BMJ  2008;336 (5 April), doi:10.1136/bmj.39539.593252.47

Editor's Choice

A diverse profession

A few years ago Carol Black, then president of the Royal College of Physicians, caused a media furore by saying that the growing number of women in medicine threatened the profession’s influence and status. As Iona Heath wrote in a BMJ editorial, this was portrayed as an astonishing position for a woman to adopt, with the clear implication that it was antifeminist (BMJ 2004:329:412-3; doi: 10.1136/bmj.329.7463.412). Heath concluded that Black’s concerns were valid because of the continuing unequal status of women in society.

The proportion of women entering medicine continues to grow, and the concerns that seemed unacceptable then, especially when expressed by a woman, continue to rankle. Whether they will be more or less acceptable coming from a man we may now find out. In this week’s Head to Head, Brian McKinstry argues that there are now too many female medical graduates (p 748; doi: 10.1136/bmj.39505.491065.94). His reasons are not about professional status but service delivery. Women are more likely to choose less pressurised disciplines, work part time, take career breaks, and leave medicine early, so how will a disproportionately female workforce deliver the services we need—especially in light of a new study that suggests that senior women doctors are less productive than their male colleagues? (Jenny Firth-Cozens, though, finds the study unconvincing and argues that women win hands down on grounds of integrity (p 731; doi: 10.1136/bmj.39526.359630.BE).)

Jane Dacre replies that although women now outnumber men at entry to medical schools and outperform them in undergraduate and postgraduate exams, they are still underrepresented in the higher echelons of medicine and academia (p 748; doi: 10.1136/bmj.39505.566701.94). She concludes, as Isabel Allen has before her (BMJ 2005;331:569-72; doi: 10.1136/bmj.331.7516.569), that to make the most of this valuable resource, we need more mentoring, more flexible on-site child care, and easily accessible and funded part time training options.

Most people will agree that adequate service delivery is a basic requirement of workforce planning, and that we need to take into account the working patterns of a major sector of the workforce, whether these are from choice or outmoded career structures and lack of social support. And what about the men who would like more chances to work flexibly?

Underlying this debate is a broader question: what sort of medical workforce do we need? The answer goes far beyond gender. The UK government continues to struggle with how to tackle inequalities in health (doi: 10.1136/bmj.39537.828032.C2). It might do worse than find ways to encourage socially disadvantaged children to enter medical school, as Trisha Greenhalgh and colleagues have proposed (BMJ 2004;328:1541; doi: 10.1136/bmj.328.7455.1541). Joan Reede, former dean of diversity and community partnership at Harvard Medical School, said in 2005 that to address healthcare disparities we have to look at workforce diversity: "People prefer discussing sensitive, health related problems with those who reflect their own identities and values."

The wide ranging practice of medicine needs an equally wide ranging array of skills: in communication, risk taking, technical ability, management, and leadership. We also need a profession that represents patients’ social, ethnic, age, and gender mix. Medicine can wait for the change towards a more equitable and diverse society, or it can lead that change.

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