Encouraging women to work in academic medicine


December 2003 Background
This document is focussed on engaging women with academic medicine, although the principles are applicable to all clinical academic staff in order to support appropriate recruitment and retention. Women are severely under-represented as clinical researchers, full time academics and heads of departments, yet they are a growing proportion of the medical workforce. To promote women in academic medicine, there needs to be significant structural and cultural change. In the UK and internationally, women academics have proved to be underpaid, have unequal access to resources and to be excluded from any substantive power within a University.

Academic medicine will suffer severe recruitment and retention difficulties unless it responds to the changing needs of the current and future NHS and university workforce. More and more doctors are signalling intent to train and/or work flexibly. It is likely that the future medical workforce, and particularly (but not exclusively) women, will want the option of breaks during the early years of a career to raise a family and perhaps later on in careers to care for relatives. Academic medicine does not preclude this but the pressures to meet research targets in grants and publications have not sat well with these needs.

The excessive demands of the NHS and the university sector on clinical academic staff are well documented, with a clinical academic career historically being the equivalent of two jobs rather than one. Some efforts are being made to properly manage these demands, for example the introduction of integrated job planning, and the “Modernising Medical Careers” initiative may well have some positive impact. But the fact remains that medical schools are sustained by the excessive effort of committed individuals to teaching, research and clinical activity. Working long hours and not stepping off the treadmill is a choice that can no longer be the expectation for clinical scientists of any age or sex.

This report outlines the issues, identifies the contribution to be made by women in clinical science and makes recommendations to remove the identified obstacles and barriers to women working in academic medicine.

The issues
In 1993 a Government White Paper stated “Women are the most under-used and under-valued human resource in science”. There is a leakage of women at every stage in the academic hierarchy in every European country.
  • In 2001, 57% of the UK medical schools’ intake were female and the trend is an upward one.
  • Staffing data for the same period showed that women made up 26% of the full time clinical academic workforce [1]. This proportion is likely to be higher for part-time appointments and in more junior posts. It is not stated how far women are represented at professorial grade in medicine, but for science subjects the Higher Education Statistics Agency estimated in 2000 that 8.9% (less than 1 in 10) of full-time and part time professors in science subjects in UK universities were women [2]. This percentage has not changed significantly over the duration that the intake of women into medical schools has changed.
  • Women achieve significantly higher grades throughout their education through to University yet are not represented to the same extent in senior academic posts.
  • Women are five times more likely to leave the academic workforce at an earlier point in their career than men.
  • Women have been marginalized within academic medicine with respect to salaries, awards, resources and space (MIT report, and data on distribution of distinction awards).
  • The achievements of women have had to be greater than men to reach the same professional status (Swedish study).
  • Gender based experiences negatively impact on the professional lives of women. Although the discrimination is largely unconscious it maintains the ‘invisibility’ of women and prevents them from succeeding. This leads to anger and feelings of injustice that can stifle research innovation and cooperation.
Clearly the gap between the number of women now entering medicine, and those reaching the most senior posts in universities (Professors, Deans and Vice Chancellors) needs to be addressed, especially if academic medicine is to remain sustainable and relevant to the nation’s medical research and teaching demands over the next 30 – 40 years.

It is not just about modifying the expectations of an academic career to encourage wider participation by women. Today’s doctors are rejecting the demands and lack of support by senior colleagues and instead are lobbying for improved working conditions, promotion, better equity and less hierarchy in the workplace. There has been a change in attitudes to work by both genders. Data from the Royal College of Physicians in 1999 showed that clinical academics were typically working a 64-hour week. It is unlikely that these hours of work and the culture it engendered will be continued in the future. Medicine requires ‘rounded’ people and a caring attitude should be considered an attribute in academic medicine.

Some barriers to women participating and succeeding in academic medicine
  • Working hours are not home friendly and the effect of reduced hours or career breaks means that costs for childcare are more than salary can afford. Childcare facilities at or near the place of work are not widely available to medical academic staff.
  • There is under-representation of women on University committees because in many cases the posts are not filled through competition, but by word of mouth. This leads to a perceived lack of experience for women and hence reduced promotion prospects.
  • Women’s careers may suffer because they did not know or felt unable to approach the “right people”. [3]
  • There are few role models available at senior levels. How many vice-chancellors, heads or deans of medical schools are women? Often the point at which people reach sufficient standing to be considered for these most senior roles coincides with the need to take on a greater role in the care of elderly relatives.
  • In line with the experience of women in the wider workforce, average salaries are lower. Research by the AUT has shown that academic salaries paid to women are 84% of those paid to men. [4]
  • Job descriptions often include the administration roles that men do not want and take time from research roles.
  • The expectations of a research career require special consideration.
(i) The strains of the present system for research assessment are problematic for all staff, but women are especially hard hit when it comes to establishing and maintaining a research career. The current review of research assessment (Sir Gareth Roberts, May 2003) proposes an increased review cycle for research to six years. While this is beneficial for recognising the long-term nature of research, a longer assessment period works against career breaks or part time work.

(ii) Women are less likely to apply for research funding, in part due to their under-representation in senior grades, or by being on a fixed-term contract, which makes them ineligible for some grants. [5]

(iii) Women are less likely than men to be involved in a range of high profile academic activities, to have a high publication record (affecting RAE scores)
and a PhD. [6]

(iv) Success in the research sphere does not lend itself to taking “time out” to have a family.

Solutions
Making the problem visible and to set targets has been the concern of women’s groups and at the EU there are policies for Universities to develop systems for gender mainstreaming. That is integration of gender equality into all systems, structures, strategies, policies, projects, processes and cultures. Data sets identifying gender are a valuable monitoring tool for all HR departments in Universities. Nurturing talent is a function of the Universities. A fair representation of women in scientific institutions brings benefits to society and to medicine itself. For example, cognitive diversity is a strength to be encouraged and may lead to more rigorous approaches to scientific study. The experience of both men and women in defining a scientific problem, researching it, presenting the results builds up the relevant scientific base in medicine for society. For example, feminist scholarship has lead to a major contribution to women’s health.

The participation of women in academic medicine can be improved by:
  • Identifying the existing data
  • Building high quality data bases
  • Identifying good practices
  • Recommending policy measures
  • Proposing monitoring indicators
The Joint Consultants Committee has acknowledged that it is becoming increasingly important that the impact of the rising number of women entering medicine be properly assessed. Only by fully modelling the effect of this gender shift on the composition of the workforce could policies be developed to ensure that the sustainability of a future NHS workforce was safeguarded [7]. The MASC recommends that as part of this exercise, the impact on clinical academic staffing should also be evaluated.

Medical Schools need to value diversity, support flexible working and manage staff according to best practice, including appraisal on the basis of achievement, not hours worked. Mentoring and networking can help overcome feelings of isolation and lack of self-confidence experienced by some women. Senior academics should be more proactive in encouraging and actively supporting more women to apply for posts and research. [8]

Professor Cheryll Tickle, Royal Society Foulerton Research fellow suggests some practical steps that can be taken to encourage more women into research:

“More women are needed in senior positions. When I was working my way up, women who were in a senior position were very helpful to me practically, as well as being inspiring. Now I try and do the same for my women colleagues. I also had a very supportive person I worked with at postdoctoral level, which was a very important factor in encouraging me. There are ways forward, such as ensuring there are suitable women in job applicant shortlists, or when organising meetings, making sure there are women speakers or calling a named lecture after a woman” [9]

In 1995 the Royal Society set up its innovative Dorothy Hodgkin Fellowship scheme to retain the most able women in science at the early career stage when many drop out. The scheme provides a full salary plus annual research expenses on flexible terms to allow career breaks/part-time working for recent postdoctoral researchers. The Royal Society has also taken other steps as follows:
  • Avoiding age limits and focusing on years of research experience when deciding eligibility for funding;
  • Encouraging more women to apply for research appointments and grants by using women who already have them as role models;
  • Offering flexible working conditions to all its research fellows and additional support for women, if required;
  • Working closely with other organisations to promote the interests of women in science;
  • Seeking funding from the government and elsewhere to support the Athena project, which produces and distributes a comprehensive gender practice guide for universities.
As reported by the Athena Project (appendix I), the University of Aberdeen has developed a Women in SET programme [10] which unfortunately excludes clinical academic staff. However, the aims of the scheme can easily transfer to medical academic careers. There is some crossover with the Royal Society scheme. The aims are:
  • To develop a model for a mentoring programme;
  • To encourage more women to continue their careers by providing them with a structured way of assisting them to examine career development;
  • To encourage a greater volume of applications in the promotions exercise from women
  • To provide female staff with the opportunity to network with others in their field in the internal and external environment;
  • To raise the profile of women in SET
  • To encourage women to submit more grant applications;
  • To enhance staff development and enable female staff in SET to realise their full potential;
  • To encourage the effective development of the mentors.
Cambridge has also run a Women in SET initiative for the Athena awards, based around mentoring. The initiative aims to raise expectations and meet the challenge of raised hopes and aspirations. Seminars were run for all staff to identify the obstacles facing women in SET careers. There is also a positive action recruitment project that takes advantage of section 48 of the Sex Discrimination Act. Two recruitment officers will work to improve the rate of applications from women in SET posts and provide training in gender awareness for senior recruiters. [11]

Mentoring
As shown above, there is considerable support for mentoring schemes, and we recommend that these are rolled out to all medical schools, research institutes and other employers of medically qualified academics. There are a number of schemes in operation, and we would highlight in particular the example at Imperial College London. This scheme is intended for non-clinical and clinical post-doctoral research fellows. It aims to give researchers the opportunity to speak with someone further on in their career about:
  • Career options
  • Routes to career goals
  • Information/people/networks of people to help them
  • Feedback on fellowship applications or CVs
  • Balance between work and family.
Mentors meet regularly with their mentee, and maintain contact via email and phone.

The guidance about the scheme also refers to the work of HESDA on career management and development of researchers. www.hesda.org.uk/crs/crs.html

There are reasons why mentoring should be a key part of attempts to attract more women into medical academic careers, which the Imperial College London paper lists. For ease of reference and completeness of this paper, these are:
  1. The research concordat [12], which focussed on the employment, career management and training of contract researchers.
  2. The main funders of medical research (Wellcome, MRC) require recipients of grants to comply with the Concordat’s recommendations.
  3. The government’s SET initiative (see below).
  4. The Fixed term Contract regulations prohibit employers from discriminating against fixed term employees, and attempt to prevent abuse arising from the successive use of short-term contracts and improve access to permanent jobs for fixed-term employees. It is in the (medical schools’) interest to ensure that staff make informed career choices, and mentoring would help.
  5. The positive experiences of mentoring in other disciplines.
The proposed resource centre for women in Science Education and Technology (SET)
The MASC fully supports the proposed establishment of a resource centre for women in scientific, engineering and technology careers, and is seeking membership of the group set up to monitor the government’s SET strategy. The contract to run the new centre is being awarded by the end of 2003.

Women who are interested in pursuing a clinical academic career should be aware of the assistance that the resource centre hopes to provide. Its current aims are to develop and disseminate guidance on best practice in SET employment (which could equally apply to clinical academic careers), provide a focus for existing women’s SET organisations, professional bodies, employers, trade unions and others. Its activities will “complement and support the government’s recent mainstream policies to secure gender equality in the workplace and education, and one of its principal aims is to identify the problems which impede the recruitment, retention and progress of women in all SET sectors, and develop initiatives to promote a step change”.

Flexible working
The “Improving Working Lives” (IWL) initiative is acknowledged as being a key improvement for staff working in the NHS. It should be possible through the principles of the Follett Report and the activities of the Clinical Academic Staff Advisory Group (CASAG), charged with implementing Follett, to extend this initiative to fully incorporate medical schools and research institutes. Examples of these initiatives include self-rostering shifts, annualised hours agreements, reduced-hours options of different kinds, career breaks and flexible retirement. Annualised hours in particular is a simple way of organising the clinical academic job plan, and is supported by the BMA. The IWL initiative has also introduced practical help with childcare and other caring responsibilities. We believe that there should be childcare provision available in university and NHS settings for medical academic staff.

The Department of Health has also established a Good Practice database for IWL, to enable local initiatives to be more widely promoted.

In March 2003, the DTI published a report on “Women and flexible working in the NHS” [13], which aims to complement a forthcoming Equal Opportunities Commission report on promoting gender equality in health services. It states that the “flexible organisation of working time policies are now at the heart of government strategies for the modernisation of the National Health Service”.

Furthermore, since April 2003 it has been a requirement that employers offer the chance to employees to work flexibly, which amongst other things is intended to help staff manage family care responsibilities and promote equal opportunities for women.

The application of these flexible-working initiatives to academic medicine, and to women in academic medicine in particular, relies on good co-ordinated management by the university and the NHS. Again, the CASAG should look specifically at flexible working in academic medicine as part of its recommendations on good management practice.

Promotion in universities
As part of universities’ equal opportunities policies and to promote transparency and advancement on merit, there should be active consideration of:
  • Training and opportunities for university posts e.g. Vice Chancellor / Head of Department or Dean being put in place;
  • Open access to positions on university committees;
  • Job descriptions that recognise the scientific excellence of women;
  • Transparency in appointments procedures;
  • Access to, and retention in, research careers;
  • Measuring gender in all aspects of employment and setting targets for improvement.
Grant awarding bodies should ensure that they amend eligibility requirements to enable more women candidates to apply for grants. Grants achieved often form the basis of promotions, which leads to a catch-22 position.

According to the NCSR, a review of funding policies and strategies, and a change in HEIs’ employment practices is necessary to ensure greater equity in the distribution of funding.

Maintaining a research career
Imperial College has established an Academic Opportunities Committee.

It also provides Research Fellowships for women returning from maternity leave to provide relief from teaching and administrative duties for six months while research can be re-established.

Appendix I – The ATHENA Project

The Athena Project was launched in 1999. Athena’s aim is the advancement of women in science engineering and technology (SET) in higher education (HE) and a significant increase in the number of women recruited to the top posts. Athena works with partner HEIs to:
  • develop, share, encourage and disseminate good practice;
  • increase the number of women working in SET at all levels;
  • improve the career development, recruitment, participation, progression and promotion of women in SET
Athena ran two successful Development Programmes in 1999 and 2000. The focus for the 1999 programme was mentoring, networking and staff development and for 2000 was changing organisational culture, practices and processes.
  1. HESA, “Full time academic staff in all UK institutions by location of institution, gender, principal source of salary and clinical status, 2001/02”.
  2. HoC Science and Technology select committee, July 2002.
  3. “Who applies for Research Funding? – key factors shaping funding application behaviour among men and women in British higher education institutions”, National Centre for Social Research, ISBN 1 841290 29 7.
  4. AUT website, equal opportunities, viewed 22 August 2003.
  5. NCSR report.
  6. Ibid, p.11
  7. JCC meeting, April 2003
  8. Article in BMA News, 12 July 2003. p6, referring to the conclusions of a meeting of the Royal Society.
  9. Ibid.
  10. University of Aberdeen Athena Awards 2002, Carol Strang 04.11.02
  11. mperial, Leeds and UEA also submitted projects to the 2002 Athena awards.
  12. In 1996 the bodies representing HEIs, the Research Councils, the British Academy and the Royal Society agreed a Concordat on Contract Research Staff Career Management
  13. Coyle, A. “Women and flexible working in the NHS” (Working Paper Series no.9), Equal Opportunities Commission / Women and Equality Unit 2003.

    © British Medical Association 2008

Log in to your BMA here