270
Hospital
Practice
HOSPITAL DOCTORS’ CAREER STRUCTURE AND MISUSE OF MEDICAL WOMANPOWER
Summerskill, Under Secretary of State at the Home Office, to describe British women as " that unique thing, an oppressed majority".3 The composition of the policy or decision making bodies within the medical profession is biased towards men (table i). CAREERS
THOMAS H. BEWLEY Medicine and Psychiatry, Departments of Community St. Thomas’ Hospital and Medical School, London SE1
BEULAH R. BEWLEY
Summary Biological
and cultural differences beand women lead to severe discrimination against women doctors who bear the burdens of pregnancy, child-rearing, and housework. These lead, from equality within medical school and at qualification, to increasing failure to obtain posts commensurate with their innate abilities. Women doctors who temporarily and partially drop out of full-time practice have been studied frequently, but men (who are equally expensive to train) have not, despite their disappearing from National Health Service practice tween men
through emigration, death, alcoholism, suicide,
or
removal from the Medical Register. In a working lifetime of forty years, a woman doctor with an average family is likely to do seven-eighths of the work of a doctor who has not had to carry the primary responsibility of bearing and rearing children. Doctors with dependants are handicapped, and a separate career structure might be set up for them. Supernumerary consultant posts are proposed.
OF
WOMEN
DOCTORS
Stanley and Last4 showed that more women medical students completed the undergraduate course without failing any examinations, and fewer failed on two or more occasions. But, after qualifying, only 30% of women compared with 42 % of men acquired additional qualifications. Hospital posts show a steady decline in the proportion of women doctors through all levels (table 11). It is very much harder for women to obtain consultant posts, and more of them end in medical-assistant (or clinical-assistant) posts. In academic medicine less than 1% of professors are women. Fewer women than men are unrestricted principals in general practice (table n). In community medicine the Department of Health estimates that 417 men and 129 women are in posts as specialists. The figures for other posts were not available, but, as Flynn and Gardner found,6 a large number of women doctors have always worked in public health, and there is little doubt that they are over-represented in the subconsultant grades. The British Medical Journalhas TABLE I-NUMBER OF MEN AND WOMEN ON COLLEGE COUNCILS AND CENTRAL POLICY COMMITTEES
INTRODUCTION
"rejoice at the thought that it should be made abundantly clear that husbands and wives come to the judgement seat on matters of money and property upon the basis of complete equality.... Complete equality requires an equal division of the assets." -Lord Justice SCARMAN.1 IT is a curious fact that as one travels eastwards from the United States there is a steady increase in the proportion of women in the medical profession-8 % in the U.S.A., 17% in England and Wales, 40% in Czechoslovakia, 48% in Poland, and 72% in the U.S.S.R.2 In England the number of women being admitted to medical school is increasing by about 1 % annually, and in the 1980s it is likely that 50% of medical-school places will be taken by women. Although at medical-school entry intelligence, ability, dedication, and perseverance are distributed equally between the sexes, postgraduate experience differs, and when doctors appear before a consultant appointments committee equal opportunity does not exist. Far fewer women obtain career posts appropriate to their abilities, either because of the handicaps of pregnancy, child-rearing, and unequal distribution of housework and family responsibility between the sexes, or because of discrimination in selection for
TABLE II-PROPORTION OF WOMEN IN HOSPITAL POSTS AND GENERAL PRACTICE: ENGLAND AND WALES
posts. The
opportunities are similarly unequal in other professions because of the same handicaps, probably more from the passive effects of tradition than from positive discrimination. Only 4% of M.p.s are women, and even in social work-a profession by tradition predominantly female-only 15 of Britain’s 172 directors of social services are women. This led Dr Shirley
Source: D.H.S.S.17.18
271 in some regions, notably Oxfordand the South-West Metropolitan,9 showed that a more flexible and imaginative approach by administrators could appreciably augment the contribution by women doctors.
Experience
discussed the economic argument commonly advanced medicine. against increasing cost of a estimated doctor was between The producing and in S15.000 (E28,000 1975), most of which tl0,000 was borne by the taxpayer. The editorial stated that over the past few years it had been accepted that about 25 % of women doctors under the age of 65 were not working in medicine, compared with a figure of 3 % for men. The selection bias against women entering medicine has almost disappeared, and the B.M.y. editorial speculated that the better examination results obtained by women might cease when the abolition of discrimination at entry meant that the previously more academically able women were diluted by students of equivalent calibre to the men. Flynn and Gardnershowed that the work record of single women doctors was very good in that 90% of them remained in continuous full-time employment and virtually all the remaining 10% worked in medicine, though less than full-time. In their sample the work performance of married women doctors fell sharply after marriage even when there were no children. Only 65% of the married doctors worked full-time and 10 % gave up medicine for a time. Of those with preschool children, only 20% worked fulltime and nearly 30 % gave up practising, but once the children were at school over 25 % worked full-time and a further 55% worked part-time. They estimated that 85-90 % of women graduates were likely to marry, and their sample showed a peak in marriages taking place in the year of graduation. Married women doctors without children worked less than their single colleagues, which highlights an inbuilt sex discrimination when both partners are working. There is often a conflict between their separate careers, and one of them has to put remaining together before their own career choice. It is traditional for the wife to make this sacrifice. the entry of
women to
Marriage, Child-bearing,
and Child-rearing A woman who has children will spend some time off work during pregnancy and it is likely that for some years she will spend more time than her husband looking after children. For 5-10 years of her profesIn a sional life she is likely to work part-time. if even a works lifetime of 40 person working years, half-time for 10 years they will have done seveneighths of the work of someone who has not taken Because it occurs in the early postany time off. this graduate years relatively small difference handicaps most women doctors for the rest of their working lives. It denies them the opportunity to compete on equal terms for the most responsible posts and limits their
professional opportunities. A successful career for a woman depends more on chance than for a man. For example, if she is married to someone forced to move as regularly as an Army officer it will be more difficult for her to aspire to independent consultant status. If married to another doctor there will be some regular contact with journals and other colleagues, and it may also be easier for careers to be planned jointly. Lawrie and her colleaguesfound that possession of a postgraduate qualification and living in a large town exerted a favourable influence on the careers of women doctors,
heavily
in Society In the past 100 years there have been changes in women’s role in society with a gradual move towards equality between the sexes. However, Oakley’s surveys 10,11 show that nearly all women, whatever their position in society, were housewives. Marriage and housewifery were basic impediments to occupational sex equality, steering women into low-status poorly paid jobs. Every woman in Oakley’s survey spent a lot of time doing housework. Her hour-by-hour breakdown of household tasks dispelled the myth that the old division of labour is breaking down and that today’s husbands take an equal share in the household tasks. Even when the wife had a full-time job the responsibility for running the house and caring for the children It would be unrealistic to suggest remained hers. radical changes to speed the equalisation programme, and it is likely that in the foreseeable future most married women will continue with the same handicaps as at present.
Changes
I
COMPARISON WITH MALE DOCTORS
When studying the work of women doctors it might be informative to compare this with that of male doctors rather than a theoretical concept. Many women work less because of pregnancy and child-rearing, but some men work less because of illness and death, and some hardly contribute to the N.H.S. at all because of emigration. Deaths among male doctors below the age of 65 from coronary thrombosis and alcoholism, among other causes, are higher. Occupational mortality data for married women are " categorised " by their husband’s occupation so we do not know the death-rates of women A review of a year’s obituaries (304) in the doctors. British Medical Journal showed that 87 men and 7 women below the age of sixty-five and 189 men and 21 women aged sixty-five or over died. One might surmise that male doctors are more likely to die before the age of sixty-five and women doctors are less likely to have a career meriting
more
,
an
obituary.
Biological Differences J. P. Mahaffy, a former provost of Trinity College when asked by those anxious to arrange for Dublin, admission of women to the university whether he could think of any essential differences between the sexes, reputed to have replied " Madam, I cannot conceive ". There are biological differences between males and females which may lead members of either sex to function less well at various times in their career. Dalton 12 has pointed out that women’s moods, temperaments, abilities, and levels of functioning may be affected by their menstrual cycles. She showed that women were more likely to be admitted to mental hospitals, to commit crimes, to do badly in exams, and to have a higher rate of minor sickness during the premenstrual and menstrual period. Though one might speculate that women were more emotional than men at a defined phase in their cycle, the same reasoning would suggest that men were emotional for the whole of the month. In the age-group fifteen to sixty-five the chances of a man being admitted to prison are roughly 30 times as great as those of a woman. The rates of admission to mental hospitals for men under sixty-five, their
was
272
probability of a car accident, the likelihood of their developing alcoholism or being struck off the Medical Register (11/1 in 1974) are all greater. a’Brook and his colleagues 13 found that 10 times as many male as female doctors were referred to them because of psychiatric illness, this ratio being the same for both outpatients and inpatients. Emigration Studies of career choices of psychiatric trainees 14.,15 have shown that women psychiatrists are less likely to emigrate than men. Bewley 14 reported that, when asked whether they would seek a post abroad rather than take a non-consultant post in Britain, male doctors generally said they would, women doctors that they would not. This is not surprising since most women doctors do not have the option of emigrating unless they separate from their husbands or persuade them to change their jobs giving preference to their wife’s career. Ashurst 15 found that 45 % of female psychiatrists in training expected or hoped for consultant status in the future, 39% did not have such intent, and the rest were uncertain. Those who did not hope for a consultant post were almost all well into middle age, and several commented that it was too late, and had there been any prospect of a career in psychiatry when they entered, they would have grasped the oppor-
tunity wholeheartedly. RECOMMENDATIONS
for Doctors with Dependants The Department of Health has devised two schemes for doctors with dependants who wish to pursue parttime training. The first of these allows a small sum (50) for buying journals and paying the mandatory subscriptions to a medical defence organisation and Special
Schemes
the General Medical Council. In return the woman undertakes to do a minimal number of paid working and educational sessions. The scheme is designed to help those doctors who are virtually unable to work at all because of family commitments to keep in touch with their medicine. The uptake of posts under the scheme has been limited. The second scheme allows doctors to be paid in the training grades on a sessional basis in supernumerary This has been devised to enable doctors to posts. continue training on a part-time basis, if other commitments make tenure of a full-time post impossible. The scheme has been unequally applied in different regions, and there are also differences between specialties. In some, such as psychiatry, it is considered feasible for a person to train part-time, while in others, such as obstetrics or surgery, it is thought to be impossible. The composition of joint committees on higher training are depressingly similar to College Councils (table I) and women doctors are grossly under-represented.
Appointment Procedure A married woman doctor can only apply for a post her home and is unable to apply for consultant posts wherever they fall vacant. This may force her to take a permanent medical-assistant post or a post without security of tenure (clinical assistant or locums) rather than remain medically unemployed. Aird and Silver 16 proposed that, following the success of the schemes for retraining in supernumerary training posts, the time had come to consider supernumerary consultant posts for those doctors (predominantly married near
women) who could only apply for work
in a restricted We would therefore propose that there should be a new category of supernumerary consultant posts. There would need to be a properly constituted advisory appointments committee to ensure that applicants Suitable applicants were of consultant standard. would then be offered posts of not less than eight weekly sessions without a private-practice option. The eight-session minimum allows a four-day week, with a day to cope with family responsibilities. Doctors who wish to practise privately could do so by applying for the next nine-elevenths non-supernumerary post that fell vacant. Any person entitled to such a supernumerary consultant post could apply to have such a post created in the area in which they lived. Doctors to whom this might apply-predominantly, but not solely, married women-would be as likely to be found anywhere in the country. If there were too many consultants in one area in a particular specialty the balance could be redressed by making no new appointment after a consultant retired or left. Alternatively when a doctor applied for a supernumerary post in an area where the work load did not justify an appointment, the appointments committee could recommend them to be appointed to the first vacant consultant post within travelling distance. These posts should be funded centrally. The medical-assistant grade would be continued for those few doctors of either sex who do not seek or are incapable of meeting the full responsibilities of a consultant post. It should not be used as a device to get married women doctors on There is a need for a separate career the cheap. structure for married women doctors with children. The people in a position to implement this are men. Rigidly insisting on notional equality perpetuates unfairness. Since they cannot conceive and do little housework, male doctors effectually force their women colleagues into subordinate posts. Equality of opportunity for women doctors can only be achieved if men give up their present privileged position. area.
Requests for reprints should be addressed to B. R. B., Department of Community Medicine, St. Thomas’ Hospital, London SE1.
REFERENCES 1. See Times, June 7, 1975. 2. World Health Organisation. Health Statistics Annual
1971; vol. III. Geneva, 1974. (1973 figures for U.S.A. and U.S.S.R., from
embassies.) 3. Community Care, March, 1975. p. 1. 4. Stanley, G. R., Last, J. M. Br. J. med. Educ. 1968, 2, 204. 5. Br. med. J. 1974, ii, 590. 6. Flynn, C. A., Gardner, F. Br. J. med. Educ. 1969, 3, 28. 7. Lawrie, J., Newhouse, M. L., Elliott, P. M. Br. med. J.
1966, i,
409. 8. Rue, R. 9. 10. 11. 12. 13. 14.
Lancet, 1967, i, 1267. Essex-Lopresti, M. ibid. 1970, ii, 204. Oakley, A. Housewife. London, 1975. Oakley, A. The Sociology of Housework. London, 1975. Dalton, K. The Premenstrual Syndrome. London, 1964. a’Brook, M. F., Hailstone, J. D., McLaughlan, I. E. Br. J. Psychiat. 1967, 113, 1013. Bewley, T. Royal College of Psychiatrists Notes and News, November, 1974, p. 2.
15. Ashurst, P. ibid. April, 1975, p. 9. 16. Aird, L. A., Silver, P. H. S. Br. J. med. Educ. 1971, 5, 232. 17. Department of Health and Social Security. Hospital Medical Staff: England and Wales national tables September 30, 1973. Statistics and Research Division, D.H.S.S., April, 1974. 18. Department of Health and Social Security. Health and Personal Social Services Statistics. H.M. Stationery Office, 1974.
Hospital
Practice
HOSPITAL DOCTORS’ CAREER STRUCTURE AND MISUSE OF MEDICAL WOMANPOWER
Summerskill, Under Secretary of State at the Home Office, to describe British women as " that unique thing, an oppressed majority".3 The composition of the policy or decision making bodies within the medical profession is biased towards men (table i). CAREERS
THOMAS H. BEWLEY Medicine and Psychiatry, Departments of Community St. Thomas’ Hospital and Medical School, London SE1
BEULAH R. BEWLEY
Summary Biological
and cultural differences beand women lead to severe discrimination against women doctors who bear the burdens of pregnancy, child-rearing, and housework. These lead, from equality within medical school and at qualification, to increasing failure to obtain posts commensurate with their innate abilities. Women doctors who temporarily and partially drop out of full-time practice have been studied frequently, but men (who are equally expensive to train) have not, despite their disappearing from National Health Service practice tween men
through emigration, death, alcoholism, suicide,
or
removal from the Medical Register. In a working lifetime of forty years, a woman doctor with an average family is likely to do seven-eighths of the work of a doctor who has not had to carry the primary responsibility of bearing and rearing children. Doctors with dependants are handicapped, and a separate career structure might be set up for them. Supernumerary consultant posts are proposed.
OF
WOMEN
DOCTORS
Stanley and Last4 showed that more women medical students completed the undergraduate course without failing any examinations, and fewer failed on two or more occasions. But, after qualifying, only 30% of women compared with 42 % of men acquired additional qualifications. Hospital posts show a steady decline in the proportion of women doctors through all levels (table 11). It is very much harder for women to obtain consultant posts, and more of them end in medical-assistant (or clinical-assistant) posts. In academic medicine less than 1% of professors are women. Fewer women than men are unrestricted principals in general practice (table n). In community medicine the Department of Health estimates that 417 men and 129 women are in posts as specialists. The figures for other posts were not available, but, as Flynn and Gardner found,6 a large number of women doctors have always worked in public health, and there is little doubt that they are over-represented in the subconsultant grades. The British Medical Journalhas TABLE I-NUMBER OF MEN AND WOMEN ON COLLEGE COUNCILS AND CENTRAL POLICY COMMITTEES
INTRODUCTION
"rejoice at the thought that it should be made abundantly clear that husbands and wives come to the judgement seat on matters of money and property upon the basis of complete equality.... Complete equality requires an equal division of the assets." -Lord Justice SCARMAN.1 IT is a curious fact that as one travels eastwards from the United States there is a steady increase in the proportion of women in the medical profession-8 % in the U.S.A., 17% in England and Wales, 40% in Czechoslovakia, 48% in Poland, and 72% in the U.S.S.R.2 In England the number of women being admitted to medical school is increasing by about 1 % annually, and in the 1980s it is likely that 50% of medical-school places will be taken by women. Although at medical-school entry intelligence, ability, dedication, and perseverance are distributed equally between the sexes, postgraduate experience differs, and when doctors appear before a consultant appointments committee equal opportunity does not exist. Far fewer women obtain career posts appropriate to their abilities, either because of the handicaps of pregnancy, child-rearing, and unequal distribution of housework and family responsibility between the sexes, or because of discrimination in selection for
TABLE II-PROPORTION OF WOMEN IN HOSPITAL POSTS AND GENERAL PRACTICE: ENGLAND AND WALES
posts. The
opportunities are similarly unequal in other professions because of the same handicaps, probably more from the passive effects of tradition than from positive discrimination. Only 4% of M.p.s are women, and even in social work-a profession by tradition predominantly female-only 15 of Britain’s 172 directors of social services are women. This led Dr Shirley
Source: D.H.S.S.17.18
271 in some regions, notably Oxfordand the South-West Metropolitan,9 showed that a more flexible and imaginative approach by administrators could appreciably augment the contribution by women doctors.
Experience
discussed the economic argument commonly advanced medicine. against increasing cost of a estimated doctor was between The producing and in S15.000 (E28,000 1975), most of which tl0,000 was borne by the taxpayer. The editorial stated that over the past few years it had been accepted that about 25 % of women doctors under the age of 65 were not working in medicine, compared with a figure of 3 % for men. The selection bias against women entering medicine has almost disappeared, and the B.M.y. editorial speculated that the better examination results obtained by women might cease when the abolition of discrimination at entry meant that the previously more academically able women were diluted by students of equivalent calibre to the men. Flynn and Gardnershowed that the work record of single women doctors was very good in that 90% of them remained in continuous full-time employment and virtually all the remaining 10% worked in medicine, though less than full-time. In their sample the work performance of married women doctors fell sharply after marriage even when there were no children. Only 65% of the married doctors worked full-time and 10 % gave up medicine for a time. Of those with preschool children, only 20% worked fulltime and nearly 30 % gave up practising, but once the children were at school over 25 % worked full-time and a further 55% worked part-time. They estimated that 85-90 % of women graduates were likely to marry, and their sample showed a peak in marriages taking place in the year of graduation. Married women doctors without children worked less than their single colleagues, which highlights an inbuilt sex discrimination when both partners are working. There is often a conflict between their separate careers, and one of them has to put remaining together before their own career choice. It is traditional for the wife to make this sacrifice. the entry of
women to
Marriage, Child-bearing,
and Child-rearing A woman who has children will spend some time off work during pregnancy and it is likely that for some years she will spend more time than her husband looking after children. For 5-10 years of her profesIn a sional life she is likely to work part-time. if even a works lifetime of 40 person working years, half-time for 10 years they will have done seveneighths of the work of someone who has not taken Because it occurs in the early postany time off. this graduate years relatively small difference handicaps most women doctors for the rest of their working lives. It denies them the opportunity to compete on equal terms for the most responsible posts and limits their
professional opportunities. A successful career for a woman depends more on chance than for a man. For example, if she is married to someone forced to move as regularly as an Army officer it will be more difficult for her to aspire to independent consultant status. If married to another doctor there will be some regular contact with journals and other colleagues, and it may also be easier for careers to be planned jointly. Lawrie and her colleaguesfound that possession of a postgraduate qualification and living in a large town exerted a favourable influence on the careers of women doctors,
heavily
in Society In the past 100 years there have been changes in women’s role in society with a gradual move towards equality between the sexes. However, Oakley’s surveys 10,11 show that nearly all women, whatever their position in society, were housewives. Marriage and housewifery were basic impediments to occupational sex equality, steering women into low-status poorly paid jobs. Every woman in Oakley’s survey spent a lot of time doing housework. Her hour-by-hour breakdown of household tasks dispelled the myth that the old division of labour is breaking down and that today’s husbands take an equal share in the household tasks. Even when the wife had a full-time job the responsibility for running the house and caring for the children It would be unrealistic to suggest remained hers. radical changes to speed the equalisation programme, and it is likely that in the foreseeable future most married women will continue with the same handicaps as at present.
Changes
I
COMPARISON WITH MALE DOCTORS
When studying the work of women doctors it might be informative to compare this with that of male doctors rather than a theoretical concept. Many women work less because of pregnancy and child-rearing, but some men work less because of illness and death, and some hardly contribute to the N.H.S. at all because of emigration. Deaths among male doctors below the age of 65 from coronary thrombosis and alcoholism, among other causes, are higher. Occupational mortality data for married women are " categorised " by their husband’s occupation so we do not know the death-rates of women A review of a year’s obituaries (304) in the doctors. British Medical Journal showed that 87 men and 7 women below the age of sixty-five and 189 men and 21 women aged sixty-five or over died. One might surmise that male doctors are more likely to die before the age of sixty-five and women doctors are less likely to have a career meriting
more
,
an
obituary.
Biological Differences J. P. Mahaffy, a former provost of Trinity College when asked by those anxious to arrange for Dublin, admission of women to the university whether he could think of any essential differences between the sexes, reputed to have replied " Madam, I cannot conceive ". There are biological differences between males and females which may lead members of either sex to function less well at various times in their career. Dalton 12 has pointed out that women’s moods, temperaments, abilities, and levels of functioning may be affected by their menstrual cycles. She showed that women were more likely to be admitted to mental hospitals, to commit crimes, to do badly in exams, and to have a higher rate of minor sickness during the premenstrual and menstrual period. Though one might speculate that women were more emotional than men at a defined phase in their cycle, the same reasoning would suggest that men were emotional for the whole of the month. In the age-group fifteen to sixty-five the chances of a man being admitted to prison are roughly 30 times as great as those of a woman. The rates of admission to mental hospitals for men under sixty-five, their
was
272
probability of a car accident, the likelihood of their developing alcoholism or being struck off the Medical Register (11/1 in 1974) are all greater. a’Brook and his colleagues 13 found that 10 times as many male as female doctors were referred to them because of psychiatric illness, this ratio being the same for both outpatients and inpatients. Emigration Studies of career choices of psychiatric trainees 14.,15 have shown that women psychiatrists are less likely to emigrate than men. Bewley 14 reported that, when asked whether they would seek a post abroad rather than take a non-consultant post in Britain, male doctors generally said they would, women doctors that they would not. This is not surprising since most women doctors do not have the option of emigrating unless they separate from their husbands or persuade them to change their jobs giving preference to their wife’s career. Ashurst 15 found that 45 % of female psychiatrists in training expected or hoped for consultant status in the future, 39% did not have such intent, and the rest were uncertain. Those who did not hope for a consultant post were almost all well into middle age, and several commented that it was too late, and had there been any prospect of a career in psychiatry when they entered, they would have grasped the oppor-
tunity wholeheartedly. RECOMMENDATIONS
for Doctors with Dependants The Department of Health has devised two schemes for doctors with dependants who wish to pursue parttime training. The first of these allows a small sum (50) for buying journals and paying the mandatory subscriptions to a medical defence organisation and Special
Schemes
the General Medical Council. In return the woman undertakes to do a minimal number of paid working and educational sessions. The scheme is designed to help those doctors who are virtually unable to work at all because of family commitments to keep in touch with their medicine. The uptake of posts under the scheme has been limited. The second scheme allows doctors to be paid in the training grades on a sessional basis in supernumerary This has been devised to enable doctors to posts. continue training on a part-time basis, if other commitments make tenure of a full-time post impossible. The scheme has been unequally applied in different regions, and there are also differences between specialties. In some, such as psychiatry, it is considered feasible for a person to train part-time, while in others, such as obstetrics or surgery, it is thought to be impossible. The composition of joint committees on higher training are depressingly similar to College Councils (table I) and women doctors are grossly under-represented.
Appointment Procedure A married woman doctor can only apply for a post her home and is unable to apply for consultant posts wherever they fall vacant. This may force her to take a permanent medical-assistant post or a post without security of tenure (clinical assistant or locums) rather than remain medically unemployed. Aird and Silver 16 proposed that, following the success of the schemes for retraining in supernumerary training posts, the time had come to consider supernumerary consultant posts for those doctors (predominantly married near
women) who could only apply for work
in a restricted We would therefore propose that there should be a new category of supernumerary consultant posts. There would need to be a properly constituted advisory appointments committee to ensure that applicants Suitable applicants were of consultant standard. would then be offered posts of not less than eight weekly sessions without a private-practice option. The eight-session minimum allows a four-day week, with a day to cope with family responsibilities. Doctors who wish to practise privately could do so by applying for the next nine-elevenths non-supernumerary post that fell vacant. Any person entitled to such a supernumerary consultant post could apply to have such a post created in the area in which they lived. Doctors to whom this might apply-predominantly, but not solely, married women-would be as likely to be found anywhere in the country. If there were too many consultants in one area in a particular specialty the balance could be redressed by making no new appointment after a consultant retired or left. Alternatively when a doctor applied for a supernumerary post in an area where the work load did not justify an appointment, the appointments committee could recommend them to be appointed to the first vacant consultant post within travelling distance. These posts should be funded centrally. The medical-assistant grade would be continued for those few doctors of either sex who do not seek or are incapable of meeting the full responsibilities of a consultant post. It should not be used as a device to get married women doctors on There is a need for a separate career the cheap. structure for married women doctors with children. The people in a position to implement this are men. Rigidly insisting on notional equality perpetuates unfairness. Since they cannot conceive and do little housework, male doctors effectually force their women colleagues into subordinate posts. Equality of opportunity for women doctors can only be achieved if men give up their present privileged position. area.
Requests for reprints should be addressed to B. R. B., Department of Community Medicine, St. Thomas’ Hospital, London SE1.
REFERENCES 1. See Times, June 7, 1975. 2. World Health Organisation. Health Statistics Annual
1971; vol. III. Geneva, 1974. (1973 figures for U.S.A. and U.S.S.R., from
embassies.) 3. Community Care, March, 1975. p. 1. 4. Stanley, G. R., Last, J. M. Br. J. med. Educ. 1968, 2, 204. 5. Br. med. J. 1974, ii, 590. 6. Flynn, C. A., Gardner, F. Br. J. med. Educ. 1969, 3, 28. 7. Lawrie, J., Newhouse, M. L., Elliott, P. M. Br. med. J.
1966, i,
409. 8. Rue, R. 9. 10. 11. 12. 13. 14.
Lancet, 1967, i, 1267. Essex-Lopresti, M. ibid. 1970, ii, 204. Oakley, A. Housewife. London, 1975. Oakley, A. The Sociology of Housework. London, 1975. Dalton, K. The Premenstrual Syndrome. London, 1964. a’Brook, M. F., Hailstone, J. D., McLaughlan, I. E. Br. J. Psychiat. 1967, 113, 1013. Bewley, T. Royal College of Psychiatrists Notes and News, November, 1974, p. 2.
15. Ashurst, P. ibid. April, 1975, p. 9. 16. Aird, L. A., Silver, P. H. S. Br. J. med. Educ. 1971, 5, 232. 17. Department of Health and Social Security. Hospital Medical Staff: England and Wales national tables September 30, 1973. Statistics and Research Division, D.H.S.S., April, 1974. 18. Department of Health and Social Security. Health and Personal Social Services Statistics. H.M. Stationery Office, 1974.
