. These features disproportionately disadvantage mothers, especially where deanery or local employment arrangements lack accommodation for less-than-full-time work or offer poor rota management and leave flexibility. This creates career penalties, often compelling women to move into less demanding roles, SAS or locally employed doctor positions, or choose specialties with shorter training or fewer out-of-hours obligations.
Though less-than-full-time training can seem like a solution, statistical evidence reveals that women experience a greater long-term pay loss than the hours lost would suggest. This is due to how time away from training and progression interacts with pay structures, often compounding over a career. Additionally, deeply embedded cultural factors — including sexism and lack of nursery or childcare support — further hinder career continuity and advancement.
One of the most structurally detrimental aspects is the NHS pay spine, which assumes a long, uninterrupted career path. Women taking career breaks or working part-time often fall behind, not just in salary but also in long-term progression. This is a key driver of the gender pay gap in medicine, which starts around age 25 and widens significantly by their mid-50s, peaking at around 12%. Even though it narrows after that, the financial loss is permanent and significant.
There is also a lack of a job evaluation scheme in the medical profession, meaning roles like SAS and consultant are not compared for equitable pay based on duties or responsibilities. This further obscures whether pay structures are fair. Compounding all of this is underreported sexual harassment and gender-based discrimination.
Efforts to address these issues include the work of the Gender Pay Gap Implementation Panel, which has successfully implemented structural reforms. These reforms focus not on changing women’s choices, but on reshaping systems — such as contractual changes, improved representation, better retention, and career progression support — to allow women to succeed equitably in medicine. While the gender pay gap is a deeply embedded issue, progress is being made through systemic change.
How it will change my practice : Relevance to current work with the NHS Clinical Entrepreneurs:
Understanding the motherhood penalty and its career and financial implications helps understand why fewer women join the clinical entrepreneur programme (CEP).
The CEP could benefit from a partnership with MWF to encourage more women in medicine to step forward with their ideas to improve NHS care or patient quality of life. MWF and CEP have shared values and could work together to amplify the voices of women in medicine, particularly in the growing fields of digital health, medical innovation, and entrepreneurship.
