• UCL Gender Equality Event
• March 18 2008
• Prof Debbie Sharp
• University of Bristol and Medical
Schools Council

Attracting and Developing the Medical and Dental Workforce of the Future

• The crisis in recruitment and retention in academic medicine and dentistry
– The annual CHMS staffing surveys
– The request from MWF to include gender in the
CHMS reports
– The increasing proportion of women entering medical schools
– The ‘Walport’ initiative
– Problems in the NHS

Clinical academics at UK medical schools
100
90
80
70
60
50
40
30
20
10
0
Female
Male
Professor Reader/Senior
Lecturer
Lecturer
Medical Schools Council Report 2007

• To review the current position of women in clinical academia by grade and specialty with reference to the international position
• To identify the most important issues which appear to be militating against attracting women into clinical academia and identify those that may be remediable
• To provide recommendations for where action needs to be taken to encourage recruitment and retention of women in clinical academia

• Main working party
• Subgroups
– Student perceptions
– Learning from experience
– Flexible working lives
– Best practice in HR
– International perspectives

“Academic makes you think more about constantly having your head in a book, rather than actual hands-on clinical work”
“I think that the general view is that it does take you away from being on the wards, and I just have an image of spending time in a lab”.
“We need more information about it. If something is surrounded with myth and legend it is never going to be attractive, especially when the myths and legends aren’t very nice”.

“Strong women are seen as scary, strong men are seen as admirable”
“I sat in a neurosurgery clinic and a consultant came up to me and said, ‘To be honest, if you want a family you can’t do neurosurgery’”.
“I am always really impressed when I see a professor with a woman’s name. I’m sorry, but it is so unusual.”

• the pathway
– AF2s
– ACFs
– (PhD programme)
– CLs
– Clinician scientists
/ HEFCE CSLs
– Professors

Barriers to success
1. Historical under-representation explains current disparity? → time will remedy inequality
– Steady increase in women medical students: 1576
(1991) – 3798 (2006) but much smaller increase in proportion of female professors
– NEJM cohort study – less women going into academic medicine in later cohorts
2 .
Differences in self-assessed competency?
– gender differences in self-assessed competencies of research knowledge and skills

Barriers to success
3. Women are not as good at science compared with men?
– No mean differences in science performance in early school years
– More women than men undertake intercalated degrees & often gain a higher degree classification than men

Barriers to success
4. Gender discrimination?
– Q survey of female professors and their male colleagues – 76 women and 75 men
– Women – more structural and ‘people’ obstacles, more career breaks, more working part time
– Fewer unsuccessful promotion experiences ( ? response bias)
– Fewer ‘merit awards’
– More aware of support required and received
– Surgical specialties particularly tough

Barriers to success
What they said!
“ Attitude problem: a female with kids plus interested in research equals disaster in a surgical specialty dominated by men”
“He was just inspirational – a role model as to how you can be a top professor and a fantastic clinician”
“ As a trainee, my male colleague was offered more demanding but more interesting things to do: a new lecture, outside presentations etc before me. I had to work hard and be a ‘bit pushy’ to get this kind of experience”

Barriers to success
5 . Women academics are less productive?
– spend less time in research and more in teaching and patient care
– fewer publications (particularly in women with children) - may be due to lack of mentors
– fewer grants – may be due to being in lower grade
– are more likely to work part time

Barriers to success
6. Women are less ambitious?
– qualitative and quantitative studies suggest similar ambitions and interests in men and women
– women less likely to actually apply for posts
– women have more concerns about potential conflict between being a good parent and career
– academia does not facilitate the balancing of these competing roleseed
– we need better HR systems and support

“I come here today….to tell you that coeducation has proved an absolute failure, from our standpoint. When I tell you that
33.3% of the ladies, students, admitted to
John’s Hopkins Hospital at the end of our short session are to be married, then I tell you that coeducation is a failure.”
Sir William Osler, 1894

• Elizabeth Blackwell
• Born in Bristol 1821
• First woman to qualify in USA
• Rejected by every medical school in NYC and
Philadelphia
• Applied to Geneva Medical College in NY State
• All male student body voted on her admission and as a practical joke they voted ‘yes’ unanimously
• She graduated 2 years later

• ‘The potential of most women (in medicine) is being wasted’.
1
– Women lag behind their male colleagues in attaining positions of leadership and authority in academic medicine, professional organisations and institutions
– Less likely to be adequately mentored
– Less likely to have same sex role models
1 Report of American Association of Medical Colleges 2002

• This is not just a womens’ issue
• Our students do not understand the term clinical academia
• Too few senior female academics to act as role models
• Discrimination has been a problem in certain specialties
• Mentorship is vital
• Flexible working opportunities in NHS and academia needed
• Most medical schools need to improve HR processes
• UK not so very different from US/Australia but Scandinavia
• does it better
• There is a lot of work to do!

Some ideas:
• Views of NHS consultants and junior doctors about academic medicine
• Flexible training
• Identification of clinical academic careers lead in each medical school
• Identification of senior academic womens’ lead in each medical school
• Learning from others