Last year, in the centenary of female suffrage, the emphasis in many commentaries was on the description of the struggle to find a democratic political voice within the British political constitution. As I reflect on the lee side of this centenary, I think of the writer Maya Angelou, mute for over 5 years after a childhood trauma. She was persuaded to talk by a woman who knew she loved and memorised poetry. Unlocking her voice gave the world a series of autobiographical texts, reflecting the struggle and the voice of black culture in the USA. It was her own personal articulation of equality, racial gender and social, exploring a deep seated and engrained bias.
Unlocking the voice of professional equality within the specialty of Gastroenterology is part of what the Network supporting women in Gastroenterology has done within the BSG. Much has been achieved in our specialty since I entered it as a registrar, an unmentionable number of years ago. We have moved from a consultant establishment of around 16 % to 21% and a trainee cohort of 40% female. This, whilst still behind medicine as a whole, represents notable progress. Moreover, within the Society there has been both articulation and acknowledgement that the BSG as an organisation is changing, and represents an organisational culture that actively values the talent and professional development of all its members.
However, the complex reasons behind persisting gender inequality in the wider workplace in the UK, exist not because of the lack of articulation of the problem, nor for the lack of willingness on behalf of most organisations to look for equity of access for all employees of equal skills set. It is far more about the unarticulated, unconscious bias embedded in our own culture and societal expectation. Whilst there are well described examples of how this bias plays out in the employment setting, tackling perceptions and unconscious bias needs to start fundamentally within our wider societal and social infrastructures. How we educate and shape the perceptions of the next generation is as important (if not more) as the professional structures we create.
There are clearly skills sets and behavioural preferences which are demonstrated to be gender specific. However, these are not the problem. The issue lies with the underlying (and sometime unspoken) expectations of what society considers the norm – the acceptability of career ambition in any context; the perceived ‘likeability’ qualities in men and woman. Whilst ever the same attributes are considered differently and weighted differently for men and women, judgement will inevitably be biased (positively or negatively).
Medicine, which is now female predominated at medical school intake level (59%), needs to ensure that women are not channelled unwittingly into perceived ‘flexible and adaptable’ specialties. This gives no opportunity for true choice or sustainable specialty workforce development – indeed it prevents us drawing from the whole pool of talent that is available.
How we articulate the logistics of delivering an inclusive and mentored career progression in specialty training, to attract the most talented of our graduates will depend on how we free our specialty culture from the underlying societal beliefs which constrain most of our unarticulated bias. This will diversify our speciality.
We can be proud in the BSG of our sensitivity to these issues, without becoming a slave to the demands of correctness. We must look wider than the statistics and the absolute numbers. Whilst we grow the pool of talent in a more gender balanced way, we need to realise that the smaller numbers of women currently in the specialty means that achieving even proportional representation in our professional society will expect women to engage and commit more to BSG activity than their male counterparts. With just over 420 female medical members we would need engagement of approximately 40% of these members at any one time to produce a representative mix on committees and other groups. This compares with an approximate 10% engagement from our male colleagues.
This is a cautionary reminder that whilst numbers are easy to quote, the sustainability of growing our membership in a truly balanced way relies on us to develop the pool from which that membership is derived.
This returns to a more comprehensive need to go beyond articulating specialty specific recruitment problems, and tackle wider, societal unconscious biases in order to draw talent into medicine from diverse communities within society. In this way, we can recruit actively some of the best talent into the medical workforce and so into the specialty of Gastroenterology and Hepatology.