Women and ethnic minority groups are less likely to reach the top rank of surgeons than white men, even when they conform with traditional ‘white male patterns of working’, according to a study.
Black women face the greatest disadvantage and are 42 percentage points less likely to have reached consultant level 10 years after joining as a junior surgeon than white men.
Academics from the University of Surrey Business School and Queen Mary University, as well as an academic from investment management company ExodusPoint Capital, analysed data on 3,402 NHS junior surgeons in England from 2009-10, studying how many had progressed to consultant level by 2020.
They found that compared to white men:
- Women of Indian and Pakistani ethnicity were 28 percentage points less likely to be promoted.
- White women were 21 percentage points less likely to be promoted
- Women of Chinese and south east Asian ethnicity were 14 percentage points behind
- Black men were 27 percentage points behind
- Indian and Pakistani men were 10 percentage points behind
- Men of Chinese and south east Asian ethnicity were 6 percentage points behind.
Even when comparing groups with the same amount of training hours and same record of “career interruptions”, such as taking time out to have children, women and Black men were less likely to reach consultant level than white males.
“The most striking finding is that even when Indian women, white women and Black men conform to white male patterns of working, the progression gap is wide and, in some cases, very wide,” Professor Carol Woodhams from the University of Surrey said.
“This is objective evidence that disadvantage against diverse groups in surgery is deep-rooted and a new progressive milieu in the NHS and the broader society has not yet translated into concrete and progressive outcomes.
“Women, and especially non-white women, are under-represented in senior ranks of consultant, making a prima facie case for the existence of a glass ceiling.
“Black male surgeons are severely disadvantaged. Black males work long hours, take very few part time or career interruptions and tend to work in most elite subspecialties of surgery. Yet they are one of the least likely to secure promotion.”
Diversity and inclusion
The study, presented at the British Academy of Management online conference, found that in 2010, 57% of junior surgeons were men, but by 2020 that figure had increased to 63% . The proportion of men who had been promoted to consultant was 53.6% and for women 36.5%.
Only 15% of surgeons in 2020 were ethnic minority women, but only 8% of trainees who were promoted to consultant were from this group.
Taking maternity leave affected the chance of a woman reaching consultant level by 2020 by 7 percentage points, while taking any other career break including working part time reduced their chances of promotion by 8 percentage points.
Professor Woodhams suggested that an “old boys’ network” persisted in the profession.
“Women and ethnic minority junior surgeons may have less access to important informal networks that bestow the sponsorship and patronage that is so important in securing a consultant post,” she said.
“In an elite profession, surgery is arguably the most elite of specialties. It is competitive, pressurised and receives the highest reward but it is consistently associated with a bullying culture that is especially hostile to women.”
Commenting on the findings, Tim Mitchell, vice president of the Royal College of Surgeons and a consultant ear, nose and throat surgeon, said:
“The findings of this research are deeply concerning – women and ethnic minorities must be fully represented throughout the ranks of the surgical profession.
“At the Royal College of Surgeons of England, we recognise that more needs to be done to ensure that all can reach the top of the profession, regardless of their background, gender or race. We are taking action to address inequalities and have committed to the findings from an independent review by Baroness Helena Kennedy QC. The action plan for this will be published in September.
“We want to lead by example and to champion equality and diversity. Our Women in Surgery Network initiative is an important step in making this a reality, as it helps to connect over 6,000 women from all career grades and specialties across the UK to collaborate, network and support each other in their careers.
“As leaders of the surgical profession, we have an essential role to play in fostering a diverse surgical community where anyone who has the talent and determination, can thrive. However, we cannot do this alone – we need to work with the NHS, government, and the surgical community to overcome these barriers.”