Being a dutiful parent of a budding sociologist, I have been broadening my mind. My reading has included Women and Power: a Manifesto by Mary Beard.¹ She quotes an exchange between Telemachus and Penelope from Homer’s The Odyssey, where he says ‘Mother, go back up into your quarters and take up your own work, the loom and distaff … speech will be the business of men, all men, and of me most of all; for mine is the power in this household.’ Beard then describes how women have been battling this context ever since.

Darwin doesn’t seem to be much more enlightened. In The Descent of Man, he writes ‘The chief distinction in the intellectual powers of the two sexes is shewn by man attaining to a higher eminence, in whatever he takes up, than can woman – whether requiring deep thought, reason, or imagination, or merely the use of the senses and the hands.’²

THE PICTURE IN THE NHS

So, where are we now? Unlike Homer’s Penelope, I leave my quarters on a daily basis. Indeed, women make up 77% of the NHS workforce. In the specialty of diabetes and endocrinology in 2017, 53% of higher specialist trainees were female, and 34% of consultants.³ In contrast, in NHS England, 85% of national clinical directors are male – a severe case of ‘He-Ja-Vu’ maybe? (A term describing the situation where a white male leader is replaced by another white male leader followed by another white male leader, and so on.⁴)

THE SITUATION IN ACADEMIA

Academia looks even less balanced. Data from higher education institutions in 2018 show 54% of staff in higher education are female. For science, engineering and technology, 20.7% of professors are female, and across higher education 31% of senior managers are female.⁵ At the University of Cambridge, 17% of professors are female, 9% of Fellows of the Royal Society are female and 3% of Nobel Laureates are female (12 for physiology or medicine and 3 for physics).

Life in the lab doesn’t lend itself to career breaks for raising a family. Listen to a wonderful conversation between Professor Dame Jocelyn Bell Burnell and Professor Dame Athene Donald on this subject, that is both inspiring and depressing in equal measure.⁶

The Wellcome Trust and MRC are very transparent about their data (available from www.wellcome.ac.uk and www.mrc.ukri.org). Among Wellcome Trust-funded senior lectures, 44% are female, whilst 16% of funded professors are female. The MRC shows data concerning grant recipients (Table). Females have a good chance of success when they apply, but they are not applying at senior levels.

It seems the higher you go, the more women are discriminated against, or absent.

IN A LEARNED SOCIETY

Closer to home, the Society for Endocrinology membership is 1416 male, 1139 female. Whilst the data must be viewed with caution as the following categories are broad, and the information is infrequently updated, there are some interesting headline figures. Junior endocrinologists are predominantly female: fellows (postdoc or research) are 56% female and 61% of student members are female. Clinical practitioners are 37% female, basic researchers 39% female, and clinical researchers 37% female, whilst 19% of retired endocrinologist are female. This gives the impression of a changing workforce, which is not a new finding, and it will be interesting to see how the landscape looks in 10–20 years’ time.

CONFERENCE DELEGATES

The highlight of the endocrine year is our Society for Endocrinology BES conference. In 2018, invited speakers (medal winners (plenary speakers) and those chosen by Programme Committee) were 44% female. Of those invited, 26 declined the invitation, but interestingly those declining comprised 15 males and 9 females. Invite us and we will come!

Overall, the whole programme was 47.5% female. Several categories stood out:

• plenary speakers were 7 male:3 female
• basic science/translational symposia 17 male:4 female
• oral communications (clinical) 9 male:15 female.

Whilst we can’t draw too many conclusions, there were occasional ‘manels’ (a panel of speakers populated entirely by men⁴), and the predominance of junior female basic scientists in the membership is not yet being represented in the programme, whereas the same doesn’t seem to be true for clinicians. The plenary lectures showed a male gender preponderance. The 2017 programme also had 7 male:3 female plenary speakers, while in 2016 the ratio was 9 male:1 female plenary speakers (of the 7 plenary lectures organised by the Society Nominations Committee in 2017, 3 were delivered by women). These data are in line with what others have described; there is an implicit bias that works against women being invited as a keynote or guest speaker at meetings. They are consequently less likely to share research findings, they have lower visibility and are less likely thereafter to be nominated for awards. Is it time to ensure our prominent roles show more gender balance, or are these data reflecting the lack of change in gender equality currently at the top of academia?

THE GENDER PAY GAP

Another area of concern has been the gender pay gap. The mean pay gap across the NHS in 2017 was 21.2%. However, for Clinical Excellence Awards (the means by which more senior clinicians get a bonus), the mean gender pay gap was 51.4% – so, for those awarded bonuses, the mean salary of male consultants was 51.4% higher than that of female consultants.

Some institutions have a minimal gender pay gap. That of Lancashire Teaching Hospitals is 0.1%, whereas Health Education England (HEE) has the highest at 52.5% (both median).⁷

The gender pay gap across an organisation may partly reflect that there are more women in administrative roles (for example), which are not so well paid as senior roles. It is likely the HEE data reflect this.

Care needs to be taken when interpreting gender pay gap data. The data do not necessarily differentiate whether an individual is paid less for the same role, for the same number of years of service. Also, whilst mean data show the difference between male and female pay, they can be skewed if there are small numbers of very large payments.

WHY DOES THE PAY GAP EXIST?

Some have tried to look at reasons for the gender pay gap. Roy describes American data from clinicians which suggest a gender pay gap of $100,000 in salary between men and women:⁸

• $40,000 was considered attributable to practice characteristics
• $13,000 was linked to choice of specialty
• $12,000 was associated with hours worked
• about 30% of the disparity remained unexplained.

This notes that there are cultural influences and biases deterring women from entering some specialties. Women generally spend more time on unpaid caring responsibilities, creating a double burden of work. There are societal expectations, and medical and academic cultures, affecting career choices and progression.⁹ And there are career consequences of hitting the ‘maternal wall’.¹⁰ There is certainly a loss of earnings associated with part time or flexible working, and not just in medicine.

Claudia Goldin, Professor of Economics at Harvard University, Cambridge, MA, USA, has extensively researched the gender pay gap and writes that it doesn’t mean that females get paid less for the same roles as males. Some of the gap is due to flexibility in working patterns.¹¹ She suggests part of the answer is to make careers adaptable and flexible, having teams that can deliver work where possible, to reduce dependence on a single person. Interestingly, in the USA, pharmacy has the lowest gender pay gap of all professions. What can we learn from pharmacy?

ENSURING FUTURE PROGRESS

Clearly there is much still to do to achieve gender equality, and I haven’t touched on power issues within a male-dominated workforce, including harassment or outright sexist behaviour. However, we should acknowledge that we have come a long way. We have some wonderful successful female role models across academia and clinical medicine in endocrinology. In 2017, there were eight female Presidents of Royal Colleges (elected), the Chief Medical Officers of NHS England and Scotland are both female,¹² and Professor Dame Jane Dacre is leading a review into the gender pay gap workforce, which will hopefully shed more light on why there is such a discrepancy and how it can be lessened.

And whilst we have concerns about gender balance in medicine and academia, we need to remember that, in education as a whole, working class white males are the smallest demographic going on to study A levels.¹³ Feminism is the belief in the social, economic and political equality of the sexes, and we should aim for gender equality across all of society.

Helen L Simpson, Consultant Endocrinologist, Department of Diabetes and Endocrinology, UCLH NHS Foundation Trust, London

REFERENCES

1. Beard M 2017 Women and Power: a Manifesto London: Profile Books.
2. Saini A 2017 Inferior: how Science got Women Wrong – and the New Research that’s Rewriting the Story London: Fourth Estate.
3. RCP 2018 Focus on Physicians: 2017–18 Census www.rcplondon.ac.uk/projects/outputs/focus-physicians-2017-18-census-uk-consultants-and-higher-specialty-trainees.
4. Choo EK & DeMayo RF 2018 BMJ 363 k5218.
5. Advance HE 2018 Equality in Higher Education: Staff Statistical Report www.advance-he.ac.uk/resources/2018_HE-stats-report-staff.pdf.
6. Donald A & Bell Burnell J 2018 Give Me Inspiration! The Paradigm Shift http://www.youtube.com/watch?v=C44XKTHEwE0?v=C44XKTHEwE0.
7. NHS Improvement 2018 Gender Pay Gap Report: 2016 to 2017 https://improvement.nhs.uk/documents/2600/gender_pay_gap_report_201617.pdf.
8. Roy B 2018 Journal of General Internal Medicine 33 1413–1414.
9. Garrett L 2018 BMJ 363 k5232.
10. Lovett K 2018 BMJ 363 k5029.
11. Goldin C 2015 The Milken Institute Review https://assets1c.milkeninstitute.org/assets/Publication/MIReview/PDF/24-33-MR67.pdf.
12. Gulland A 2017 BMJ 358 j3250.
13. Sutton Trust 2015 White Working Class Boys from Poor Neighbourhoods Unlikely to do A-Levels www.suttontrust.com/newsarchive/white-working-class-boys-from-poor-neighbourhoods-unlikely-to-do-a-levels.
14. MRC 2018 Success Rates https://mrc.ukri.org/research/funded-research/success-rates.