When suffragette surgeon Flora Murray addressed her all-female staff during the First World War, at Endell Street Military Hospital, she was pragmatic: ‘What would be accepted from a man will not be accepted from a woman. You have got to do better.’

We like to think that things have changed, but statistics revealed in this week’s long-awaited Mend The Gap Review speak for themselves. It shows that, even when factors such as a difference in hours worked are considered, female doctors in hospitals are paid nearly 19 per cent less than their male counterparts, female GPs are paid 15.3 per cent less and clinical academics, almost 12 percent less.

Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England, is the conclusion of an investigation led by Professor Dame Jane Dacre into the working experiences of women doctors. It concludes that unless the structure of medical training and service delivery alters, ‘it will be difficult, if not impossible, to eliminate the gender pay gap’.

It’s shocking that even 10 years after the Equality Act and 45 years after the Sex Discrimination Act, that the scale of the gender pay gap in the medical profession is so stark. But the review comes as no surprise to many of us in the profession who have known about the multiple and complex causes of this and gender equality in medicine for many years. Women, although now well established in the profession after years of underrepresentation, still face additional challenges accessing senior positions and entering male-dominated specialties. There are still gendered attitudes towards caring responsibilities and a lack of transparency around pay, particularly for those who have taken breaks for caring responsibilities at some point in their career.

Overall, medical careers and the culture of the profession have failed to evolve with the changing demographics of the profession in the past 20 to 30 years – and this goes beyond issues around women and work to equality of race, disability and other characteristics. This means that alongside analysing the inequality between men and women’s earnings, it is important the such future research is intersectional and embraces and tracks the progress, or not, in these areas.

A quick overview of the review’s recommendations that should be acted on immediately are:

• Extending enhanced shared parental leave to all doctors in England
• More NHS nurseries offering out-of-hours cover for shift work
• Ensuring that taking a career breaks is not detrimental to career progression
• Challenging barriers that deter women from entering certain medical specialities e.g. orthopaedics and surgery 
• Making GP Partnerships more attractive to women
• Equality in pay: transparency around pay and additional payments, shortening pay scales and fairer pensions so that women working less than full-time are not penalised in their pocket.

We must learn from this review and make sure we put actions into place to deal with this. It’s too easy to say that in the time of COVID-19, this is a ‘nice to have’ and not a priority, but if we want to ensure the medical profession is fit not only for the next generation of medics who will take us beyond the current pandemic, but for the wider NHS, it’s imperative we do.

To paraphrase Flora Murray, ‘we’ve all got to do better’.

Helena McKeown is BMA representative body chair