Women in anaesthesia

The idea for this article came about after one of us had an interesting experience at work: “After anaesthetising a COVID-positive patient, I doffed and exited into the corridor outside the theatre suite. However my ID badge was in the prep room where we donned our PPE, so I was therefore locked out. A male colleague in the corridor kindly let me in via the male changing room (he did check first to see no one was getting changed). To my surprise I walked through the most enormous space, including places to sit – quite the opposite to the female changing room. The female changing room is tiny, dark and cramped, but this was luxurious in comparison! So, despite there being far more female members of staff, the men had the much bigger space. I mentioned it to one of our senior sisters. “What do you expect?” she said, “this place was built in the 1970s, all the doctors were men and all the nurses female – that’s why the female changing room is so small.” Apparently that is just the way it is, and apparently the way it will therefore stay. As I put on my scrubs (designed and sized for a man, not a woman) it started me thinking about gender, medicine, anaesthesia and the role of women……

Where have we come from and where are we now?

Historically medicine has been a male dominated profession. Dr Elizabeth Garrett Anderson was the first woman to qualify as a physician in the UK in 1865. In 1948 Dr Katharine Georgina Lloyd-Williams became the first woman awarded the FFARCS. Fast forward to 2019, and more women (54%) than men are graduating from medical school in the UK. There are 20% more women doctors in 2019 than in 2012 as the predominantly male workforce retires and is replaced by the increased number of female medical school graduates. Currently 48% of registered UK doctors are women, with even higher numbers in Scotland and Northern Ireland where women make up the majority of the medical workforce at 53% and 51% respectively [1].

In anaesthesia, women are still in the minority but the numbers are increasing. In 2007 only 28% of anaesthetic consultants were women, whereas this has risen to 38% in the 2020 RCoA census [2], similar to 41% for Association of Anaesthetists membership [3]. There is still a gender difference in working patterns, with census data showing that women are more likely to work part time (< 10 PA) than men [2].

When attendance at Association events for the first part of 2021 was analysed, 46% of our delegates were women. It is important that those attending our conferences see diversity amongst our speakers: at the 2021 Trainee Conference 51% of speakers were women, and at the 2021 Winter Scientific Meeting 40% of speakers were women. The Association are keen to aim for gender balance amongst conference speakers, and have pledged that they will aim for 50% women speakers at future conferences.

The increasing number of women in anaesthesia is being reflected by women having more prominent roles within the speciality in recent years, and we celebrate the leadership of:

• Kathleen Ferguson, first female President of the Association of Anaesthetists (2018-2020). 
• Fiona Donald, President of the RCoA (2021-present). 
• Anna Bachelor, President of the Society of Intensive Care (2005-2007) and Dean of the Faculty of Intensive Care Medicine (2013-2016). 
• Alison Pittard, Dean of the Faculty of Intensive Care Medicine (2020-present) and recently awarded an OBE. 
• Featherstone Professors Rachel Collis (2019) and Nuala Lucas (2020). 
• Ramani Moonesinghe, Professor of Perioperative Medicine at University College London and Director of the National Institute for Academic Anaesthesia. 
• Association of Anaesthetists Trainee Committee chairs Emma Plunkett (2016), Deirdre Conway (2017), Sally El-Ghazali (2018), Roopa McCrossan (2020) and Divya Raviraj (2021).

We’ve come a long way, but there is still a long way to go

Although there are positive female role models at the top of the profession, women in clinical leadership positions are still relatively uncommon, with the Clinical Leaders in Anaesthesia Network reporting that only 59 of the 200 clinical directors are women (where gender information is available) [4]. The recent BMA report ‘Sexism in medicine’ showed that women are disproportionally affected by sexism and gender bias [5], and there is a large body of research on the medical gender pay gap [6]. Data from the Advisory Committee for Clinical Excellence Awards shows that there is significant underrepresentation of women applying for CEAs; in 2019, only 26% of all applicants were women [7].

The demographic makeup of the workforce is undoubtedly changing, and perhaps it is time for the Association and RCoA to work towards offering more support, coaching and mentoring to support women develop their careers. Is there a role for a ‘Women in anaesthesia’ network to advocate for women anaesthetists? Diversity within leadership is known to promote organisational success; acknowledging that there is an issue, identifying the barriers and instituting systemic changes is the only way to strive for equality within the anaesthetic workforce.

Karen Stacey
Consultant Anaesthetist
Imperial College Healthcare NHS Trust, London 

Katy Miller
Consultant Anaesthetist
Birmingham Women’s and Children’s NHS Foundation Trust 

Roopa McCrossan
Locum Consultant Anaesthetist
South Tees Hospitals NHS Foundation Trust, Middlesbrough 

Twitter: @karenstacey82; @drkatymiller; @roomccrossan

References 

1. The General Medical Council. The state of medical education and practice in the UK, 2019. https://www.gmc-uk.org/-/media/documents/the-state-of-medical- education-and-practice-in-the-uk---workforce-report_pdf-80449007.pdf (accessed 28/9/2021). 
2. Royal College of Anaesthetists. Medical workforce census report. https://www.rcoa.ac.uk/sites/default/files/documents/2020-11/Medical-Workforce-Census-Report-2020.pdf (accessed 28/09/2021). 
3. Personal communication, Ms Nicola Heard, Head of Membership Services, Association of Anaesthetists. 
4. Personal communication, Dr Hamish McLure and Dr Tei Sheraton, Clinical Leaders in Anaesthesia Network. 
5. British Medical Association. Sexism in Medicine, 2021. https://www.bma.org.uk/media/4487/sexism-in-medicine-bma-report.pdf (accessed 28/9/2021). 
6. Department of Health and Social Care. Mend the gap: the independent review into gender pay gaps in medicine in England. https://assets.publishing. service.gov.uk/government/uploads/system/uploads/attachment_data/file/944246/Gender_pay_gap_in_medicine_review.pdf (accessed 28/9/2021). 
7. Personal communication, Dr Tei Sheraton, ACCEA focus group.

Read next: Lost in the ether