J Epidemiol Community Health 54:10-16 doi:10.1136/jech.54.1.10
  • Research report

Women in hospital medicine in the United Kingdom: glass ceiling, preference, prejudice or cohort effect?

  1. I C McManus,
  2. K A Sproston
  1. Centre for Health Informatics and Multiprofessional Education (CHIME), Royal Free and University College London Medical School, Archway Campus, Highgate Hill, London N19 3UA
  1. Professor I C McManus.
  • Accepted 25 April 1999


OBJECTIVE To assess from official statistics whether there is evidence that the careers of women doctors in hospitals do not progress in the same way as those of men.

DESIGN The proportions of female hospital doctors overall (1963–96), and in the specialties of medicine, surgery, obstetrics and gynaecology, pathology, radiology/radiotherapy, anaesthetics and psychiatry (1974–1996) were examined. Additionally data were examined on career preferences and intentions from pre-registration house officers, final year medical students, and medical school applicants (1966–1991).

ANALYSIS Data were analysed according to cohort of entry to medical school to assess the extent of disproportionate promotion.

RESULTS The proportion of women in hospital career posts was largely explained by the rapidly increasing proportion of women entering medical school during the past three decades. In general there was little evidence for disproportionate promotion of women in hospital careers, although in surgery, hospital medicine and obstetrics and gynaecology, fewer women seemed to progress beyond the SHO grade, and in anaesthetics there were deficits of women at each career stage. Analyses of career preferences and intentions suggest that disproportionate promotion cannot readily be explained as differential choice by women.

CONCLUSIONS Although there is no evidence as such of a “glass ceiling” for women doctors in hospital careers, and the current paucity of women consultants primarily reflects historical trends in the numbers of women entering medical school, there is evidence in some cases of disproportionate promotion that is best interpreted as direct or indirect discrimination.


  • Conflicts of interest: none.

  • * In the UK the career structure of doctors changed in the early 1990s. Before that hospital doctors had proceeded through the hierarchy of house officer (pre-registration and not considered here), senior house officer (SHO), registrar, senior registrar, and consultant. As a result of the Calman Report in 1993, the registrar/senior registrar grade was replaced between December 1995 and January 1997 by a composite grade of specialist registrar (SpR). The data for 1993–1995 are under the old system but provide information only on SHO, “registrar grades”, and consultant, and the data for 1996 give SHO, registrar, SpR, and consultant (registrar presumably referring to those in non-Calmanised registrar posts). For the present analysis the “registrar grades” data for 1993–95 have been used in both the registrar and SR categories, and for the 1996 data the registrar data have been used for registrars and the SpR data for senior registrars.