Women in hospital medicine in the United Kingdom: glass ceiling, preference, prejudice or cohort effect?

Objective-To assess from official statistics whether there is evidence that the careers of women doctors in hospitals do not progress in the same way as those of men. Design-The proportions of female hospital doctors overall (1963-96), and in the specialties of medicine, surgery, obstetrics and gynaecology, pathology, radiology/radiotherapy, anaesthetics and psychiatry (1974-1996) were examined. Additionally data were examined on career preferences and intentions from pre-registration house officers, final year medical students, and medical school applicants (1966-1991). Analysis-Data were analysed according to cohort of entry to medical school to assess the extent of disproportionate promotion. Results-The proportion of women in hospital career posts was largely explained by the rapidly increasing proportion of women entering medical school during the past three decades. In general there was little evidence for disproportionate promotion of women in hospital careers, although in surgery, hospital medicine and obstetrics and gynaecology, fewer women seemed to progress beyond the SHO grade, and in anaesthetics there were deficits of women at each career stage. Analyses of career preferences and intentions suggest that disproportionate promotion cannot readily be explained as differential choice by women. Conclusions-Although there is no evidence as such of a "glass ceiling" for women doctors in hospital careers, and the current paucity of women consultants primarily reflects historical trends in the numbers of women entering medical school, there is evidence in some cases of disproportionate promotion that is best interpreted as direct or indirect discrimination.