© 2003 The Royal College of Psychiatrists
© 2003 The Royal College of Psychiatrists
Opinion & debate |
Women in academic psychiatry in the United Kingdom
Social and Community Psychiatry, Royal Free and University College Medical School, Department of Psychiatry and Behavioural Sciences, Royal Free Campus, Rowland Hill Street, London NW3 2PF
Social and Community Psychiatry
Mental Health Care in Older People
Learning Disabilities
Royal Free and University College Medical School
Although there seems to be a shared impression that the proportion of women in academic psychiatry is substantially lower than in National Health Service (NHS) posts, we are not aware of any empirical data on this. In the USA, women physicians have been shown to be more likely to pursue an academic career than men (Nonnemaker, 2000), but the number who advance to Professor appears significantly lower than expected (Reiser et al, 1993; Nonnemaker, 2000). Women in academic psychiatry in Canada also appear less likely to advance to senior positions than their male colleagues (Penfold, 1987). A recent survey of 44 academic institutions in the UK, carried out by the National Centre for Social Research (Blake & La Valle, 2000), found that women occupied lower grade academic posts than their male counterparts and therefore were less eligible to apply for project research grants. Those that were eligible were as successful in gaining funding as their male colleagues.
We aimed to investigate the number of women in substantive academic psychiatry posts across the UK and to compare it with that of equivalent NHS posts. We also investigated the gender distribution within subspecialities in academic psychiatry posts in London.
Method
We contacted all academic psychiatric institutions in London (University College and Royal Free Medical School, Queen Mary and Westfield College, the Institute of Psychiatry, King’s College, Guy’s and St Thomas’ Hospitals, St George’s Hospital Medical School and Imperial College) and gained information on the numbers and types of academic posts and the gender of the current post-holders. We also contacted the Royal College of Psychiatrists for the same data about registered members in the UK. In addition, we obtained data on the numbers and gender of consultant psychiatrists and specialist registrars from the Royal College’s annual census of psychiatric staff (Royal College of Psychiatrists, 2001).
The numbers and percentages of men and women in substantive academic posts
were examined and the gender distribution analysed. The 
2
statistic, odds ratio (OR) and 95% confidence interval (CI) were calculated to
compare the numbers of men and women in academic and NHS posts, and the number
of male and female academic psychiatrists who had attained a professional
chair. We obtained the dates of full registration of professors at London
academic institutions of psychiatry from the General Medical Council website
and compared the length of time from full registration to present day for male
and female professors using the Student’s t-test. In addition,
we contacted the Medical Research Council and Wellcome Trust to ascertain the
numbers of male and female trainee psychiatrists awarded training
fellowships.
Results
Table 1 shows the number of men and women in academic and NHS posts in the UK. Overall, males were significantly more likely than females to have an academic post as compared to an NHS post. Men occupied 81% of academic posts and 63% of NHS posts (P=0.000, OR=2.4, 95% CI=1.8–3.2). Men were significantly more likely to occupy a professional position than women (135/265v. 15/64, P=0.000, OR=3.4, 95% CI=1.7–6.7). Eighty-nine per cent of professional positions were occupied by men. Between 1993 and 1998, the Wellcome Trust awarded 29 mental health training fellowships, 14 of these (48%) to women. Between 2000 and 2002, the MRC awarded 14 training fellowships in health service research and neuropsychiatry to trainee psychiatrists, 6 of these (43%) to women.
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View this table: [in a new window] | Table 1. Gender distribution of academic and National Health Service (NHS) posts in the UK (Royal College of Psychiatrists, 2001) |
Table 2 shows the gender and grade distribution within psychiatric sub-specialities for academics in London. Men are overrepresented when compared with women in all specialities except learning disability and liaison psychiatry, where numbers were very small. Overall, the male:female ratio in London was 3:1 compared with 4:1 for the UK as a whole. General Medical Council registration data were obtained for all 11 female professors at London academic institutions of psychiatry and 43 of the 49 male professors. There was no statistically significant difference in the mean years since full registration for male and female professors: 29 s.d.=8.0 v. 25 s.d.=5.6; t=1.7; 95% CI of the difference in proportion was –0.77 to 7.9.
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View this table: [in a new window] | Table 2. Gender and academic rank distribution within the psychiatric sub-specialities in London |
Discussion
The main findings from this survey were that, in psychiatry, women appeared significantly less likely than men to pursue an academic career and within academic posts, women were much less likely to occupy a professional position than men.
The main limitation of our survey was the possible missing data. We relied upon figures given to us by employees and personnel departments of the institutions included. These figures were, to the best of our knowledge, complete. The Royal College of Psychiatrists’ data rely on members notifying the College of changes in post and relates only to subscribing members. The inaccuracy in this data was illustrated by the discrepancy in the numbers of lecturers, with the number in our London survey being greater than that reported in the Royal College’s census for the whole of the UK. However, there is no reason to believe that any missing data would have introduced any systematic bias affecting our results. We included data on Wellcome Trust and Medical Research Council fellows because we felt that they were likely to pursue an academic career, but honorary specialist registrars employed as part of research grants were not included owing to the difficulty in obtaining accurate information about these posts, many of which are short term, and because we felt that they were less likely to lead to an academic career.
The very large gender difference at professional level could reflect the small number of women entering medicine in previous generations, especially when quotas for female medical students were fixed. However, comparison between mean time since full registration for men and women suggests that this may not be so, because female professors have been qualified almost as long as their male peers. Comparing the ratio of men to women among readers and senior lecturers (3:1) with NHS consultants (2:1) also suggests that the under-representation of women in academic psychiatry cannot be explained simply as a cohort effect. At the most junior level, numbers surveyed are small and evidence is mixed as to whether we can expect women to catch up in academic psychiatry. Data from the Medical Research Council and Wellcome Trust fellowship schemes are encouraging, but those regarding lecturers are less so, such that future trends cannot be predicted at present with confidence.
Recruitment within psychiatry is currently problematic, and our findings highlight that we are not attracting and retaining women into senior academic posts. Over the past 2 years, a group of London-based female academic psychiatrists has met informally. Discussion among this group and at a workshop held at the 2001 Royal College Annual Meeting about the issue of gender disparity in academic psychiatry suggested a number of possible explanations:
- A perception that it is ‘too hard’ to combine academic,
clinical and family commitments, illustrated by the lack of female role models
in academic psychiatry, is supported by Blake & La Valle’s
(2000) findings that women
scientists were less likely to be in a relationship than their male
counterparts and less likely to have dependent children. However, female
academics who did have domestic commitments were more likely to be responsible
for household duties and childcare than male academics with children. Only 50%
of women academics with children had applied for grants, compared with 62% of
male academics with children. The survey also found that older universities
(including all the academic institutions of psychiatry in London) were less
likely than newer institutions to provide support in terms of career breaks
and parental leave for academics with families. The discussion groups noted
that there are very few part-time clinical academic psychiatrists, male or
female, and felt that the difficulties of fulfilling both academic and
clinical commitments within a part-time working week would be great.
Acknowledgement of this and greater flexibility within working hours and the
structure of academic careers are needed.
- Changing from NHS to academic employment or working on short-term research
grants or fellowships can be daunting for women planning to have children
because the arrangements for paid maternity leave may be unclear. Research
grants are usually awarded over a fixed time period, with no provision for
maternity leave, and arranging cover for carrying out or supervising projects
can be problematic. Although women are legally entitled to maternity leave and
Blake & La Valle’s survey
(2000) has led the Wellcome
Trust and the Medical Research Council to address this problem, the discussion
groups felt that the lack of clarity around this issue was a strong
disincentive to women considering academic careers.
- A further issue was gender discrimination. This has been shown to occur
early on in the careers of women in medicine. A study of 1000 medical students
in the USA showed that 29% of women had experienced gender discrimination
during their training (Mangus et
al, 1998), and female medical students in Leicester reported
gender discrimination, particularly in surgery
(Field & Lennox, 1996). Gender discrimination has also been reported among female clinicians and
academics working in radiology (Deitch
et al, 1998), plastic surgery
(Capek et al, 1997) and cardiology (Limacher et al,
1998). A large study of medical academics across the USA showed
that women were more than twice as likely to perceive gender discrimination in
the academic environment than their male colleagues and, although their
academic productivity was similar, they had poorer career satisfaction
(Carr et al, 2000).
Although there have been no surveys of gender discrimination in psychiatry,
there is no reason to assume that our speciality is free from it.
- Our discussions highlighted the issue of mentoring, which has been
emphasised as an important factor in encouraging an academic career choice
(Stewart, 2002). It was felt
that female mentors would encourage female trainees to consider academic
psychiatry and that more formal mentoring schemes would give all trainees the
opportunity to make links with senior academics, regardless of gender.
In order to assess the issues raised in this paper and their relevance to academic psychiatry in the UK, further investigation is required. This could include a survey of academics’ perceptions of the obstacles they have faced during their careers, including gender discrimination, the reasons for their career choice and trainees’ perceptions of academic careers, as well as an exploration of strategies that might encourage talented junior psychiatrists of both genders to enter academic psychiatry.
Limitations
- Missing data: we relied on employees and personnel departments of the
academic institutions to provide us with our data and did not include honorary
specialist registrars in our survey.
- Any inaccuracy in the national figures gained from the Royal College of
Psychiatrists’ census
(2001).
References
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- CAPEK, L., EDWARDS, D. E. & MACKINNON, S. E. (1997) Plastic surgeons: a gender comparison. Plastic Reconstructive Surgery, 99, 289–299.[Medline]
- CARR, P. L., ASH, A. S., FRIEDMAN, R. H., et al
(2000) Faculty perceptions of gender discrimination and sexual
harassment in academic medicine. Annals of Internal
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889–986.
[Abstract/Free Full Text] - DEITCH, C. H., SUNSHINE, J. H., CHAN, W. C., et al (1998) Women in radiology: data from a 1995 national survey. American Journal of Radiology, 170, 263–270.
- FIELD, D. & LENNOX, A. (1996) Gender in medicine: the views of first and fifth year medical students. Medical Education, 30, 246–252.[Medline]
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[Abstract/Free Full Text] - MANGUS, R. S., HAWKINS, C. E. & MILLER, M. J. (1998) Prevalence of harassment and discrimination among 1996 medical school graduates: a survey of eight US schools. Journal of the American Medical Assocation, 280, 851–853.
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[Abstract/Free Full Text] - PENFOLD, S. (1987) Women in academic psychiatry in Canada. Canadian Journal of Psychiatry, 32, 660–665.[Medline]
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[Abstract/Free Full Text] - ROYAL COLLEGE OF PSYCHIATRISTS (2001) Annual Census of Psychiatry Staffing. London: Royal College of Psychiatrists.
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[Free Full Text]
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