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Women in Academic Medicine

July 2007

The Women in Academic Medicine (WAM) project
Aims
The WAM study aimed to:

• test personal and institutional assumptions on career progression;
• identify barriers to women’s careers;
• provide a baseline database for future studies to evaluate improvements;
• identify solutions (e.g. good practice, training);
• facilitate the sharing of good practice.
• It is hoped that the findings will assist in both raising awareness of the current gender disparities that exist in academic medicine and provide possible solutions that universities, medical schools and individuals working in academic medicine can use to address these issues.

This project is particularly timely given the new responsibilities of UK legislation, the Gender Equality Duty for England, Wales and Scotland. This places a requirement upon public bodies to ensure that they have due regard to the need to eliminate unlawful discrimination and harassment against either women or men and also to ensure that their policies do not maintain or lead to gender inequality. The recommendations suggested here should assist institutions in meeting these new requirements.

Background
Despite the increasing feminisation of the medical workforce, women doctors are still strikingly under-represented in the university sector compared to their male counterparts, particularly at more senior levels. This is despite women accounting for more than 40% of medical graduates in the past 20 years. One in 5 medical schools do not have a female professor, two out of the 33 heads of UK medical schools are women and at professorial level only 11% of clinical academics are women.

Academic medicine is currently failing to attract and retain women doctors. Given the demographic changes in medical schools and the availability of a major competitive employer such as the NHS, unless the reasons for this are addressed it is unlikely that this situation will be reversed.

The under-representation of women in senior academic positions has also been found in the field of Science, Engineering and Technology (SET). The Athena Project was set up to promote good practice in this field. It has raised the profile of SET through a variety of initiatives, but these have not to date had an impact in medicine.

The Athena Survey of Science Engineering and Technology (ASSET2006) on-line questionnaire collected responses from male and female medical doctors across the UK. The respondents were self-selected and came from most specialties, health care and higher education (HE) sectors. Of the 1,162 respondents, 38% were working in HE, 53% were in the NHS and the remaining (7%) were working in other sectors or on a career break. Three quarters (73%) of WAM respondents were female (HE 68%, NHS 77%). Men and women in both HE and the NHS identified barriers to career progression, but for women these were often of a greater magnitude and there were HE/NHS differences.

A literature review, focus groups and interviews with key stakeholders were also undertaken. This part of the project supplied examples of good practice that have been included in the recommendations. A Project Steering Group with key stakeholders including HE and NHS sectors provided broad expertise and input into the questionnaire, focus groups and recommendations.

Key findings
In the full WAM report, findings from the survey results are structured under four headings:

• Appointments and promotions processes;
• Structures, systems and activities in place regarding career progression;
• Organisational arrangements and culture;
• Flexibility in working life.
• The full report includes further detailed survey results, supported by qualitative results from the focus group and stakeholder interviews and examples of good practice. Under each heading, the research results are followed by recommendations for good practice.

Below are some findings from each of the four areas identified by WAM as being key to women’s career progression:

Appointments and promotions processes

• 37% of all WAM respondents received encouragement from senior colleagues or professional contacts to apply for a job at the next level (NHS female 37%, male 33%, HE female 38%, male 43%).
• 68% of all WAM respondents had at least some knowledge of the criteria and 66% of the processes for promotion.
  - Criteria - NHS female 67%, male 73%, HE female 66%, male 79%.
  - Promotion - NHS female 65%, male 69%, HE female 61%, male 77%.
• Despite appraisal being a professional requirement for doctors, 12% of WAM respondents did not have regular appraisal. (NHS female 9%, male 4%, HE female 16%, male 14%).

Structures, systems and activities in place regarding career progression

• 11% of respondents considered the lack of role models and 24% considered the availability of personal mentor were important factors to career progression.
  - Lack of role models - NHS female 13%, male 3%, HE female 16%, male 4%.
  - Availability of mentoring - NHS female 26%, male 21%, HE female 29%, male 19%.

Organisational arrangements and cultures

• 34% of HE respondents were on editorial boards or journals compared with 12% of NHS respondents (NHS female 9%, male 19%, HE female 30%, male 40%).
• 23% of HE respondents were on grant giving panels compared with 9% of NHS respondents (NHS female 6%, male 17%, HE female 20%, male 30%).
• 9% of HE respondents achieved an editorship, compared with 3% of NHS respondents (NHS female 2%, male 6%, HE female 6%, male 14%).

Flexibility in working life

• 53% of female respondents (male 42%) saw working conditions as influential in their current choice of employment. Those who saw working conditions as influential were asked to select the most important from a range of eight factors. Flexible working was ranked top by men and women in both sectors (NHS female 26%, male 11%, HE female 32%, male 18%).
• A quarter of WAM respondents did not know whether their contract allowed for flexible working (NHS female 18%, male 24%, HE female 37%, male 34%).

In conclusion, the same problems face both men and women but not equally. The results highlight important factors that are impeding recruitment and retention of women in academic medicine as well as solutions. Some solutions may be activated immediately through the recent legislation on the right to request flexible working and gender equity duty. Others warrant active measures from senior managers to clinical staff as identified in our recommendations. Our findings are thus timely and identify for the first time gender differences and their magnitude in career progression between the NHS and HE sectors.

There is an urgent need to implement the following recommendations, if universities and other public bodies are to meet their statutory responsibilities as well as enabling the advantages that women bring such as diversity and skill mix. Our hope is that this will be to the benefit of patients, academic excellence and the UK economy.