This week, as part of International Women’s Day, the BMA launches our pledge to end sexism in medicine.

This I can whole-heartedly get behind as a dyed-in-the-wool feminist. Pictures of Elizabeth Garrett Anderson (the first woman registered as a doctor In England) and Eleanora Fleury (the first woman registered as a doctor in Ireland) sit in my office. Fleury went on to work as a psychiatrist, paving the way for me and my colleagues.

As doctors, I imagine we would prefer to think that such a pledge is not needed, but unfortunately, this is not the case.

Ever since I first decided to pursue a career in medicine, I had the support of those around me. I had a family who never doubted I could achieve this goal, and the all-girls school I attended has a proud tradition of inspiring pupils to become strong, ambitious young women.

As an under-graduate, I was perhaps not as aware of sexism within medicine as I am now. During training, and now, working as a consultant, I have witnessed casual, every-day sexism from male colleagues that has caused frustration and disappointment. I have been asked to ‘bring in the tea and coffee’, along with another female colleague, whilst we were both standing beside a male colleague, who was equally capable of doing so.

I’ve been asked ‘is that the women’s job now?’ when I brought chairs into a room to be helpful. I’ve witnessed a consultant colleague address his female foundation doctor colleague as ‘love’.

For the most part, I don’t believe these colleagues were being intentionally sexist, but we all need to do better, in terms of avoiding such casual sexism, and challenging it when it arises (and you can be rest assured, I challenged all the episodes outlined above). 

You don’t just have to take my anecdotal evidence as an indication that we have a problem that needs to be addressed; the BMA’s own report on sexism in medicine reveals that an overwhelming majority of women (91%) had experienced sexism at work in the past two years. Sadly, but probably not unsurprisingly 42% of those who experienced this chose not to raise it with anyone.

The same report revealed that 61% of women felt they were discouraged to work in a particular specialty because of their gender, with 39% going on to not work in that specialty.  At a time when recruitment and retention of staff is becoming an ever-more crucial issue, I am at a loss as to why someone would score the spectacular own goal of putting someone off joining their specialty. 

Whilst the issue of everyday sexism must be addressed, other more troubling issues are highlighted in the report. 56% of women respondents had received unwanted verbal conduct relating to their gender compared to 28% of men respondents and 31% of women respondents experienced unwanted physical conduct in the workplace (as did 23% of male respondents). 

The similar findings of Simon Fleming and Rebecca Fisher in their paper Sexual assault in surgery: a painful truth | The Bulletin of the Royal College of Surgeons of England (rcseng.ac.uk) make for unsettling reading. The Royal College of Surgeons have recognised this and commissioned an independent review into sexism (as well as homophobia and racism) in surgery. A welcome beginning for a much-needed cultural sea-change.

However, there’s no medical specialty that can claim not to have an issue with sexism, and when we look at wider healthcare, the gender pay gap is a clarion call to the need for action. Another 2021 report, Mend the Gap: The Independent Review into the Gender Pay Gap in Medicine, details what this looks like.

Non-adjusted gender pay gap is 24.4% for hospital doctors, 33.5% for GPs and 21.4% for clinical academics. Women are under-represented in the highest paid positions, grades and specialties. Even when accounting for the fact that women are more likely to work less than full time, especially when training, predominantly owing to caring responsibilities, the gap remains. We have some way to go to reach the nirvana suggested by Ruth Bader Ginsburg: ‘Women will have achieved true equality when men share with them the responsibility of bringing up the next generation.’ 

To return to the sexism in medicine report, the finding was that, even for women without children, there was an assumption that women would choose a specialty thought to be compatible with flexible working and family life. We don’t make the same assumptions about men who have caring responsibilities.

My husband and I have five children together; do you want to guess who is asked more frequently ‘Do you work full time?’ (Spoiler – it’s me.)  I’m often asked if I chose psychiatry as it’s deemed to be a specialty that fits around family life well. The answer is no; I chose the specialty because I loved it, and it’s where I knew I would be happy working.

My advice to my younger female colleagues is to choose the specialty that is the right for you professionally. That choice is your right, as it is for your male colleagues. The reality is that very few of us can plan exactly when we might have caring responsibilities, and our employers should be able to accommodate them when they arise.

Increasing numbers of women are choosing to study medicine (FE News | UCAS record: 68% of medical-related degree applicants are female). My hope for these young women is that they will have the same opportunities, the same pay, and the same choice of specialties as their male counterparts will have.

My hope is that by the time these new doctors join our workforce, that sexism will have become as unacceptable as other forms of discrimination, and that the everyday sexism that so many women in medicine currently experience will have become obsolete.

There is no doubt that great progress has been made from the days of Dr Anderson and Dr Fleury, but still, there is so much work to do. A starting point is to acknowledge the issue, to begin to recognise everyday sexism, and to call it out and to challenge it when it arises. To quote Ruth Bader Ginsburg once more: ‘Real change, enduring change, happens one step at a time.’  Take those steps and walk with me.

Dearbhail Lewis is a consultant liaison psychiatrist in the Belfast Trust