Advancing women in medicine: how can we move from rhetoric to action?

‘In no nation are women equal to their men.’ The words of Aparna Mehrotra of UN Women stirred many at our recent summit aimed at advancing women in medicine. Like many in our mostly female audience, my thoughts ran to the number of injustices perpetrated against women globally, including violence, denial of access to education and the freedom to choose.

But gender inequality can take more subtle forms. Women in medicine, for instance, are still facing professional and personal barriers to taking up senior roles – despite women accounting for 77 per cent of employees in the NHS. Only 24 per cent of trust medical directors are women, and in some surgical specialties only one in ten are women.

It is worth applauding the fact that a number of royal medical colleges have appointed female presidents, the British Medical Association has a female chair, and Chief Medical Officer Dame Sally Davies holds office at the same time as the Department of Health has its first female permanent secretary. But at the summit, we were all aware that these landmark posts were not representative of the wider landscape for women in medicine.

Views from the advancing women in medicine summit

Views from the advancing women in medicine summit

Views from the advancing women in medicine summit

Why does the gender imbalance in medicine persist? Gender stereotyping and discrimination, organisational cultures and women’s personal expectations all play a part in perpetuating the imbalance. Unconscious and conscious biases, like ‘all-male interview panels’ and ‘old boys’ networks’ for example, were mentioned several times throughout the summit. Dr Krishna Kasaraneni, Chair of the Equality and Inclusion Committee at the British Medical Association, reminded us that this is not a problem limited to medicine or health care – women only make up 22 per cent of the House of Commons.

But why does the number of women in senior roles matter? It matters because having women at the top of organisations has been shown to improve organisational performance and change cultures. ‘Oestrogen dilutes testosterone in the boardroom,’ Sir Bruce Keogh, Medical Director at NHS England, said in one of the most tweeted comments from the day.

In his contribution, Jeremy Hunt, Secretary of State for Health, pledged to see more women appointed to leadership roles in health, acknowledging their considerable contribution. Finding, supporting, nurturing and promoting talent from within a workforce increasingly made up of women is key to changing cultures.

Commitments to advance women in medicine from attendees at the summit

Commitments to advance women in medicine from attendees at the summit

Commitments to advance women in medicine from attendees at the summit

If inspirational female role models are part of the answer, Dr Kate Granger OBE is a great example of a doctor who is leading cultural change. Kate, who is terminally ill with cancer, has recently achieved the professional status she has long aspired to: Consultant in Medicine for Older People, currently working at Mid Yorkshire Hospitals NHS Trust. Her experience as an inpatient prompted her to establish the now globally recognised #hellomynameis campaign which has changed the way many health professionals view their behaviours and attitudes towards providing patient care. ‘I thought I would do something…’ she modestly told the summit.

Studies have shown that shining a light on the barriers to women advancing in medicine will also make a contribution towards enabling us to tackle other inequalities, including the absence of black and ethnic minority leaders in health and medicine when compared to the numbers who make up the working population.

A career in medicine is ‘not for the faint-hearted – you have to be able to make hard choices’, Clare Marx, the first female president of the Royal College of Surgeons, told me in a post-summit interview. She called for a more open discussion of those choices – which for women so often stand in the way of career advancement. Clare also described the importance to her career of support and sponsorship from male colleagues. Tackling gender inequality is everybody’s issue – we cannot advance this agenda without the support of our male counterparts.

Vijaya's interview with Clare Marx

At the summit we heard from women and men who have taken action, taken on organisations and started to make the progress we need to advance women in medicine, but there is still much more to do. It is through the commitment and determination of all those who attended or followed this summit that we will move from rhetoric to action.

If you are making a difference in this area, please do get in touch or leave a comment below.

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#483717 Krishna Kasaraneni
Chair of Equality & Inclusion Committee

The first sentence of the blog says it all. For far too long under-representation of women in senior positions in the NHS has been observed. Yes, 'observed'. Merely noted and not much done about it. To see Clare Marx as the chair of Royal College of Surgeons of England, a college of predominantly male members, does show that the profession is breaking out of its silos and finally started to acknowledge the value women leaders bring to the profession. We need to build on the momentum created by Clare's election and push this agenda forward. The King's Fund summit brought together the leaders of the profession to commit to action and I look forward to working with Vijaya and the team to move this forward.

The lack of diversity in leadership in the 21st century health service is simply not acceptable. I've don't have all the solutions, but the BMA is trying to address this in house and I hope the other organisations can also build on this.

#486456 Binita Kane
Final year respiratory SpR and HENW Leadership Fellow
University Hospital of South Manchester

Thank you for this blog Vijaya. It’s time to change perceptions. I am a mother of two daughters and when asked previously, have always said that I would discourage them from doing medicine. ‘It’s too hard as a woman’ I have found myself saying. This has been based on my experiences of trying to balance a passion for medicine and being fiercely ambitious, with motherhood. I have experienced the stigma of working part-time and the guilt of working full-time. It has taken me 9 years instead of 5 to complete my specialty trainee, doing night-shifts with small children at home is really hard. However with incredible support from my husband, Deanery, Consultants and Organisations I have worked in, I have somehow made it. The right people have encouraged me at the right time and since attending the Advancing Women Summit I have reflected on my views about my daughters.
It’s time for change. There needs to be cultural change at national level (within government, NHSE, and medical training) and at organisational level, adapting the workplace to working mothers. It should be the social norm for women to have a family and progress their career in the same way as anyone else instead of women ‘sacrificing’ their career choices. We need to change the mindset of men to champion this cause and for them mentor women who have the potential to be leaders. A culture change also needed amongst women, we need to change the language we use and stop accepting the status quo (as described I have been guilty of this). Finally we need our junior doctors to be the driving force behind these changes. Organisations need to support this cause, but it is individuals who will ultimately make the difference.

#486505 Vijaya Nath
Assistant Director
The King's Fund

Binita , it was good to hear at Summit that you and many of the next generation of Drs are role modelling the change we all want to see.
Making sure that Women in Medicine (as in all walks of life ) achieve their potential , whatever form that takes .
We look forward to continuing to support all your successes in whatever way we can at The King's Fund. Together with all the organisations we collaborated with , our commitment to advancing Women in Medicine will continue .

#487485 Jill Parnham
Operations Director
Royal College of Physicians

Well done 'The Kings Fund' for hosting such an inspirational day. 'Thank you' Vijaya for your vision, drive and enthusiasm, a shining example to us all.

The 'Advancing women in medicine' summit brought a wealth of fabulous speakers and expertise together with multiple resources and knowledge. Pledges were made and follow up is pending, but with many potential thoughts and ideas for good practices, what are the next steps to ensure that healthcare structures and networks collaborate to ensure advancement for women who have worked hard and deserve it?

'Many women report they do not want to be the subject of special treatment or quotas, but what they do need are flexible solutions to manage work and family time commitments'. (Women in business and management: gaining momentum, International Labour Organisation 2015. )

Interestingly, respondents to the ILO company survey (reference within link above link) indicated the kind of follow-up and practical support that would be helpful to their companies to advance women in business and management. We must do more to think through, address, extrapolate and generalise these practical support mechanisms within the healthcare sector also.

#489907 Sally Davies
Medical Women's Federation

MWF was proud to be one of the five organisations supporting and participating in the Advancing Women in Medicine Summit. Thanks to Vijaya and the King's Fund for arranging and sponsoring such an event. This marks the beginning of a sea change in medicine with benefits for all especially patients. As came across clearly at the Summit, the current situation cannot continue. Women doctors need to believe that they can strive to leadership positions, step up and be enabled to achieve their full potential.
It was inspirational to hear both women and men committing to supporting, mentoring and encouraging women in leadership within local, national and international health organisations. We champions need to take forward the change in culture within the NHS and other bodies by fulfilling the commitments made on the Wall.

#491678 Peter Lees
Chief Executive and Medical Director

It is ironic that we laud having the ‘mother of all parliaments’, a phrase coined exactly 150 years’ ago, when little progress has been made in terms of equal representation of gender in the corridors of power. And while women are predominant in the modern NHS, they remain under-represented in medical leadership roles.

FMLM applauds all those who have been appointed as presidents of medical royal colleges, as Chair of the Academy of Medical Royal Colleges, as CMOs and as the permanent secretary at DH. It should be noted that these female leaders are clearly not the assumptive ‘queen bees’ who are pulling up the ladder of opportunity behind them, as reported in the media. They all have a refreshing approach which they shared at the recent Advancing Women in Medicine Summit and are looking to build an entirely different structure to pass on to the next generation. Their argument is built on the logical and evidence based premise that under-representation of women reduces the talent pool and denies the system the different talents women bring to leadership. Clare Marx, Royal College of Surgeons of England President and FMLM Council Member, captured it at the summit, when she outlined the wealth of good fortune, education, training and dedicated support she had received to help her to her current position, then said: “And let me know if there’s anything I can do to help”. While it is particularly powerful when women look for ways to support, mentor and champion each other, the point was also made, by Clare and others, that male mentors are extremely valuable. Ultimately, both genders need to support each other to develop the very best in medical leadership.

FMLM values diverse leadership and supports women to realise their leadership potential. We are committed to this as a medical faculty and will continue to work with The King’s Fund, BMA, royal colleges and others to ensure the leadership agenda is a rich and diverse one.

#503914 Ruth Taylor
Anglia Ruskin University

Thank you for an interesting blog Vijaha. I am not a medical doctor but relate to the issues raised. I have recently been appointed to the post of Dean within a faculty of health, social care and education after a career spanning clinical practice (as a nurse) and higher education. I was a single mum for much of that time juggling the demands of challenging roles and ongoing study within inflexible working conditions (at the time). It was hard, but worth it. However, I think it could have, and should have, been easier for me. Not in terms of achieving what's required to be successful, but in terms of having the support and flexibility within the working situation to enable me to achieve my potential whilst also being able to support my children (and lose some of the guilt of trying to do it all). All these years later, and things don't seem to have moved on massively - it is crucial that things change for women so that we can all achieve our potential and contribute to society as fully as we are able. It is inspiring to hear from people like you, and to see people like Kate Granger achieve so much. People in roles like mine need to make sure that we do all we can to enable other women to have an 'easier' journey by removing some of the barriers that exist - and by being open minded to different ways of working that can benefit us all.

#534069 Beryl De Souza
Honorary Secretary
Medical Women's ederation

I agree with the comments and sentiments expressed above that change is needed – very pleased that the King’s fund steered by Vijaya Nath brought together the Medical Women’s Federation, British Medical Association and the Faculty of Medical Leadership and Management to coordinate and host an inspiring Summit on Advancing Women in Medicine.
2015 is a remarkable year where we will have six women doctors in Royal College Presidential roles which is worth celebrating and demonstrates that change is happening.
As women doctors, we are each one of us empowered to make a difference no matter what grade or specialty. We need to look and ask for equality and inclusivity in all committees, organisations and establishments to improve decision making with the goal being to achieve the best outcomes for our patients and for rewarding medical careers.

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