How sexism affects female GPs’ career progression

Presumptions around female GPs’ career intentions and interests continue to hamper progression. Eliza Parr reports. Read more from the investigation here

It may seem that the overt sexism of the 20th century has long been resigned to the past. Like when Dr Susan Bowie interviewed to become only the second female GP the Shetland area had ever seen in the 1980s, and was asked outright about the contraception she was using. Or when a GP in Sheffield applied to GP training schemes around the same time, and was directly asked by a female interviewer whether she was on the pill. ‘I was prepared for quite a degree of misogyny, but I was shocked by that,’ she says.

Today, general practice is a female-dominated medical profession. As of the end of 2023, 57% of fully-qualified GPs in England were women. This is undeniably positive progress when it comes to female representation in medicine.

But it’s a different picture when you drill down into different GP roles. Men make up 53% of partners in England, while women account for 46%. Meanwhile, two-thirds of male GPs are partners, compared with only two-fifths of female GPs.

Deciding which career path to take as a GP – partnership, salaried, locum, portfolio – is an individual choice. But there are undoubtedly structural and cultural barriers in place for some women, especially those who want to balance progression with having a family.

Across all GP roles, more than a quarter of female GPs say their gender has directly hampered their progression within general practice, according to Pulse’s survey, which received just under 700 responses. And over half say they have been treated differently to male counterparts as a result of their gender.

Dr B, a Yorkshire GP who says she now has ‘more control’ after moving into locum work, describes women in general practice as ‘really disadvantaged’.

‘Practices are set up as small businesses – their own little fiefdoms. There’s a lack of career structure, and you can just end up languishing for years,’ she adds.

There is also a problem for female GPs that receives less attention – that they tend to be given certain types of clinical work, regardless of whether they want that work or not. This leads to greater feelings of burnout and dissatisfaction.

President of the Medical Women’s Federation Professor Scarlett McNally says Pulse’s survey findings are ‘shocking’, but ‘sadly’ reflect the experience she hears from her members. That 28% of female GPs feel their career progression hampered is a ‘tragedy for the UK’, she adds.

‘GPs are the backbone of the NHS and contribute to the health of the nation…we need vibrant women doctors to lead us to be healthier as a country. Each of these instances [of sexism] has a painful immediate or long-lasting impact on the doctor concerned. But outdated attitudes are not only damaging to individuals, but are blocking the future health of the country.’ 

Family commitments

Dr Farzana Hussain, a GP in Newham who worked as a single-handed principal for 21 years, says it is definitely ‘harder’ to be a partner if you’re a mother. ‘It does require a huge amount of commitment and no work-life balance. You have to mash it all up, like work-life spaghetti really.’ This is particularly acute in general practice, where the usual timeline for qualifying and feeling prepared to take on partnership coincides with when many women may want to have children.

Dr Hussain emphasises that ‘partnership isn’t really centred around people with caring needs and women’.

A locum GP, Dr C, who was in a 15-year partnership with a male GP says childcare commitments contributed to her decision to dissolve the partnership ‘in a major way’. ‘My male partner couldn’t accept that I was no longer as flexible.’

Dr Stephanie deGiorgio, a portfolio GP in Kent, says childcare needs are a ‘huge issue’ for female GPs, especially as ‘childcare costs are rising’. ‘The social norm still remains that female GPs are usually the ones who adapt their job to childcare.’

One GP partner responding to Pulse’s survey said it is ‘stressful’ balancing partnership with childcare responsibilities, but the culture is to ‘just get on with it’. While another said that when she’s had childcare issues, her colleagues have pressured her to put her ‘children at risk’ on many occasions, in order for her to keep working.

Then there is pressure from male GP partners about which career path they should take. Dr D, a GP partner in London, says that when she took up her first partnership in 2007, one of the local male GPs said: ‘Why are you becoming a partner? You should be salaried’. She says there’s a ‘presumption you can’t be both a partner and a mother’. Meanwhile, Dr B says she sees a ‘real preference for male GPs to be partners’ and there’s the ‘perception’ that male GPs ‘won’t go off on parental leave’.

That is not to say it is impossible to combine being an independent contractor with having young children. Dr Susan Bowie, a GP on the Shetland islands, says being single-handed worked really well for her parenting and caring responsibilities. ‘I arranged it so that my surgery started at 10am so I had time to get the children out to school, and I was usually home in the afternoon when they came home from school,’ she says.

Dr Hussain says that despite the difficulties, she was ‘lucky’ because she was able to flex the role around her family commitments. ‘I had a lot of flexibility being the partner, I could make it to sports day because I could change my sessions around. So there are advantages.’

Sessional roles

For many female GPs, taking up a salaried role or working as a locum allows for more flexibility when raising young children.

But sexist presumptions about having a family have an impact on salaried GPs too. One GP in the South East, Dr E, describes an experience where she faced ‘real discrimination’ when applying for a role last year.

‘I reached out to a practice about a salaried role and they were really keen to meet me. We were talking for two hours, having a really good conversation. Then one of the male partners asked if I had children, and I asked jokingly whether he can ask a prospective female employee that. He looked a little surprised that it wouldn’t be a reasonable question, and said he was just interested. Later, they said they liked me so much they wouldn’t even put a formal advert out for the role.

‘I later heard from a female GP in her early 30s who worked at the practice that the male partner had said to her: “We hadn’t considered that you might both be off on maternity leave at the same time”. This was despite neither of us having or actively planning to have children. I didn’t get the role in the end. The partners hired someone in her mid-40s as they said she had more experience. I feel that if I’d said I didn’t have or want children, I would have got the job.’

Dr E says she decided not to go down any formal or legal routes because it’s a ‘small world’ and she ‘didn’t want to smear [her] own name’. ‘It definitely put me off working in a GP surgery,’ she adds.

While many female GPs may choose to become locums because it offers flexibility and freedom, some may have felt forced into it. Dr Hussain says: ‘If they want to be eternal locums, that’s fine – but many of them don’t. They feel they’re stuck in this no man’s land forever, because they can’t move forward.’

Around 70% of the National Association of Sessional GPs membership is female, and its chair, Dr Richard Fieldhouse, says many female GPs contact him in tears. ‘The story usually goes along the lines of: they loved their GP training, they became a partner and/or a salaried, and at some stage they felt sidelined or bullied or gaslit. And then they’ve moved into locum work.’

‘Women’s work’

While the unique career structure within general practice may disadvantage female GPs in many ways, a more disturbing issue holding them back is perhaps workload dump.

An astonishing nine in 10 female GPs say certain types of work are disproportionately diverted their way because of their gender. Some of this is due to patient choice – female patients preferring to see female GPs, especially for gynaecological conditions. It may also be the case that patients of all sexes want to see female GPs for personal or psychological problems – as one GP puts it, men might ‘feel that it’s not going to be a competitive macho situation’.

There is, however, a long prevailing attitude of colleagues giving certain presentations to female GPs. Dr F, a GP who worked for many years in Sheffield, says that when she first qualified in the 1990s, she was left dealing with lots of gynae consultations. ‘It was a bit horrible that Monday morning, you’d just have a row of smears in those days – it was so boring.’ Dr Hussain says that right from the start of her career there was a ‘very big assumption’ that because she was a woman she would definitely want to train in coil insertions, women’s health, and children’s health. Dr Bowie says that when she worked as a GP retainer earlier in her career she was ‘only encouraged to see “lady things”’.

This behaviour doesn’t seem resigned to the past. A salaried GP in London, who also preferred not to be identified, says she is assigned certain examinations by male GPs just because of her gender.

‘I would have to do a penis examination, whereas a lot of my male colleagues will refuse to do vaginal exams and book them in with me. It’s a bit weird, but it’s just accepted as part of the culture.’

Whether it is due to the more understandable patient choice, or the less acceptable workload dump by male colleagues, it amounts to the same thing – female GPs being forced to specialise in a medical area they may not be particularly interested in. As Dr Bowie puts it, ‘I’m not particularly interested in gynaecology – that was all just put my way.’ Similarly, Dr Hussain says:  ‘Personally, I have no interest in that at all – I’m interested in all health’.

Even when GPs do have an interest in these issues, this type of workload dump can have serious consequences, such as burnout.

Dr Stephanie deGiorgio, a GP in Kent, says there is a ‘syndrome of the “nice lady doctor”‘. ‘This means that receptionists direct patients to these GPs and their appointment lists are biased towards gynaecology, HRT, contraception or psychological issues. These are often not quick consultations and don’t fit easily into 10 minutes, which means these GPs end up running late.’

‘I have had this exact experience in every practice I have worked in…In one practice, where I was a partner, my job became more and more difficult with me running late. I did numerous time management courses and became more and more burned out, until I realised that the issue was NOT me, it was my patient list.’

Dr deGiorgio says she is not alone: ‘Many female GPs tell me it is why they have left salaried or partnership jobs and changed to locum jobs, because although they love the nature of this women’s health work, as I did and continue to do, it does not fit easily into 10 minute appointment slots.’

She has taken this issue up with NHS England and the RCGP – but says it is ‘never seen as a priority’.

It seems female GPs are often subject to assumptions from their colleagues. Assumptions about when they will have children, about their ability to balance childcare with career, or about their preference for women’s health work. Tackling these prejudices is key to ensuring women in general practice can thrive.

Pseudonyms have been used throughout this article to protect anonymity.