Opinion | Monday, 25th January 2021

How we can close the gender pay gap in medicine?

Professor Carol Atkinson explains how the career structure of doctors has helped to sustain the gap

The gender pay gap between men and women in medicine is highest for hospital doctors, according to a new report
The gender pay gap between men and women in medicine is highest for hospital doctors, according to a new report

Last month the UK government published an independent review into gender pay gaps in medicine in England. The “Mend the Gap” report, commissioned by the Department of Health and Social Care, is the largest and most comprehensive review of its kind ever completed in the public sector.

The report found that the gender pay gap between men and women in medicine is highest for hospital doctors, with female doctors earning 18.9% less an hour when adjusted for contracted hours.

The report also found the disparity in medicine is considerably higher than other professions – the gap being 2% for accountants and 8% for teachers.

During the COVID-19 pandemic we have seen the vital role our frontline medical professionals, both men and women, have played.

I was honoured to be a part of the independent research team behind the report, which clearly shows that despite previous studies, policy interventions and initiatives, there are a range of factors that are still sustaining the gender pay gap in the sector.

Using data from doctors at various stages of their careers, I led the part of the project that analysed interviews from 30 men and women doctors, exploring their circumstances, experiences and paths to draw out factors that have influenced their salary.

As a result, we identified various cultural and structural factors that have created career disadvantage, predominantly for women.

Challenges and insights

While many of the challenges facing women doctors are based on assumptions of typical behaviours and choices, often reflecting the fact that women may take maternity leave and choose to train and work less than full-time, challenges are also imposed by the way support training and career progression is structured. These are often based on a masculine mode of managing work and career progression.

It is these stereotypes of ‘appropriate’ roles and behaviours that limit women’s career choices and earnings.

We also found a wide range of evidence of female doctors who were not taken seriously because of their desire or need to work part-time, despite long working hours.

The way doctors should work and behave are based on white, middle-class presumptions and we found that ethnic minority women often struggle to progress within the profession as they find it hard to fit within these norms.

A male perspective offered important insights into these processes. For example, men often avoid part-time work and many we spoke to have reflected (unwittingly) on the privilege their gender afforded. At senior levels in the profession, we found that tournament systems of promotion offered advantage to white, middle-class men.

There is a fear of challenging entrenched white middle-class masculine norms, with ethnic minority women fearing the label of troublemaker and emphasising their need to fit in to progress.

The enduring narrative blamed individuals, not systems and structures, for any lack of career progression.

Revolutionary action

These findings, along with the independent government report, provide evidence that systemic changes and policies are needed to challenge deep structural issues in the medical profession.

These changes must replace typical attempts to change or help women progress, which often emphasise the need to fit in, for example through mentoring programmes.

These new policies need to deliver revolutionary actions. For example, limits on hours worked for men and women alike could be introduced - as part of a wider re-design of services which protects or could potentially improve levels of care - and training structures could be designed in a way that does not disproportionately penalise those working less than full time.  

Work also needs to be done to address informal interactions between professionals working in the sector, which are an important part of helping women feel that they can progress.

The government is now working to establish an Implementation Panel to help address our recommendations outlined in the report. The panel will include gender pay experts and representatives from across the health service and I look forward to seeing the difference that our research and interventions have on closing the gender pay gap.

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