The pay gap

The following article is by Dr Timothy Tomkinson, a doctor currently working in the NHS. 

The NHS is a very interesting prism through which to view the recent discussion on the gender wage gap.

Language matters, and a lot of the statistics quoted are misleading to the point of falsehood. Listening to Stellar Creasy last week, she referenced an unknown hospital where “for every fifty nine pence a woman earns, a man earns a pound”

Such a quote gives the distinct impression that men are paid 60% of what men are paid for the same work. Of course this is not true. Men and women are paid the same money for the same work. That has been a legal requirement since the Equal Pay Act in 1970.

It is such a misleading figure to quote, because it simply takes an average of all the earnings of men and comparing it to an average of all the earnings of women within a hospital. There is no mention if this is just within doctors, or comparing all professions within the hospital.

There is a maelstrom of questions here, most of which are valid and merit discussion and debate. The four key ones are:

  1. To ascertain what differences exist in career choice and/or pay
  2. Why they arise
  3. What can we do about them
  4. What should we do about them

We know that within medicine, women, in general, earn less than men over a lifetime in the NHS.

Why these differences arise is more complicated. For many years now there have been more female than male medical students (about 55% to 45%), and indeed there are more female doctors under the age of 30. There are also more female than male GP consultants. However, there are still clearly more male consultants within hospital practice.

Certainly part of it will be a time delay. Before the last ten years, men were the majority at medical school, therefore it makes sense that they would be the majority at consultant level. However this probably does not account for the whole disparity.

It may be there is a culture which needs addressing. There is an argument that some specialities (surgery springs to mind) are male dominated and passively discourage women from applying because they appear like a men’s club.

Another aspect which may be a contributory factor is that women have traditionally been the ones to do most of the childcare. As men are starting to do more of this, overtime the disparity from time out of work to raise a family will become more equitable.

However, there is still an elephant in the room, and that is the issue of personal choice!

Whilst we can strive to make a playing field more equal, there is an overwhelming body of evidence to suggest that – due to our biology rather than our upbringing – men and women have different preferences. As Jordan Peterson points out, in countries such as Sweden, which have done the most to eliminate societal differences between men and women, the effect is opposite to that intended: women choose lower paying, lower prestige jobs like nursing and teaching by an even greater percentage, and men choose careers like engineering even more.

The same applies in the UK. For whatever reason, women often prioritise lifestyle over work and therefore end up choosing specialities or career paths which pay less. A lot of the reason for this is that such jobs require fewer on-calls, and more regular, less anti-social hours. For my part I think they’re much more sensible to do so and I can’t see any incentive to work longer hours if it won’t make me happy. However, more men than women do see such incentives.

There is a concern that if the goal becomes eliminating the difference between the average wages of men and women, authoritarian steps will be taken to achieve this. When we assume that it is institutional bias which is the cause of differences (as several people imply), rather than personal choice, we then assume that any means to eliminate that gap become desirable government policy.

Parliament already has all-women shortlists for some constituency posts, with a view to achieving greater representation of women in our parliamentary system. Is this sensible in a medical context? Would the general public prefer to be treated by the best doctor, or one who was appointed because of her gender? The logic is the same. The only difference is that promoting less competent women in a parliamentary setting, has as its downside the fact that we are exposed to Diane Abbott and Liz Truss more than we would like. However, if it were applied to other professions, like medicine, then the downside would be more measureable – patients would suffer.

Along with that, most female doctors I know would find it hugely patronising to think that they were given positions because of who they are, not their ability to do a job.

How do you “solve” the difference in earnings between male and female doctors? They have the same education, but for whatever reason, men and women prefer different things. Although it will be possible to reduce this over time by measures addressing work culture and parental leave, the gap will be impossible to eliminate without coercive measures. Let us hope we don’t continue down the authoritarian route we’ve started.

Or we could just stop paying men extra for doing anti-social hours and night shifts. I wonder what would happen then…

All views expressed in contributions by named authors are their own and may not reflect the views of The Freedom Association.

Photo Credit: The Blue Diamond Gallery 

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