Sexism in general practice begins in training – it’s time we faced it

Drawing on her own experiences and those of colleagues, Dr Louise Clarke highlights the ingrained sexism affecting GPs from training levels

Last year Pulse brought long-overdue attention to the entrenched sexism in general practice with an investigation that involved surveying over 700 female and marginalised gender respondents. The findings were stark. Women were underrepresented in GP leadership roles; reported being held back due to gender; and routinely faced sexual harassment from both colleagues and patients. We already knew that general practice has the largest gender pay gap in medicine – even when other factors such as full-time equivalency are accounted for – and the investigation emphasised this too.

A year on, and sexism in general practice is still as salient as ever. Just last week, a retired surgeon said on Times Radio that the increase of women in the NHS workforce was problematic as ‘women go onto have babies’. He specifically singled out general practice, saying: ‘Most of the women are working part time and that is one of the reasons why patients cannot get access to the same GP all the time.’ His comments are a blatant reminder that misogyny in medicine still exists.

But I want to reflect on where these attitudes come from. They certainly don’t suddenly emerge post CCT; sexism is baked into the system from the very start, at trainee level. While no equivalent survey has been conducted among trainees, the problem is clear from anecdotal accounts. Female trainees frequently receive unsolicited advice on everything from appearance to family planning, struggle to organise flexible working,  and instances of sexual misconduct remain disturbingly common.

General practice pushed as a path

When I became unexpectedly pregnant during my F1 year, I was suddenly met with a barrage of unsolicited advice. People made assumptions about my ambitions, my capacity, even my value as a trainee. My educational supervisor wrote that he couldn’t comment on my future in obstetrics and gynaecology due to my ‘personal situation’ – despite me having repeatedly expressed interest in the specialty.

Later, I was steered toward GP training purely because I had a child. While I’ve since found real fulfillment in general practice, I believe I could have succeeded in another specialty had I chosen it. Others have faced similarly reductive guidance.

Dr A was once told by a consultant, during handover: ‘I can smell your ovaries – that’s why you’ll never make it to the end of any specialty training other than GP.’ Another trainee, Dr P, was advised by a senior male doctor to avoid emergency medicine because it could ‘impact [her] chances of finding a man, getting married and raising a family.’

These are not outdated anecdotes. They are still happening.

Sexual misconduct

The most distressing stories, however, are those involving sexual misconduct. And trainees may be especially at risk. In a 2025 GMC survey, 9% of female doctors in training reported experiencing unwelcome sexual comments or advances that caused embarrassment, distress or offence – more than double the rate for male trainees.

Soon into my F1 year, a consultant came up behind me and placed his hand across my buttocks. I moved away and carried on, but later that day, I broke down and told other junior doctors what had happened. We agreed that the ‘safest’ option was for a male colleague to swap teams with me. No one asked why. In retrospect, I realise this behaviour was known, tolerated, and unchallenged.

Other women have suffered worse. Dr F shared a horrifying incident where a registrar asked her to perform an unnecessary testicular exam on him for a sign-off. He began undressing and physically restrained her when she tried to leave. When she reported it, the service lead brushed it off as a ‘cultural misunderstanding’ because the registrar had recently arrived in the UK.

Why trainees don’t report

At the time of the incident I described above, I didn’t report it. I didn’t know how. I was newly pregnant, unsure of the system, and afraid of the career consequences. And looking back, it’s clear the consultant’s behaviour was not a one-off; it was known and tolerated. There’s a complicity at the upper levels of the system.

Trainees also don’t speak up because the cost feels too high. Trainees rely on senior colleagues for assessments, references, and rotations. The structures are deeply hierarchical and often opaque. Even when doctors do report misconduct, they are frequently met with apathy or subtle threats to their progression.

In some cases, it’s clear that the perpetrator was shielded because they filled rota gaps or brought in valued clinical skills. Institutions that face chronic staffing issues often choose to protect themselves rather than the most junior, most vulnerable people in their workforce.

We urgently need better systems to support trainees and keep them safe. That includes:

• Confidential, multi-route reporting tools, including anonymous option
• Thorough and prompt investigations, led independently of the department in question
• Protection for the reporting party, both emotionally and professionally
• Real accountability for perpetrators, as well as departments and leaders who fail to act

It also requires cultural change. Trainees must receive thoughtful and respectful advice about their careers; not paternalistic assumptions about their reproductive futures. Senior colleagues should model equitable behaviour, and challenge those who don’t. And men have a role to play too: as allies, as active bystanders, and as people willing to reflect on whether their actions (or silence) enable harm.

Training structures that enable harm

While many think of GP training as a relatively flexible and supportive route, trainees still encounter systemic issues, particularly those working less than full-time (LTFT). Women remain the vast majority of LTFT trainees, often because of caregiving responsibilities.

When I started LTFT training 12 years ago, I had to find my own job share, was restricted to working exactly 50% FTE, and received no return-to-work support after maternity leave. While some of these barriers have eased, challenges remain. Rotas are still frequently issued late, often changed without warning. Despite BMA guidance recommending six weeks’ notice, this is often ignored. And since it’s ‘just guidance,’ there’s no obligation to comply.

I’ve spent countless evenings frantically messaging friends and family to arrange emergency childcare or pleading with colleagues to swap shifts. LTFT trainees are also frequently targeted for extra out-of-hours shifts, since adding weekend nights doesn’t technically breach working time regulations for part-timers.

Sexism in general practice does not begin at partnership level. It is baked into the training pipeline. If we want to change the future of the profession, we need to start at the very beginning and support trainees. That means recognising that gendered assumptions and abuses of power can derail careers before they’ve even begun. It means creating a training culture that is safe, accountable and responsive, where concerns are not just heard but acted upon, and where junior doctors are treated with respect, regardless of their gender, background or working pattern.

The future of general practice depends on attracting and retaining diverse, talented doctors. We cannot afford to lose them to silence, burnout, or preventable harm. Addressing these issues at trainee level isn’t just the right thing to do; it’s essential for the survival and integrity of the profession. 

Dr Louise Clarke is a salaried GP in Derbyshire and an academic at the University of Nottingham