- The Independent Review into Gender Pay Gaps in Medicine in England was commissioned in 2017 by the Department of Health and Social Care, and its findings were published in December 2020.
- The review was chaired by Professor Dame Jane Dacre and led by Professor Carol Woodhams.
- The aim of the review is to understand the structural and cultural barriers affecting the female medical workforce and make recommendations on the changes needed to achieve equality in the profession.
- The review is extensive and has chapters that focus specifically on the issues of: gender pay gaps in hospitals and community doctors; GPs and clinical academics and the various causes of pay gaps.
Gender pay gap in medicine
- Researchers found that the gender pay gap is not seen at the start of medical careers but rather in the later stages of training, between the ages of 30 and 40 – when many women usually have children.
- The gender pay gap in medicine is considerably higher than other professions – the gap being 2% for accountants and 8% for teachers.
- Overall, findings revealed that women doctors working in hospitals in England, earn approximately 18.9% less than men, female GPs earn 15.3% less than men and clinical academics 11.9% less than men.
- The total medical gender pay gap in England is 24·4% for hospital doctors, 33·5% for general practitioners, and 21·4% for clinical academics.
The review notes that the issues that contribute to the gender pay gap in medicine are complex and wide ranging. However, the review was able to unveil several influencing factors including:
The unequal impact of different working hours on women
Female doctors are more likely to work less than full time (LTFT) or take time off work due to caring responsibilities than men. This leads to a disproportionate impact on their pay even after accounting for the reduced hours worked and periods of leave.
This explanation is supported by data from the RCPCH Workforce Census report which found that 35.6% of female consultants and 10.7% of male consultants in the UK worked LTFT in 2017.
Pay grade and experience
Male doctors are usually much older and have more experience than female doctors as they have been in practice for longer periods of time. This therefore allows them to occupy, more senior and higher paid positions, whereas periods of LTFT working for women, reduces their experience and slows down or stalls their progress to senior positions. This is a key component for explaining the gender pay gap in medicine.
Women are segregated into particular specialties
The review found high levels of gender segregation in the profession. Specialties that are largely surgical tend to be more male dominated and female-dominated specialties include geriatrics and palliative medicine. Findings revealed that surgery had the lowest proportion of female doctors (12%), followed by ophthalmology (28%). Paediatrics - and obstetrics and gynaecology - have more than 50% female doctors, illustrating that gender pay gaps are evident and highest in male-dominated specialties.
Difficulties with working LTFT results in pay penalties for women, particularly relating to non-basic pay additions, such as clinical excellence awards (CEAs.) The report revealed that among hospital doctors, gender gaps in total pay – which include CEAs, allowances, and money from additional work such as waiting lists initiatives, ie Saturday clinics or operating lists, and management supplements – are larger than gaps in basic pay alone.
These recommendations are in line with the measures set out in the NHS People Plan, to improve recruitment and retention, including ensuring equal opportunity and access to flexible working for both men and women:
Review pay-setting arrangements
- Among hospital doctors, this means using fewer scale points and greater use of job evaluation. The aim is to ensure that gaps related to grade are justified.
- More structure and greater transparency is recommended in GP pay setting. Decentralised or local practices in pay setting can increase gender pay gaps.
Give greater attention to the distribution of additional work and extra payments
- Increase transparency around additional allowances and individually negotiated pay (for example, for locums or waiting list initiatives). An expanded workforce would reduce dependence on these gender-segregated pay elements.
- Monitor the gender split of applications for CEAs; change the criteria to recognise excellent work in a broader range of specialties; and encourage more applications from women.
Promote flexible working for both men and women
- Advertise all jobs as available for LTFT.
- Reconsider the structure of LTFT training, so that it focuses on competency not time served, reducing long-term career penalties.
In sum, from the review, it is clear that the medical profession has failed to keep up with demographic changes and modern day working patterns, resulting in a lower average salary for the female workforce. While, medical careers were initially designed for a predominantly male workforce, with the expectation that doctors would work full-time, without any breaks in service, over many years, this is evidently no longer the case.
Systematic and policy changes are needed to ensure that doctors are paid fairly, according to their skills and the work that they do and not their gender or desire to have children.
As the professional body of a predominantly female workforce, we welcome the review and its recommendations, and we are committed to support the work to narrow the gender pay gap in the profession. We will be working closely with the Academy of Medical Royal Colleges (AoMRC) and others to press for this to become a reality.
Additionally, the COVID-19 pandemic has demonstrated that it is more pressing than ever to improve lifelong careers and opportunities for women training and working to provide paediatric care. We believe that this a pivotal moment to change how paediatrics and the future of our children will look for the better over the next twenty years. Our vision for what this might look like is as follows:
- Flexible and progressive rotas which allow doctors to deliver high quality patient care, not impeded by excessive workload, allowing for both continuity of care and attention to sleep, as appropriate
- Staff wellbeing being at the forefront of institutions, with attention to taking proper breaks to refuel on nice, healthy food, the ability to rest and recharge and initiatives to promote health and balance
- All staff feeling like they are part of a cohesive team, with true inclusivity, attention to diversity and modern leadership
- Paediatricians with caring responsibilities or those who wish to work LTFT being able to take advantage of the advances made in online working during the pandemic and participate in work activities or other professional opportunities from home
- Inclusion of different working models within paediatric teams and inclusion of more varied multidisciplinary team members to support patients
- More online meetings for wider professional activities to allow paediatricians with young families or other home commitments to easily engage fully in meetings
- Trainees who are supported to obtain the best career fit, with flexible training options
- A paediatric workforce that is involved and influences global health, climate changes and inequality
- Flexible childcare arrangements as school closures and more limited access to other less formal childcare negatively impacts women working in healthcare
- Further research to better understand the experience of the female paediatric workforce with other protected characteristics, such as race and disability.