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Women and medicine THE FUTURE A report prepared on behalf of the Royal College of Physicians by Mary Ann Elston Emeritus Reader in Medical Sociology Department of Health & Social Care Royal Holloway, University of London

June 2009

The Royal College of Physicians The Royal College of Physicians plays a leading role in the delivery of high quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 20,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.

Citation for this document: Elston MA. Women and medicine: the future. London: Royal College of Physicians, 2009.

Copyright All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Copyright © 2009 Royal College of Physicians

ISBN 978-1-86016-361-6 Review date: 2010 ROYAL COLLEGE OF PHYSICIANS OF LONDON 11 St Andrews Place, London NW1 4LE www.rcplondon.ac.uk Registered Charity No 210508 Typeset by Dan-Set Graphics, Telford, Shropshire Printed in Great Britain by The Lavenham Press Ltd, Sudbury, Suffolk ii

Contents

Acknowledgements

vi

Executive summary

vii

Summary of key findings

xii

Abbreviations 1

2

3

xxiii

Introduction to the project

1

The intake to UK medical schools

3

The medical workforce in the NHS in England

3

The UK medical profession: stocks and flows

7

Modernising Medical Careers

9

Re-organising doctors’ days (and nights)

11

The dynamic division of medical labour

13

Research methods

18

Introduction

18

Literature search

18

Official and institutional data sources

19

Information from cohort studies of UK medical graduates

21

Information on medical women’s representation on elite leadership and decision-making bodies

21

Statistical information for international and inter-professional comparisons

22

Seminars and interviews

22

The final report

22

Trends in entry to the profession

23

Introduction

23

Trends in entry to UK medical schools

23

Applications and acceptances for UK medical schools

24

Possible explanations for the higher acceptance rate for female applicants to medical school between 1996 and 2006

25

Variations between medical schools

30

© Royal College of Physicians, 2009. All rights reserved.

iii

Women and medicine

4

5

iv

Gender differences in medical school performance

32

Trends in applications and acceptances to UK medical schools in a wider context

32

Entry qualifications and degree subject choice

33

The declining relative share of male applicants for medicine

34

Summary of recent trends in entry to UK medical schools

35