Medical women: internet resource
July 2006
Choice versus discrimination
Several papers have indicated that being female is a barrier to achieving consultant status, due to the obstacles that women face (see references 14 and 15).
In the past, fewer women at higher levels could be explained by the lower proportion of women entering medical school. Since 1977, the number of female applicants to medical school has increased from 35 per cent to over 40 per cent in 1980, approximately 50 per cent in 1990 and 59 per cent in 2003 (see reference 16). This rapid increase in female medical students should be reflected in increasing proportions of women at all levels of medicine, but this is often not the case. For example, women represented only 25 per cent of all consultants in 2004, although it would be expected to be nearer 50 per cent, given the 1990 proportion of female entrants to medical school (see reference 6). A study of promotion to consultant level in Scotland found that the probability of promotion of female hospital doctors to consultant is considerably less than for male doctors. This took into account the slower accumulation of experience of those working part time (see reference 17).
There are undoubtedly barriers to women reaching senior career grades, which are still entrenched within the medical profession. For example, a survey of surgeons in the UK found that discrimination is still present, and this was preventing women from progressing in their careers (see reference 10).
But the issue is not as simple as just discrimination, and women may choose to pursue careers in certain areas for reasons not necessarily related to imposed career barriers. Women are concentrated in certain medical fields, while being under-represented in others (see reference 18). It is suggested that they may have ‘natural’ preferences for certain specialties, or are more influenced in their choice of career by factors relating to home and lifestyle than are men (see reference 19). Theories have been proposed about subconscious gender characteristics, which affect people’s behaviour and choice (see reference 18). According to this theory, women tend to be nurturing and expressive, while men are autonomous, assertive and task orientated. These characteristics affect perceptions of the abilities and performance of the different genders, and influence their career choices. Thus women tend to opt for specialties such as paediatrics, obstetrics and gynaecology, whereas men are more drawn to surgery.
Women are also encouraged to enter such specialties by senior colleagues, and it is suggested that both men and women can earn more income in a specialty that fits these gender characteristics. It would appear that the UK medical field gender distribution conforms to this theory. The questions still remain: is the pattern of women in medical specialties the indirect result of some form of bias in those who advise women on career choices and the opportunities made available for women, and to what extent is this pattern influenced by preference and individual freedom of choice? (see reference 11) It will be interesting to see how the current gender patterns change in the future as more child-friendly and flexible working schemes are introduced.
Table 1 below shows examples of the difference in the total number of male and female practitioners in a variety of hospital specialties, and at consultant level.
Table 1: Total number of male and female practitioners and consultants by specialty (see reference 6).
| Specialty | All medical staff | Consultants | ||||
| Total no | No of males (%) | No of females (%) | Total no | No of males (%) | No of females (%) | |
| Cardiology | 1,929 | 1,533 (79.5) |
396 (20.5) |
710 | 652 (91.8) |
58 (8.2) |
| Gastroenterology | 1,552 | 1,187 (76.5) |
365 (23.5) |
674 | 597 (88.6) |
77 (11.4) |
| General Surgery | 6,066 | 4,528 (74.6) |
1,538 (25.4) |
1,641 | 1,519 (92.6) |
122 (7.4) |
| Obstetrics and Gynaecology | 4,673 | 2,236 (47.8) |
2,437 (52.2) |
1,413 | 1,006 (71.2) |
407 (28.8) |
| Paediatrics | 6,336 | 2,919 (46.1) |
3,417 (53.9) |
1,839 | 1,067 (58.0) |
772 (42.0) |
Source: Department of Health 2004 medical and dental workforce census
Women’s career choices may change as they progress through medical training.
A study carried out in Norway found that there was no difference between the numbers of men and women starting their training in ‘male-oriented’ specialties, such as surgery and internal medicine (see reference 20). This study gives little support to gender-specific theories of choice of speciality. However, as women progressed through their training, they were more likely to leave these areas than men, and move towards more ‘female-oriented’ specialties such as general practice.
One major reason for this shift was combining career and children. Having a family influenced the direction that some women were likely to take. In 1995 the BMA began a 10-year longitudinal cohort study of the career paths and attitudes of 545 medical graduates. The tenth annual report of this cohort study (2005) - read more here, found that while 22.8 per cent of female doctors planned to enter general practice on graduation, 44.8 per cent worked in general practice nine years later (compared with 13.3% and 24.1% of men respectively) (see reference 21). Similarly, the number of women choosing surgery dropped, from 9.1 per cent in 1995 to 3.6 per cent in 2004. The study also showed that two major reasons for changing the choice of speciality were hours of work and working conditions (24 per cent) and domestic circumstances (16.9 per cent). These considerations may influence women early on in their training, before they actually have children.
A woman’s career can also affect her domestic situation. Research has shown that a large proportion of female doctors in North America and Europe are unmarried and do not have children (see reference 18). It has been shown that it is difficult to combine a career in surgery with pregnancy and bringing up children, and women who specialise in surgery tend to postpone having children until a few years later than those in other specialties (see reference 20). It is interesting to note that in the UK, the Royal College of Obstetrics and Gynaecologists, a speciality that is favoured by women, was one of the first colleges to introduce arrangements for part-time training, more than 20 years ago (see reference 11). In contrast, the most popular specialty for women, paediatrics, has on-call and out-of-hours commitments, things which in theory would be disincentives to women (see reference 13).
In a survey in the US, (see reference 22) women cardiologists reported overall lower satisfaction with work and advancement, particularly within academic practice, compared with male cardiologists. They reported more discrimination, more concerns about radiation and more limitations due to family responsibilities, which may ultimately explain the low percentage of women in cardiology. Another study (see reference 23) found that generally there was no disproportionate promotion of female doctors except in some stages in hospital medicine, surgery, obstetrics and gynaecology, and anaesthetics. They concluded that the disparity in numbers was not easily explained by choice and it was more likely a result of direct or indirect discrimination.
Ultimately, however, the distinction between choice and discrimination may be blurred. There are differences in values related to career success and recognition, which also have an impact on female doctors (see reference 24). Gender has a significant influence on how important it is to climb the career ladder, with men considering it of greater importance than women (see reference 25).