Warning over womens' role in medicine backed by male peers

A senior male figure from the medical establishment yesterday backed Professor Carol Black's controversial warning that a female-dominated profession could lose its power.

Professor Black, president of the Royal College of Physicians, said having too many female doctors risked lowering medicine's status, and family commitments made it more difficult for women to devote themselves to specialities such as cardiology, which required long, unsociable working hours.

Professor Colin Blakemore, chief executive at the Medical Research Council, recognised the dilemma and said similar potential difficulties existed in research. "Her comments at this time are an extraordinary coincidence, because I have mapped out the same concern in my head recently," he said. "We should recognise the potential problem for the sake of the future."

More than half of those entering doctoral work and research were women, a trend which could potentially pose a "crisis on our hands", Professor Blakemore warned. "It is absolutely fine that we have many women in research. But if the glass ceiling that is excluding women from senior positions continues to operate, we will find ourselves with a problem in the future. The worst-case scenario is that we will have a real crisis of retention."

He added that adequate mechanisms were needed to enable women to pursue their careers alongside family commitments and child-care. "We cannot just give them six months' maternity leave. Science moves too quickly. They have to stay in touch so we need to create facilities for them to stay involved in research work even when they are not physically present."

Early indicators suggested the growth of female recruits at a lower level was being mirrored by the increase of female executives, though only 5 percent of scientists and professors in medical research were female.

Professor Black suggested that women tended to be drawn to specialist areas such as geriatrics and palliative care and avoided cardiology and gastroenterology where they would be required to work long hours.

Adam Timmis, professor of cardiology at the London Chest Hospital and former secretary of the British Cardiac Society, has just completed a report in cardiology and women. He found that women were actively discouraged from entering specialisms for several reasons.

"Women accounted for 37 percent of those interviewed for training programmes for medical specialities and 42 percent were appointed, but in cardiology, only 9 percent were interviewed and 8 percent were appointed," he said.

"We know women are being turned off cardiology although at medical school it is a popular speciality ambition for women and men. It could be that women have observed the long, family-unfriendly hours that trainees often work, coupled by the unavailability of childcare in hospitals.

"There is also not the easy availability of flexible training that exists in other specialisms. It is difficult to fit flexible trainees in the cardiology rota and there is not sufficient funding for it. Another problem is that there is a paucity of female role models in cardiology."

In the British Medical Association's recent report on the demography of medical schools, the growing number of women students was highlighted, but it added that there was an under-representation of women at a senior level.

Dr Vivienne Nathanson, head of science and ethics at the British Medical Council, agreed with Professor Black but said it was easy to "misinterpret" her comments. Doctor Judith Hulf, medical secretary at the Royal College of Anaesthetists, said: "The danger signals for the medical profession as outlined by Professor Black are reality.

"Entry to medical faculties reflects the proportion of male/female applicants: that is more women are applying than men. This is because medicine has become unattractive to men professionally, financially, socially and academically.

"If we are to reverse this trend, these issues have to be addressed urgently. Professor Black says, 'I would like to see equal numbers of male and female doctors'. As a college, so would we, thus we would reflect the society which the profession serves."

But some medical professionals were critical of Professor Black's comments, which they felt did little to challenge the traditional view of structures within medicine. Dr Yasmin Drabu, medical director of North Middlesex hospital, felt the debate should not be focused on gender but on the balance of work and life in the profession, which has a round- the-clock work culture.

"I think Professor Black has raised awareness but it is not a simple issue of feminisation," she said. "The medical profession has to learn to find a work-life balance. To expect either men or women to work 24 hours of the day is totally unrealistic. My view is that it's good 60 per cent of medical students are women, because they will drive the change required by both men and women. It is unacceptable to work 24-seven. We need to have a workforce that has an outside life as well as works dedicatedly."

Dr Drabu, who specialised as a microbiologist, said that male professionals were just as keen to see an end to the long hours in many specialisms, and that it was not just female medics who felt torn between career decisions and family life.

"I have found that many young men who say they don't want to work the excessive hours required of them are leaving the profession.

"We need to treat maternity and paternity as part of a normal career progression and build a workforce that takes that into consideration. It is just a much a father's right to be with their baby than the mother's. These changes will not 'feminise' the profession. They will just make the health service a good employer. We have two men in our trust who job-share."

WHAT THE EXPERTS SAY

Dr Maureen Baker, honorary secretary, Royal College of GPs

It is perfectly reasonable to expect that the status of any profession is upheld by its workforce. We must ensure men and women understand they have an equal ability to do their job and know what their profession expects. If a higher ratio of men or women working within a profession is deemed to be reducing its status, there is a problem with the way society views the abilities of the sexes.

Professor James Underwood, President, Royal College of Pathologists

The UK is so desperately short of doctors that we need to open up the professions to as many people as possible. A decline in the medical profession's status is not an inevitable consequence of the "feminisation" to which Carol Black refers. Much more important than a doctor's gender is the effectiveness of their practice, their leadership and their integrity.

John Bangs, the head of education at the National Union of Teachers

I have heard all sorts of rubbish about the feminisation of teaching. The parallel she [Professor Black] drew between the greater inclusion of women in teaching and the profession's supposed declining power is misinformed. What we need to focus on is whether we have enough of a pool from which we can recruit the best teachers, whether that be men or women.

Dr Selena Gray, President, Medical Women's Federation

I'm rather surprised [Professor Black] wants to return to the days of male dominance. Female doctors today are entering a great profession with every opportunity to specialise, but there is the issue of how to keep women in these roles. As the large proportion of female GPs has shown, flexible training and working conditions are of critical importance in this respect.

Ang Langley, mental health nurse

Her comments are a bit rash, especially coming from a woman. Medicine is a career that should be open to anyone, and shouldn't be dominated by white middle-class males. I am against positive discrimination as a solution - success should be based on qualification whether you are male or female. There are opportunities in nursing and across the NHS to achieve a better work-life balance.

Dr George Rae, GP in Whitley Bay, Tyne and Wear

The problem may be that the profession is too dominated by white males at the moment. It is difficult to get to the top of some of the higher career structures but Carol Black herself is an excellent example of how this can be achieved. The profession shouldn't be dominated by either gender. Diversity is what we are looking at for the future, and I think that we have to welcome it.