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Are there too many female medical graduates?

Citation for published version: McKinstry, B & Dacre, J 2008, 'Are there too many female medical graduates?' BMJ, vol 336, no. 7647, pp. 748-749. DOI: 10.1136/bmj.39505.491065.94

Digital Object Identifier (DOI): 10.1136/bmj.39505.491065.94

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Download date: 28. Apr. 2017 HEAD TO HEAD

Are there too many female medical graduates?

Brian McKinstry senior research fellow, Community Health dren are older. However, research among gen- Sciences: General Practice Section, University of Edinburgh, eral practitioners has shown that many Edinburgh EH8 9DX [email protected] women in their 50s, when their children are relatively independent, continue to Too many female graduates work part time, often because of other car- are bad for medicine, just as ing demands.7 8 In addition, more female gen- too many male ones have eral practitioners plan to retire before the age been in the past. The numbers of men and of 60 than men, shortening their working life women entering medical school should further.7 In psychiatry, one study found that roughly refl ect the numbers in society. The nearly twice as many female consultants (41%) case for this is simply on grounds of equal as male planned to fi nish work on or before opportunity. But there are also strong eco- their 55th birthday.9 Fewer women than men nomic and workforce planning reasons. I will choose to work out of hours,8 and the increase argue this largely from the perspective of my in women doctors may have partly infl uenced own specialty, general prac- Women doctors concentrate the recent abdication of out tice, which illustrates most in a few specialties regarded of hours work by general strongly the impact of the as family friendly and tend not practitioners in the UK. feminisation of medicine. Although some research to take up some specialties Over the past 30 years suggests that younger male the proportion of women attending medical doctors are also seeking part time careers,10 schools has steadily risen in many countries there is little evidence that they are actually including the UK, US, Canada, and Aus- opting for this lifestyle. Is the increasing feminisation of tralia.1 2 In 2002-3, all UK medical schools had health care a cause for celebration or more female students than male, with the per- Time bomb a threat to future delivery of services? centage of women exceeding 65% in some.3 We are yet to feel the full effect of the feminisa- This partly refl ects the increasing number of tion of primary care in the UK and elsewhere. Although several large studies have shown women applying for medical courses and their Above the age of 45 years men, mostly work- differences, these differences are very small increasing examination success in science. For ing full time, are still the majority, whereas and of little practical importance.13 Men and many years the relative lack of female doctors most general practitioners younger than 45 women may bring different, complementary was bemoaned, but the tables are turning and years are female and mainly working part skills to medicine. There is some evidence that soon male doctors will be in a minority. This time.11 As older mainly full time doctors retire, women engage in more patient centred com- is already the case in primary care in many unless employment behaviour changes from munication.14 However, women consult for parts of the UK. past patterns, there will be a major shortfall in longer with patients,14 and in one UK study primary care provision. of out of hours consultations they were 30% Workforce implications This demographic change may also affect more likely to refer to hospital increasing pres- Why does this matter? The main concerns education, research, and development. In an sure on hospital services.15 Moreover, recent centre on the work patterns of women doc- American study of women in internal medi- UK research shows that even full time female tors and also around the development of the cine,12 the researchers found that compared consultants see fewer patients than their male profession. Women doctors concentrate in with men with children, women with children colleagues.16 Empathy and communication a few specialties regarded as family friendly had fewer publications (18.3 v 29.3; P < 0.001). skills are important, but so are effi ciency and (for example, primary care4 and psychiatry5) However, no signifi cant differences between the ability to live with risk. and tend not to take up some specialties such the sexes were seen for doctors without chil- For years women have been unfairly dis- as surgery.4 This unequal distribution means dren. In our study in primary care we found criminated against in medicine. I fully sup- that some specialties feel the implications of that women were contributing about 60% of port their role and the strengths they bring to part time working and maternity leave, such the activity of men in development aspects modern medicine. However, in the absence as lack of continuity of care and resource use of general practice such as training, teaching, of a profound change in our society in terms disproportionately. research, and committee work.7 It is not clear of responsibility for child care, we need to Female doctors are more likely to work to what extent this is through choice or lack take a balanced approach to recruitment in part time than their male colleagues.6 Despite of opportunity. the interests of both equity and future deliv- many years of feminist discourse society still Some have argued that the future feminisa- ery of services. expects women rather than men to reduce tion of medicine is justifi ed on the grounds that I thank Iain Colthart for his help with the literature review. BMcK is work commitments to look after children and women perform better than men in under- funded by the Chief Scientist Office of the Scottish Government. not to return to full time work until the chil- graduate and postgraduate examinations. Competing interests: None declared.

748 BMJ | 5 APRIL 2008 | VOLUME 336 HEAD TO HEAD

UK universities are now producing more female doctors than male. Brian McKinstry argues we are risking future staffing problems, but Jane Dacre thinks there is still some way to go before we reach true equality

shared by men and women, female doctors in Both men and women make first rate particular engage patients as active partners in doctors. They should be encouraged into care, offer emotional support, and engage in the profession, but in order to welcome psychological discussion.6 Such patient centred women to the more senior positions, it is care results in better health outcomes.7 worth paying attention to the institutional barriers that prevent their progression into Under-representation leadership positions. These include lack of Women now outnumber men in most medical role models, lack of fl exibility of rotas, and schools by about 3:2,8 but as many of them low acceptance of career breaks and part time may want to work fl exibly for some of their working. Recent work on leadership styles working life, numbers in the workforce overall commends a more collaborative approach, are likely to even out. with the development of good team working Despite this increase in female students, and communication skills. there are still few women in some areas, espe- cially clinical academia. The Medical Schools Embrace fl exibility Council report, published in June 2007, The shape of the workforce is changing. Pro- showed only 11% of the professorial staff in jections suggest that there will be too many UK medical schools are women compared doctors looking for jobs in the UK in the with 36% of clinical lecturers. The proportion near future, and unemployment is already a of women decreases with increasing academic concern for trainees caught up in the recent grade. A similar situation exists in the United debacle with the Medical Training Application States, where only 15% of full professors and Service. The health service will soon have to 11% of department chairs are women.9 This is achieve a 48 hour working week to comply

REX FEATURES REX despite several recent studies of leadership that with the European Working Time Directive. show women are good at empowering others Rather than focus on the detrimental effect of Jane Dacre vice dean, academic vice president, Faculty of and are good team leaders.10 having too many female graduates, the femi- Biomedical Sciences, University College London, London WC1E 6BT and Royal College of Physicians, London Women are also not represented equally nisation of medicine should be welcomed as [email protected] across the profession, with specialties requir- an opportunity to be creative with workforce ing more acute and on-call responsibilities and planning and to recognise that a more fl exible Medicine needs and wants to more technical skills seeming less attractive.11 approach is required to deliver good quality attract the best and brightest Women’s performance in examinations in our patient care at all times of the day and night. people, whatever their sex. Some medical schools12 and in the MRCP exami- This change to a more fl exible way of working patients prefer to see the same sex doctor as nation13 is now better than Women and men wanting will be more acceptable to 1 2 themselves —so we should ideally have equal that of men, so the reason a more flexible career path into colleagues with domestic numbers of men and women. for this lack of career pro- medicine should be welcomed and other commitments As the fi rst female dean of Duke University gression is not explained and is likely to result in School of Medicine said incredulously, after by lack of academic aptitude. This is a strong more women taking on leadership positions. her appointment had made the headlines on argument for ensuring equality of opportunity Women and men wanting a more fl exible national public radio, “Brilliance and ability in medicine, rather than worrying about hav- career path into medicine should be wel- are not restricted to certain groups, so it seems ing too many women. comed. To encourage them to take on the lead- logical that if they draw from the widest pos- Recently, a much larger number of women ership roles that the profession needs. however, sible talent pool, the very best institutions will have taken leading roles in the medical royal some changes need to be considered, includ- naturally have diversity at all levels.”3 colleges and other areas of health care. It may ing greater availability of fl exible on-site child Medicine is a caring profession. The just be a matter of time before the overall care and easily accessible and funded part time attributes of the doctor as documented in the numbers at the top of the profession refl ect training options. A few small steps would sup- UK General Medical Council’s Good Medical the current increase in numbers of women in port giant leaps in the development, quality, Practice include care, consideration, dignity, the medical schools. Although women may and leadership of the medical workforce. and respect.4 The Royal College of Physicians take time off to have children, they retire later Competing interests: JD chairs the Royal College of working party on medical professionalism has so stay in the active workforce for longer14 and Physicians research project on women in medicine. agreed that doctors should be committed to therefore have more time to climb the career All references are in the version on bmj.com integrity, compassion, altruism, continuous ladder and to develop their leadership roles. WHERE DO YOU STAND ON THE ISSUE? improvement, excellence, and working in They also gain broad experience of life outside Tell us on bmj.com partnership.5 Although these are characteristics the workplace.

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