DHSC (Department of Health and Social Care) have released Mend the Gap: The Independent Review into the Gender Pay Gap in Medicine. It provides detailed analysis of the pay gap, looking at different grades and elements of pay, and uses analysis to identify the main contributing factors.
The review aims to make recommendations on the changes needed to achieve equality in the profession.
You can view our briefing on the findings and our response to the review in the commentary below.
What the gender pay gap in medicine looks like
In England, women hospital doctors earn on average 18.9% less than men (based on a comparison of full-time equivalent mean pay). Women GPs earn on average 15.3% less than men and clinical academics 11.9% less than men.
The total non-adjusted gender pay gap is 24.4% for hospital doctors, 33.5% for GPs and 21.4% for clinical academics. These figures are higher than those above because a significant amount of the gender pay gap can be explained through women, on average, working fewer contracted hours.
According to the review, the pay gap is mostly because of the under-representation of women in the highest paid positions, grades and specialties.
However, even after adjusting for age, seniority and a range of other factors, a gender pay gap remains.
The review identifies additional causes that are ‘multiple and complex’, though include the following.
The unequal impact of caring responsibilities on careers
Women doctors are more likely to take time out or have periods of working or training LTFT (less than full time) to care for others. This has a disproportionate impact on their pay even after accounting for the reduced hours worked and periods of leave.
Medical careers have failed to evolve with changing demographics and working patterns
The structure of medical careers was designed originally for a predominantly male workforce, with the expectation of full-time work for a long career and an ability to take on extra commitments. This has resulted in a lower average salary for the female workforce.
Women are segregated into lower paid career paths – particular roles and specialties
This is due to the difficulties working LTFT (less-than full time), or the structure of careers in some specialities. This results in pay penalties, especially relating to non-basic pay additions, such as CEAs (clinical excellence awards).
Men in the profession are more likely to be older and been in practice for longer. This leads to them occupying the highest paid positions (consultants, associate specialists, GP partners, professors).
The gender pay gap compares the average pay of all women and men working in a sector or a profession. The gender pay gap is calculated using full-time equivalent pay, or hourly pay to give a better 'like for like' comparison. A 24.4% gender pay gap for hospital doctors means the average pay of all female hospital doctors is 24.4% lower than that of all male hospital doctors.
The gender pay gap is different from equal pay. Equal pay for equal work is a legal right set out in the Equality Act 2010. It means a woman doing the same work as a man, or work that is different but of equal value (eg in terms of effort, skills, knowledge, responsibility), is entitled to the same pay.
Instances of unequal pay may contribute to an overall gender pay gap. However, differences in workforce composition and the kinds of jobs men and women do are more likely to be significant drivers of the gender pay gap. These differences may result from women experiencing discrimination or greater hurdles in accessing particular jobs or progressing in them.
Learning from the review
The structural and institutional factors that lead to the gender pay gap should be removed as soon as possible. The cultural factors should have plans put in place that will guarantee effective change.
To ensure progress is being made the gender pay gap must be checked against protected characteristic intersectionality to give accountability that the issues identified in this review are being addressed.
Covid-19 has changed the working environments, but the workforce need is greater than before and retention of women in medicine is a priority for the healthcare sector.
The structural and attitudinal issues identified in the review may become exacerbated if there is no action to address them now. We will continue to influence and promote the findings of this report and the recommendations.
We welcome many of the recommendations. However, there are still three significant issues to raise:
- some of these recommendations would clearly require contractual change and potentially changes to pay structures
- due to the time that has passed since the research was initiated the data may no longer be relevant and current BMA policy positions may not align with recommendations as they stand
- there have been significant changes to the health system due to COVID-19, and we must view all the findings with consideration of the current environment.
Some recommendations need to go further
There are some areas where the recommendations lack specificity or we believe the review could have gone further, for example in efforts to change culture. Some areas were overlooked, for example the unfairness of LTFT pension contributions. The intersection of gender with other protected characteristics also needs further investigation.
Doctors continue to face significant pressures through the ongoing pandemic. We believe this should be considered when looking at how to prioritise the gender pay gap review recommendations (made prior to the pandemic). It is more important than ever to act to improve retention and the career progression opportunities for women.
It seems like every time somebody has a baby in the NHS, everyone’s completely surprised, as if it’s never happened before… Well over 50% of the medical workforce is female, and yet we still have not made it possible for women to combine motherhood and being doctors.Participant in DHSC review
What we're calling for
- More to be done to support doctors when they have children or other caring responsibilities and to minimise the career costs of caring.
In mixed-sex couples, men should also be encouraged to take time off work and play more of a role in caring to help challenge stereotypes around gender, work and care and minimise the disproportionate impact for women.
- Enhanced pay for shared parental leave must be extended to all doctors.
- Gender pay gap monitoring and reporting to be standardised.
- More work must be done to understand the differences in the gender pay gap with the intersectionality of different protected characteristics eg race and disability.
- Poor behaviour, stereotypical attitudes and bullying cultures must be tackled to create a welcoming environment for all doctors.
- Structural inequality such as treating LTFT (less than full-time) doctors differently without justification must stop immediately.
- Increase provision of NHS nurseries and other support for childcare including access for doctors working in primary care, to accommodate out-of-hours and shift working.