There’s much to celebrate on the advancement of women within the medical profession.

It wasn’t so long ago that women faced considerable, and at times seemingly insurmountable, barriers to both entering the profession and advancing. Now they’re afforded the same career opportunities as men and, research suggests, there are no delays to career progression if they work full-time.

There are, however, potential implications for women becoming the majority of doctors within 10 years, as predicted by the Royal College of Physicians’ report Women and medicine: the future. Many more doctors will want career breaks, to work part time, and work within certain specialties. For starters, it will demand more consultants and for NHS work to be organised differently. The NHS needs to take note and plan for it.

There’s less to celebrate when it comes to developing the next generation of medical and academic leaders. Paradoxically, we could find that as the proportion of women increases the leadership talent pool dries up.

It was a salient point made by Professor Dame Carol Black back in 2004 but quickly became lost in the media frenzy. Female dominated professions have a tendency to lose their influence. 

But, let’s be clear about what level of leadership we’re talking about.

There should be no shortage of leaders at clinical service levels. With the investment in the NHS, the prospects for a woman to achieve a consultant post are high.

They form the majority of entrants now embarking on specialist training in the majority of specialties. And women already represent 47% of the very small number of early appointed UK-trained consultants aged between 30 and 34, according to the Royal College of Physicians’ report.

Furthermore, a paper by Oxford’s UK Medical Careers Research Group suggests that women doctors who work full-time have similar career progression to men, even if they’ve had children. This contrasts sharply with other professions such as law or accountancy.

Working part-time is clearly compatible with holding an NHS consultant post in many specialties. And, what’s more, the overall numbers of male doctors are also increasing so there should be plenty of leadership candidates at a local, clinical level.   

The real problem lies with elite roles, such as clinical and medical directors, presidents of royal colleges and leading societies, medical school and deanery leads, even chief executives.

Data is thin apparently but what does exist suggests at these rarified levels women are in short supply.

Women and medicine: the future suggests that women are in the minority on royal college councils, and there is yet to be a female president of a royal surgical college. In 2007, only 12% of all clinical professors on university contracts were women. In 2006, six medical schools had no female professors. And just two out of 34 medical school deans were women.

The picture is no better in primary care with very few women chairing the professional executive committees of PCTs.

It’s in part due to a legacy of male dominance – with women accounting for less than 20% of the entire pool of consultants over 55.

But, it’s also due to the requirements of getting into that elite role. Landing one of these jobs is difficult. It demands single-minded determination and involves long work hours, either attending many meetings and events, or building up a portfolio of research in addition to clinical responsibilities, or both. It’s not for those who want to spend a lot of time with their family.

Unless current trends change, women doctors will continue to work part-time in large numbers; take more time off than male counterparts and focus on particular specialties.

The report suggests that it’s unlikely that most women will make it to the top in proportion to their increased entry into the profession. Senior echelons will be made up of ‘best of the rest’ and the quality of leadership - both medically and academically - could be compromised.  

But, Professor Bhupinder Sandhu, co-chair of the BMA’s equal opportunities committee, disagrees. She doesn’t believe there will be a shortage of female leaders in future and the trends that have seen a dramatic rise in female leadership in her health community in Bristol will play out across the country.

She believes that the quality of leadership among recent luminaries has been high – and points to the Department of Health’s Professor Sally Davies, Professor Parveen Kumar, co-author of Clinical Medicine and former BMA president, Dame Deirdre Hine, chairman of the RSM, and Professor Shelia Hollis, Professor Dame Janet Husband and Professor Dame Carol Black, all former presidents of royal colleges.

“Many other potential women leaders already exist but are held back by the culture and ethos that has historically existed. This is slowly changing and will continue to do so,” she says.

A working group convened by Chief Medical Officer Sir Liam Donaldson, and chaired by Baroness Ruth Deech, to discuss problems faced by women in medicine is due to report before the end of the year. It’s anticipated that it will provide a range of recommendations to improve the availability of part-time training and working, and encouraging leadership development.  

Dr Helen Goodyear, president of the Medical Women’s Federation, believes women doctors need more encouragement to put themselves forward for leadership roles.

She says: “Role models are few and there will be a need for mentorship as well as resolution of the gender pay gap for women to succeed in these areas.”

RCP report’s recommendations for accommodating more female doctors  

1. The organisational implications of changing workforce patterns and preferences with respect to working hours and specialty choices should be urgently examined so that the effective delivery and continuity of patient care is not compromised.

2. The economic impact of changing work patterns and their interaction with policy initiatives already under way needs to be evaluated.

3. Critical information gaps must be filled with some urgency to gain timely, rigorous and systematic insights into the implications of the new workforce trends.

4. The scope and detailed coverage of workforce planning needs to be extended and its analytic methods upgraded to take full account of the demographic shifts now under way.

5. Individual doctors at each stage in their career - and especially at the point of selecting their preferred specialty - should be provided with far more extensive information, guidance, and feedback on their career choices and aspirations.