150 years after Edinburgh Seven, is medicine still a patriarchy? – Professor Lorna Marson

On the 150th anniversary of the Edinburgh Seven’s admission to Edinburgh University to study medicine, there is still a need to consign the culture of ‘boys clubs’ in some specialities to history, writes Professor Lorna Marson.

This month marks 150 years since the first women were admitted to study medicine at the University of Edinburgh. The Edinburgh Seven, as they became known, were the first women to study at any British university.

Despite passing all their exams, the women were ultimately prevented from graduating after a court ruled the university had acted illegally in admitting them. Earlier this year, seven of today’s medical students accepted posthumous degrees on their behalf.

We have come a long way since then; nearly half of all doctors in the UK are women. Despite this, women are still hugely under-represented in the senior echelons of medicine.

Looking back to 1869 and the current moment, it is timely, then, that the annual Edinburgh Medical Debate will this week be asking the question: Is medicine is still a patriarchy?

Doctors care for all members of society, irrespective of race, gender or social standing. We hold this privilege and responsibility on behalf of the UK’s diverse population, yet the majority of senior roles in most medical specialities are still held by white men.

Many argue that wider society should be better represented throughout the medical profession. To achieve this, we need to consider gender, race and socio-economic status when we offer medical training to future students.

In Scotland, more than half of medical students are women. However, women make up about one in six doctors in specialist medical training and when you reach senior leadership positions – the decision-makers who design policy that influences the lives of us all – fewer than one in four are women.

The disparity is even higher in university roles, where fewer than one in six medical professors are women. In addition, these numbers are underpinned by a serious gender pay gap. In 2018/19, NHS figures revealed women who do the same job as men can earn as much as £11,700 less.

Senior doctors’ attitudes

We should not assume that as we train more women to be doctors and progress through the ranks, differences will disappear.

We know the attitudes that young women meet from some senior doctors often act as a disincentive. The absence of women already in these senior positions adds to the problem. A surgical trainee recently told me: “You cannot be what you cannot see.” Discouraging attitudes must be challenged and I am encouraged to see many of our young women using social media platforms to discuss the challenges they have faced in their medical careers and how they have overcome them. Follow #HowIBecameAWomanInSurgery for an insight into their working lives.

Gender is by no means our only challenge on the road to a diverse medical work force. A medical career still remains the domain of people from the highest socio-ecomomic groups. Access to medical school for those from lower groups remains a challenge. People from Asian backgrounds are well represented in the medical profession, but people from black ethnic groups are much less so. Again, it is hard to be what you cannot see.

If we focus on gender alone we will not succeed. The number of students who apply to medical school from the least affluent areas is still low. Lack of teaching resource in schools is a huge problem – pupils need excellent results in science subjects to gain a place. There are ways to resolve this with a pre-medical or foundation year but financial, social and psychological support also makes a huge difference to students once they get to university and can contribute to their long-term success.

‘Boys clubs’

All medical schools in Scotland offer support for school children from more challenging areas to gain the work experience they need to get into medical school, but it is clear we need to do more once they get there.

Women and men who hold senior positions in medicine have a responsibility to encourage the entirety of the next generation of doctors. It is important to help them believe they can succeed in whatever area of medicine they are passionate about, and to not be discouraged by those who may try to dissuade them.

Only then will we truly be able to represent the public we serve. The culture of ‘boys clubs’ in certain specialties must be consigned to history and women should not have to ‘pull the ladder up’ behind them. The privilege of a medical career must be open to everyone based on their ability to learn, heal and care for others – not their gender, race or where they come from.

Much has changed since those seven pioneering women joined the university in 1869, but the question of whether medicine is a patriarchy still lingers for a reason.

Perhaps the students leading the debate will be the people who will make diversity in leadership and the practice of medicine a reality. If they can, it would be good for us all.

Lorna Marson is the first female professor of surgery appointed by the University of Edinburgh. She will be on the panel for the ‘Edinburgh Medical Debate 2019: Is Medicine still a Patriarchy?’ at the McEwan Hall this evening.