Shift in UK doctor demographics is welcome but imbalances remain

Since Elizabeth Garrett Anderson became the first woman in Britain to qualify to practise medicine in 1865, it has been a long road to gender parity. Now, for the first time, female doctors outnumber their male counterparts in the UK, according to figures from the General Medical Council, which also reveal that black and minority ethnic doctors are now in the majority.

The shift in demographics is welcome, not least in a profession that has frequently fallen short of meeting the needs of female and minority ethnic patients. There have been a series of scandals in women’s health, from failing maternity units to harm caused by vaginal mesh and the anti-epilepsy drug sodium valproate.

The Covid crisis, when people from black and minority ethnic backgrounds died in disproportionate numbers, put a harsh spotlight on the unequal access and treatment that has long existed. Black women in the UK remain four times more likely to die in pregnancy and childbirth than white women, and black and Asian patients receive worse care for a host of conditions including type 2 diabetes and cancer.

Most agree that a more representative workforce will be crucial in addressing systemic racial biases and a culture of medical misogyny highlighted by the patient safety commissioner last year.

“Diverse teams work better,” said Prof Scarlett McNally, the president of the Medical Women’s Federation and a surgeon. “It gives people permission to challenge things, ask questions and make suggestions.”

And there is ample evidence that diversity makes a difference to patient outcomes. Female GPs outperform males in training exams for the Royal College of General Practitioners and in GMC fitness-to-practise tests, and minority ethnic doctors were found to outperform white British GPs in clinical tests. There is evidence from US research that minority ethnic patients treated by a doctor of the same ethnicity as them tend to experience better health outcomes.

People who are operated on by female surgeons are less likely to experience complications and need follow-up care, according to one study of more than 1.2 million patients, while a second study found that patients had better outcomes when treated by hospital surgical teams that included more female doctors.

Dr Lola Solebo, a consultant ophthalmologist at Great Ormond Street hospital and a researcher at University College London, said: “Research suggests that having a diversity across medical practitioners is great for reducing health outcome disparities. I have high hopes that this change in the workforce brings much-needed attention on women’s health and child health.”

She added: “Women are socialised to talk less and listen more. I wonder if that leads to more empathy across consultations and a more patient-driven attitude to what a good health outcome looks like.”

The latest GMC data shows there are now 164,440 women (50.04%) registered with a licence to practise, compared with 164,195 men (49.96%), and that just over half the workforce is black, Asian and minority ethnic (BAME).

However, the gender balance is not reflected across all specialties or at all levels of seniority. While women are in the majority in obstetrics and gynaecology (63%), paediatrics (61%) and general practice (58%), there is still a low proportion of female doctors in surgery (35%), and in intensive care medicine the proportion of female doctors fell from 41% in 2019 to 34% in 2023.

McNally suggested that the punishing eight-year training period to become a surgeon remained off-putting to many women at a time when many are starting a family, citing US research that found a 42% miscarriage rate among female surgeons, which she said might indicate the unreasonable pressures some faced.

“People are working ridiculous rotas and commuting long distances. If you have small children, you don’t want to be commuting for an hour and a half in rush hour,” she said. “We’ve been delivering healthcare as if we’re in the 1950s.”

She added: “A lot of that could be improved. We need to give more support to get through those critical years.”

Similarly, not all minority ethnic groups make up a larger share than in the wider working-age population. Just 3% of consultants were black, compared with 5% of the working-age population, according to recent analysis by the Institute for Fiscal Studies, and just 1% of UK-trained consultants are black.

“The large representation of non-white ethnicities among NHS doctors should not be taken as a sign that all is well – it may well be that non-white doctors who are succeeding are doing so in spite of unequal opportunities,” the GMC report concluded.

Prof Habib Naqvi, the chief executive of the NHS Race and Health Observatory, said the substantial increase in the number of minority ethnic doctors working in the NHS boded well for patient experience, safety and outcomes, but he noted that doctors from some minority ethnic backgrounds remained less likely to be promoted, more likely to face formal disciplinary processes and referrals to regulatory bodies, and more likely to report bullying or harassment.

“Diversity is not always a precursor to inclusion,” he said. “Unfortunately, while some progress has been made in these areas in recent years, further concerted work is needed.”