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Women remain under-represented in cardiology, with reports of only up to 10%–15% women working at senior level in clinical cardiology, with little evidence of change,1 and there is now a focus on improving the gender balance. This is an important goal in a world where equality between men and women has become a marker of a progressive society. Other specialties, like geriatrics and palliative medicine, have a larger percentage of female doctors, and although each specialty has its own specific attributes this has shown that gender equality is possible in medical specialties.
A short history of women in medicine in Britain
Women have come a long way, however, since medicine became recognised as a profession. Healthcare began in the home, with women traditionally caring for the sick and the family. With the creation of the Medical Royal Colleges in the UK, medicine changed and became professionalised, and at the same time being a doctor became a role for men. The Royal College of Physicians of London was the first Medical Royal College in England. It was given its Royal Charter by Henry VIII in 1518, as a result of the work of Thomas Linacre. It became a men-only organisation from then until the first woman, Helen Mackay, was admitted as a Fellow in 1934.2 The first female president was Professor Dame Margaret Turner Warwick in 1989. There have been only three female presidents in the Royal College of Physicians’ 500-year history (figure 1).
Women have been working in medicine for around 100 years now, in spite of some early opposition to women playing a more prominent role in the society. In the 1870s, the antisuffrage movement had concerns expressed in their publications that menstruation made women too weak for higher education and that it may risk their reproductive capacity.3 Some early female pioneers questioned the status quo, and led to women eventually being accepted into medical schools. The most well known of these in the UK was Elizabeth Garrett Anderson (1836–1917). She trained at the Middlesex Hospital, but was asked to leave. She passed the exam for the Society of Apothecaries (it was a written examination, so they were not aware she was a woman). In 1874, she led the establishment of the London School of Medicine for Women, along with her colleague, Sophia Jex Blake. Sophia Jex Blake had failed to get into Harvard. She trained in Edinburgh but did not graduate, and was eventually licensed in Berne and Dublin. She helped to set up the London School with her friend Elizabeth Garrett Anderson, and also set up the Edinburgh School of Medicine for Women (This Vexed Question4). Perhaps the most unusual of these pioneers was James (Miranda) Barry. She graduated from Edinburgh in 1812. She joined the army and became the surgeon general, but it was only after her death that it was discovered that she was a woman.5
Women in medicine today
Women in medicine today are increasing in numbers. They were predicted to become the majority of the profession in 2017/2018 in the UK. They are changing the face of medicine, as they chose to work in a different range of specialties and are increasingly working part-time. They are more likely to choose to work in areas that have plannable hours, and less reliance on technical skill and more on the caring side of medicine.6 The female intake into medical school has risen, and in the UK now outnumbers men with a ratio of approximately 60:40. Women are, however, still under-represented at the top of the profession. Reactions to this in the media have been interesting, with concerns expressed about the profession becoming at risk of being less powerful politically.7 Cardiology and academic medicine are lagging behind other specialties, with lower numbers of women, although efforts are being made to address this.
Issues have been raised about unconscious bias against women, but this is set against the view that women are different, and may not be interested in the top jobs and are reluctant to put themselves forward.8
The gender pay gap in medicine
Most recently, the focus has been on the existence of a gender pay gap for women in medicine. The National Health Service data show a 15% gender pay gap between men and women in medicine. This is a large discrepancy for a single profession. In England, the Department of Health and Social Care has commissioned an independent review to characterise this pay gap and to make recommendations to work towards eliminating it. The review will report in the Spring of 2019.
Women have come a long way in medicine, but true equality has not been achieved yet. Recognition that a problem exists is the first step towards resolving it. Cardiology is one of the specialties with the smallest number of women, but, with other specialties, is making some progress. Although it may feel slow, remembering that women have only been working as doctors for a century may bring some hope for the future.
Competing interests None declared.
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Provenance and peer review Commissioned; internally peer reviewed.