Erin Dean asks why the glass ceiling has yet to be cracked, even for women in such a highly paid profession.
On one particularly busy day crammed with clinics and theatre time, Scarlett McNally remembered that she was doing more work than she was being paid for.
‘I was doing clinics and had a full operating list. It was very busy and I didn’t have time to think,’ says McNally, a consultant orthopaedic surgeon in East Sussex. ‘I knew I was doing all the same hours but some other surgeons were paid a session more at that time. That day I just picked up the phone to the medical director, as it had to change.’
Discussions with the department’s managers had not got McNally anywhere before. Yet within a day of her chat with the medical director, she was receiving the pay she should.
She had to go right to the top to sort out that problem a number of years ago, and she says it can be a difficult step to take. ‘If I hadn’t done anything I would have continued to be paid less and I had to demand that it was reviewed and that is a difficult position to put yourself in,’ she says. ‘It can become quite personal between colleagues, and people have long memories.’
Although female doctors naturally have to go through the same education and rigorous training as their male colleagues, they generally will earn considerably less during their careers.
And this gap, instead of narrowing, appears to be getting worse. According to the Office for National Statistics, in 2004 male doctors earned 21% more than their female colleagues, but by 2015 they earned 41% more.
Although figures for the pay gap in surgery in the UK are relatively scarce, a 2009 BMA report suggests it is about 20%. The Pay Gap for Women in Medicine and Academic Medicine, which used detailed data from more than 1,160 doctors, found that the average male surgeon earned £92,250, whereas the women earned £73,482. The highest reported pay gap was in paediatrics, with a 38% gap, followed by ophthalmology (30%) and obstetrics and gynaecology (28%). The data included income from clinical excellence awards.
This report also showed that even when all the factors that are believed to make a difference are taken into account – such as breaks for maternity leave, being less likely to hold high-profile posts, and having fewer years of experience – this still doesn’t account for all the pay gap. The causes of up to 50% of the pay gap for female trainees – and 40% for female consultants – is unknown.
There are a number of factors contributing to the gender pay gap in surgery, Scarlett McNally says.
Although the number of women in the specialty is increasing, the number who are in the best-paid consultant positions is still low. In 2014, 11% of surgical consultants were women, according to the Health and Social Care Information Centre (HSCIC).
Women are also enjoying fewer of the extra payments that consultants can enjoy. There are 12 levels of clinical excellence awards in England, and a declining number of women are applying for the highest, according to the latest figures from the Advisory Committee on Clinical Excellence Awards (ACCEA) in England and Wales.
In 2011, 386 women applied for the four highest national awards – bronze, silver, gold and platinum – compared with 297 in 2014. In 2014, 1,242 male consultants applied. Figures are not kept on what proportion went to female surgeons, according to ACCEA. The awards are worth between almost £3,000 and more than £75,000 per year
McNally says that there are more women in specialties that are less well paid. Research into the income of consultants in 2003/04 found that the best-paid surgeons when NHS and private income was combined were plastic surgeons, with an annual income of more than £217,000.1 Plastics was followed by trauma and orthopaedics at almost £178,000, and neurosurgeons at £158,000, and then general surgeons at £128,000. The list, which did not include all specialties, had paediatric surgeons earning less than half the average for plastic surgeons at £94,000.
Average amounts paid just for NHS work also varied according to specialty, the study found. Cardiothoracic, general, and neurosurgeons were the three highest earners from the NHS, followed by paediatric surgery.
Paediatric surgery has the highest percentage of female consultants – at 26% – according to information from HSCIC in 2014. Trauma and orthopaedics has the lowest at 5%, with neurosurgery close behind at 7%. The second-highest proportion of female consultants can be found in plastics, but they still only make up 17% of this consultant workforce
‘I have been looking into this for more than 20 years. It was said at one time that women don’t want to go into these specialties, they want to be at home,’ Scarlett McNally says. ‘But we now have 31% of surgical trainees who are women, so that proves that some women do want to do it. So whether they used to choose specialties that don’t tend to come with higher earnings, or whether they were almost encouraged away, is not clear.’
‘There are national terms and conditions so we ought to be earning the same, but it is a bit more subtle. One factor is women being encouraged away from the highest-paid specialties, and the other is a lack of confidence to demand good salaries when they start a job… and then demand a job pay review when they are in a job.’
Many of the higher-paid specialties, such as general and neurosurgery, also have high on-call commitments, which women with young children may find more difficult as they are expected to find suitable childcare.
Access to more and better flexible training needs to be improved, female surgeons say. Undertaking maternity leave and part-time working can be difficult to arrange for junior surgeons, and it has a lasting impact on their pay. Ciara McGoldrick, an ST8 plastic surgeon, says that she has been in contact with many female juniors struggling to find a way to balance training with maternity leave and less than full-time working. Paediatric and plastic surgery, with the highest proportion of women, have tended to provide the most options, she says. Funding that supported supernumerary part-time training across different branches of medicine has disappeared now, making the situation even tougher.
‘Across the UK there has been a huge variation in what has been offered in training at less than full-time,’ she says. ‘I went to 80% in a full-time slot and the service absorbed the difference, creating a solution that can work well for surgeons happy to work a higher percentage. This is the route I would recommend, although it isn’t easy, as I was working 80% of a 60-hour week. But if you want to work less than that it can be very difficult. Deaneries are putting on a lot of pressure for women to job-share, but finding another woman in the same specialty and the same level of seniority wanting a job-share at the same time is not easy. Some women don’t want to work half-time as it is a huge drop in salary and doubles the length of training, but they may not have any other option.’
Each time the surgeon moves, they will need to renegotiate the working arrangements with their new employer and firm, which can be a stressful and arduous process.
Less than full-time training affects pay in a number of ways. It means that trainees can’t take on extra shifts, which offer more money and experience, the way full-time colleagues generally do. Inevitably they spend much longer training, whereas other colleagues progress swiftly to higher-paid consultant posts.
‘Working less than full-time definitely leads to a hit in pay,’ explains Ciara McGoldrick, who is a fellow in oncoplastic breast reconstruction at the St Andrew's Centre in Chelmsford. ‘When trainees who have worked less than full-time become consultants, they should start at a higher pay point to take into account the extra time they have spent training. It is enshrined in European law to protect women in this situation, but it doesn’t always happen.’
Once a woman has sorted precious flexible working arrangements, they can be fearful to demand the pay they deserve. ‘It is still seen almost as a favour to be able to work less than full-time,’ McNally says. ‘Having finally got a placement or job, she doesn’t want to say “I am entitled to this or that”.’
Scarlett McNally believes units that are allocated less than full-time trainees in craft specialties should receive extra funding to smooth out any difficulties or rota gaps that may occur.
Jemima Olchawski, Head of Policy and Insight at the Fawcett Society, which campaigns for equal pay, says that women who realise they are earning less than their male colleagues may be able to make a legal equal pay claim.
‘You can begin the legal process to redress it and claim the pay that you are entitled to,’ she says. ‘But more often it is the case that women just aren’t at the same level and that is much harder to deal with. This isn’t an issue for women to deal with individually, it is something we need to address collectively, with more flexible roles and stronger regulation.’
Volume: 99 Issue: 1, January 2017, pp. 12-14
DOI: http://dx.doi.org/10.1308/rcsbull.2017.12
Published online: December 24, 2016
On one particularly busy day crammed with clinics and theatre time, Scarlett McNally remembered that she was doing more work than she was being paid for.
‘I was doing clinics and had a full operating list. It was very busy and I didn’t have time to think,’ says McNally, a consultant orthopaedic surgeon in East Sussex. ‘I knew I was doing all the same hours but some other surgeons were paid a session more at that time. That day I just picked up the phone to the medical director, as it had to change.’
Discussions with the department’s managers had not got McNally anywhere before. Yet within a day of her chat with the medical director, she was receiving the pay she should.
She had to go right to the top to sort out that problem a number of years ago, and she says it can be a difficult step to take. ‘If I hadn’t done anything I would have continued to be paid less and I had to demand that it was reviewed and that is a difficult position to put yourself in,’ she says. ‘It can become quite personal between colleagues, and people have long memories.’
Although female doctors naturally have to go through the same education and rigorous training as their male colleagues, they generally will earn considerably less during their careers.
And this gap, instead of narrowing, appears to be getting worse. According to the Office for National Statistics, in 2004 male doctors earned 21% more than their female colleagues, but by 2015 they earned 41% more.
Although figures for the pay gap in surgery in the UK are relatively scarce, a 2009 BMA report suggests it is about 20%. The Pay Gap for Women in Medicine and Academic Medicine, which used detailed data from more than 1,160 doctors, found that the average male surgeon earned £92,250, whereas the women earned £73,482. The highest reported pay gap was in paediatrics, with a 38% gap, followed by ophthalmology (30%) and obstetrics and gynaecology (28%). The data included income from clinical excellence awards.
This report also showed that even when all the factors that are believed to make a difference are taken into account – such as breaks for maternity leave, being less likely to hold high-profile posts, and having fewer years of experience – this still doesn’t account for all the pay gap. The causes of up to 50% of the pay gap for female trainees – and 40% for female consultants – is unknown.
There are a number of factors contributing to the gender pay gap in surgery, Scarlett McNally says.
Although the number of women in the specialty is increasing, the number who are in the best-paid consultant positions is still low. In 2014, 11% of surgical consultants were women, according to the Health and Social Care Information Centre (HSCIC).
Women are also enjoying fewer of the extra payments that consultants can enjoy. There are 12 levels of clinical excellence awards in England, and a declining number of women are applying for the highest, according to the latest figures from the Advisory Committee on Clinical Excellence Awards (ACCEA) in England and Wales.
In 2011, 386 women applied for the four highest national awards – bronze, silver, gold and platinum – compared with 297 in 2014. In 2014, 1,242 male consultants applied. Figures are not kept on what proportion went to female surgeons, according to ACCEA. The awards are worth between almost £3,000 and more than £75,000 per year
McNally says that there are more women in specialties that are less well paid. Research into the income of consultants in 2003/04 found that the best-paid surgeons when NHS and private income was combined were plastic surgeons, with an annual income of more than £217,000.1 Plastics was followed by trauma and orthopaedics at almost £178,000, and neurosurgeons at £158,000, and then general surgeons at £128,000. The list, which did not include all specialties, had paediatric surgeons earning less than half the average for plastic surgeons at £94,000.
Average amounts paid just for NHS work also varied according to specialty, the study found. Cardiothoracic, general, and neurosurgeons were the three highest earners from the NHS, followed by paediatric surgery.
Paediatric surgery has the highest percentage of female consultants – at 26% – according to information from HSCIC in 2014. Trauma and orthopaedics has the lowest at 5%, with neurosurgery close behind at 7%. The second-highest proportion of female consultants can be found in plastics, but they still only make up 17% of this consultant workforce
‘I have been looking into this for more than 20 years. It was said at one time that women don’t want to go into these specialties, they want to be at home,’ Scarlett McNally says. ‘But we now have 31% of surgical trainees who are women, so that proves that some women do want to do it. So whether they used to choose specialties that don’t tend to come with higher earnings, or whether they were almost encouraged away, is not clear.’
‘There are national terms and conditions so we ought to be earning the same, but it is a bit more subtle. One factor is women being encouraged away from the highest-paid specialties, and the other is a lack of confidence to demand good salaries when they start a job… and then demand a job pay review when they are in a job.’
Many of the higher-paid specialties, such as general and neurosurgery, also have high on-call commitments, which women with young children may find more difficult as they are expected to find suitable childcare.
Access to more and better flexible training needs to be improved, female surgeons say. Undertaking maternity leave and part-time working can be difficult to arrange for junior surgeons, and it has a lasting impact on their pay. Ciara McGoldrick, an ST8 plastic surgeon, says that she has been in contact with many female juniors struggling to find a way to balance training with maternity leave and less than full-time working. Paediatric and plastic surgery, with the highest proportion of women, have tended to provide the most options, she says. Funding that supported supernumerary part-time training across different branches of medicine has disappeared now, making the situation even tougher.
‘Across the UK there has been a huge variation in what has been offered in training at less than full-time,’ she says. ‘I went to 80% in a full-time slot and the service absorbed the difference, creating a solution that can work well for surgeons happy to work a higher percentage. This is the route I would recommend, although it isn’t easy, as I was working 80% of a 60-hour week. But if you want to work less than that it can be very difficult. Deaneries are putting on a lot of pressure for women to job-share, but finding another woman in the same specialty and the same level of seniority wanting a job-share at the same time is not easy. Some women don’t want to work half-time as it is a huge drop in salary and doubles the length of training, but they may not have any other option.’
Each time the surgeon moves, they will need to renegotiate the working arrangements with their new employer and firm, which can be a stressful and arduous process.
Less than full-time training affects pay in a number of ways. It means that trainees can’t take on extra shifts, which offer more money and experience, the way full-time colleagues generally do. Inevitably they spend much longer training, whereas other colleagues progress swiftly to higher-paid consultant posts.
‘Working less than full-time definitely leads to a hit in pay,’ explains Ciara McGoldrick, who is a fellow in oncoplastic breast reconstruction at the St Andrew's Centre in Chelmsford. ‘When trainees who have worked less than full-time become consultants, they should start at a higher pay point to take into account the extra time they have spent training. It is enshrined in European law to protect women in this situation, but it doesn’t always happen.’
Once a woman has sorted precious flexible working arrangements, they can be fearful to demand the pay they deserve. ‘It is still seen almost as a favour to be able to work less than full-time,’ McNally says. ‘Having finally got a placement or job, she doesn’t want to say “I am entitled to this or that”.’
Scarlett McNally believes units that are allocated less than full-time trainees in craft specialties should receive extra funding to smooth out any difficulties or rota gaps that may occur.
Jemima Olchawski, Head of Policy and Insight at the Fawcett Society, which campaigns for equal pay, says that women who realise they are earning less than their male colleagues may be able to make a legal equal pay claim.
‘You can begin the legal process to redress it and claim the pay that you are entitled to,’ she says. ‘But more often it is the case that women just aren’t at the same level and that is much harder to deal with. This isn’t an issue for women to deal with individually, it is something we need to address collectively, with more flexible roles and stronger regulation.’
Volume: 99 Issue: 1, January 2017, pp. 12-14
DOI: http://dx.doi.org/10.1308/rcsbull.2017.12
Published online: December 24, 2016