• But men still hold on to very top jobs, says report
A quiet sexual revolution, brought about by the overwhelming success of bright young women applying to medical schools, is about to deliver the NHS into female hands. Within eight years, according to a report published today, most doctors will be women.
The old medical patriarchy has left, retired, gone underground or been forced to change its views.
Already 40% of doctors are women. In the GP surgeries, 42% are female. By 2013, says the two-year review from the Royal College of Physicians, women will make up the majority of GPs and by 2017, hospitals will also be dominated by female doctors.
But the prospect raises some major planning issues for the NHS, the college warns. Unlike in some professions, such as accountancy and the law, the report says, female doctors are able to continue in good jobs while working part-time, which many choose to do when they have a family.
Among female GPs, almost half (49%) work part-time. Nearly a third (30%) of female hospital consultants also work part-time. That means substantially more doctors will need to be trained and employed to ensure adequate care for patients.
On the plus side, the NHS does not lose its well-trained and very able female medical staff, says the report. There is no evidence to support the widely held view that women are more likely than men to leave medicine entirely, creating a pool of "wasted" talent, it says.
But the NHS must urgently look at its future workforce needs, the college says, because most of the female doctors are young. The big surge of girls going to medical school began in the 1980s. By 2007, they accounted for 57% of medical students, rising to about 60% now.
Across the NHS, 43% of female doctors are under 35, which means that many will not yet have had children. With the large numbers of young women now in medical schools, there will be an increasing proportion of female doctors of childbearing age.
The review is a snapshot of the doctors we have now, said Professor Jane Dacre, chair of the working group that wrote it. They can't say how long women are likely to work part-time, or whether it damages their career prospects in the long term. There isn't good enough longitudinal data, she said.
They know there are still very few women at the very top, although the exact numbers in leadership roles, even as clinical directors of trusts, are hard to come by. But most of the men holding those positions are over 55, she points out, and were trained at a time when female doctors were a small minority. Only 20% of the over-55s are women, she said.
There may be other reasons why women do not have the top jobs. There are potential issues that need to be thought through about whether people who are working part-time can or would be willing to take on leadership positions, she said.
Female doctors prefer jobs that involve interaction with patients but also have more predictable hours, conducive to family life. They elect to be GPs, paediatricians, psychiatrists or public health doctors in preference to surgery or cardiology.
Among the female consultants, 44% are paediatricians and 49% are in public health, but only 8% are surgeons. Increasing numbers, however, are also going into emergency medicine and anaesthetics, which were traditionally male-dominated but where organisational changes are making working hours more regular.
These distinct preferences of women for certain specialities over others will require the NHS to think through which jobs are likely to be sought-after and which may be harder to fill.
The review was triggered by remarks from the first female president of the Royal College of Physicians, Dame Carol Black, which sparked a furore. She warned that the domination of medicine by women would end with the profession losing power and influence.
"We are feminising medicine. It has been a profession dominated by white males. What are we going to have to do to ensure it retains its influence? she said in 2004.
"Years ago, teaching was a male-dominated profession – and look what happened to teaching. I don't think they feel they are a powerful profession any more. Look at nursing, too."
The review warns that the route to the crucial leadership roles involves long hours and extra work, such as presentations and speeches and research on top of a clinical job, that a part-time doctor may not be prepared to take on. But, it says, these concerns can be overstated. Medical schools have expanded and there is a larger pool of talent from which to draw.
Dacre says that what is happening is not the result of any reluctance of young men to apply to study medicine: more men are applying, but not in such great numbers as women. The percentage of female applicants has levelled off in the last two to three years. There is a question about whether this is just playing catch-up from the women's point of view.
"Men who are interested in medicine are often keen on numbers and technology," she said. "We thought bright young men might be being attracted instead by IT and the City. It will be interesting to see what happens now."
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http://www.guardian.co.uk/society/2009/jun/03/women-doctors-nhs-medicine-review
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