The feminisation of the medical profession in England: implications and responses

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Abstract

This thesis aims to understand the implications of, and responses to, the recent feminisation of the medical profession in England, through exploring the changes in the employment and careers of doctors and their relationship, if any, to this change of the workforce. Four main contextual issues are evident that are unique to the medical profession. First, there is gender segregation across medical specialties. Second, medicine is traditionally seen as an elite status profession within society. Third, the profession is characterised by long working hours and a high number of years dedicated to training. Fourth, the profession is largely under the monopsony of the NHS, thus bound to the public sector during a period of economic austerity. Moreover, unexpectedly prior to conducting the research, the state’s changes to the junior doctors’ contract led to industrial action, thus adding another dynamic to the research context. The thesis seeks to explore these four key areas within a feminising profession, addressing four questions: 1) what shapes gender segregation, and is it becoming further entrenched following feminisation; 2) has the profession experienced devaluation following feminisation; 3) how do long working hours shape the employment experiences of doctors; and 4) how do the roles of the state play a part in shaping the employment experiences of doctors? The research addresses the overarching research aim and questions through analysing the employment experiences of doctors from anaesthetics, general practice and paediatrics across three key points of the medical career trajectory. The research takes a simple mixed methods approach by employing a questionnaire, in-depth semi-structured interviews, and content analysis of secondary data. To ensure the views of a wide range of actors are included, the research sample includes specialty trainees, consultants, salaried GPs, GP Partners, Training Programme Directors, BMA and Royal College Officials and a Practice Manager. The findings show there are gendered reasons for medical specialty choices, and also reveal that there is evidence to suggest potential devaluation of the medical profession, although it is too early to see the full extent of this. The extreme model of working time in medicine greatly influences the employment experiences of doctors, in terms of their career choices; work-life-balance; and pay. Finally, it appears largely the role(s) of the state, through its interventions (and lack of) further entrench gender segregation; contribute to possible devaluation; and exacerbates the employment experiences of doctors. The research findings contribute to four areas of discussion. First, it appears the roles of the state (through the availability of LTFT training) and Royal Colleges (through training programme organisation) are creating ‘diversionary pathways’ that lead women to medical specialties that are perceived as being more conducive to family life, which leads to a new theoretical framework to help explain horizontal gender segregation within medicine. Second, the suggestion of devaluation has been largely driven by the state, particularly through proposed changes to the junior doctors’ contract. Thirdly, the medical profession is an example of hybrid model of results-based and standard working time that creates an extreme male breadwinner model of working time. Fourthly, the research brings to the fore the importance of the role of the state as the deliverer of a public service. The research also provides potential employment policy recommendations within these areas, and directions for future research of other medical specialties and feminising professions.

Keyword(s)

feminisation; feminisation of professions; gender and employment; medical careers; roles of the state; state as the employer; women and professions; working time

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