The Glass Slipper and Other Challenges for Women in Medicine

Rachel Morris: One of the things that frustrates me so much is that even in 2023, we often see women taking on the brunt of the childcare, the household chores, and the emotional labour. And it’s no better in medicine. We know that the gender pay gap in medicine, if anything, is still massive and still growing. So with up to 60% of the medical workforce being women, why are we still in this situation, and how can we make it better?

In this episode, I’m chatting with Professor Chloe Orkin and Dr Nuthana Bhayankaram from the Medical Women’s Federation about their many experiences of sexism in medicine, why it’s an issue, and just what we can do to change things. Chloe and Nuthana share their experiences and discuss some strategies for action. Yes, the medical world of work can still be very difficult to navigate as a woman, but there are ways in which women can self-sabotage, perhaps by not applying for jobs until they can tick nine or 10 boxes out of 10 and by some of their own unconscious biases.

There are some small but powerful things we can all do about this. Sexism is a problem for everybody, no matter what’s your gender. So listen to this episode, if you want to know what the glass ceiling, glass cliff, and glass slippers are and how to avoid them. And finally, why it’s not always helpful to call stuff out immediately, and what to do instead.

Welcome to You Are Not a Frog, the podcast for doctors and other busy professionals in high stress, high stakes jobs. I’m Dr Rachel Morris, a former GP now working as a coach, trainer, and speaker. Like frogs in the pan of slowly boiling water, many of us don’t notice how bad the stress and exhaustion have become until it’s too late. But you are not a frog. Burning out or getting out are not to your only options. In this podcast, I’ll be talking to friends, colleagues, and experts and inviting you to make a deliberate choice about how you live and work so that you can beat stress and work happier.

Are you a busy, even overwhelmed, leader struggling to manage your own work on top of what you’re doing for everybody else? Do you find advice about setting boundaries and saying no just doesn’t apply because the buck always stops with you? Join me for a free upcoming training called ‘If I Don’t Do It, No One Will: The Ultimate Guide to Loving Your Limits for Leaders Who Do It All.’ You’ll learn practical ways to reduce stress and create more time, even when you’re the person everyone else relies on. It’s happening on the 27th of March at 8pm, and there’ll be a recording if you can’t make it live. Register for your place at the link in the show notes or at shapestoolkit.com/doingitall.

So it’s really wonderful to welcome onto the podcast today, Professor Chloe Orkin. Now, Chloe is a Professor of HIV Medicine at QMUL. She’s a consultant at Barts, and she is the president of the Medical Women’s Federation, and, so I’m told, world expert in monkeypox. What amazing spectrum of things you do. It’s wonderful to have you here. We’re going to talk about all of that in a minute. I’ve also got Dr Nuthana Bhayankaram. Nuthana is apaediatric registrar in the North West, and she’s also the Vice President of the Medical Women’s Federation. And she’s host and co-producer of The Medical Women Podcast. I have actually been interviewed on Nuthana’s podcast, so it’s nice to flip roles now, and I get to interview her. So welcome.

Dr Nuthana Bhayankaram: Yeah, lovely to be here, Rachel.

Rachel: Today, we are going to be talking about women, women in medicine, and there’s all sorts of things that I would like to know. Obviously, as a former GP and woman in medicine myself, I know what it’s like, and it would be really nice to be able to unpick some of the issues that are going on and also work out what is it that we can we can all do about it. Because if I’m right in thinking, sexism in society and medicine is not just a problem for women, is it?

Prof Chloe Orkin: No, sexism is not a problem only for women. And I think people think about sexism as something that happens to women and that men perpetuate, and I think that that is often true. But sexism is, really, at its heart, it’s around unconscious bias, and it’s about the snap judgements and our snap opinions that we have about what a woman should be, what they shouldn’t be, and what are the qualities of a woman.

It’s not only men that imbibe these views, but women do too. Women internalise these things, and then they enact them on each other. To be honest, as a doctor in the workplace, what I’ve noticed is that, when I was a junior doctor, I didn’t really notice sexism particularly at those grades. The further up I went, and certainly when I took on national leadership roles, that was when I really started to notice sexism. And it wasn’t just from men; it was very much from women.

I think that what happens is that, I think women experience what we could call internalised misogyny. They sort of minimise the value of themselves. They mistrust women themselves, and they actually believe in the gender bias in favour of men. When you watch societal beliefs, which demean the value and skills of women around you all the time, eventually you start to believe they are true.

I think that’s what underlies the fact that, like in political situations, where you would think that women would be really shocked by some of the politicians’ policies and abortion, various things, and yet politicians like Trump were massively supported by women. I think part of that is because of what they think of themselves. And then if they see a woman who is not conforming to that and is not inhabiting these gender norms, that’s really threatening, and that’s when women on women, sexism starts to happen — when a woman steps out of the box that they should be in.

Rachel: So interesting, isn’t it? I think— the reason for my question was just thinking, actually, is this just a podcast for women to listen to, to make their lives better? But actually, you’re right. It’s not just for women. If we nailed the sexism issue, it would be better for everybody because God knows we need some really good women politicians, don’t we, who aren’t having to conform to gender stereotypes and gender norms. So this is to make things better for everybody. You guys are running the Medical Women’s Federation. I’d love to hear a bit about how that started. Because it’s not a new organisation, is it, Nuthana?

Nuthana: No, it isn’t. February 1917 was when the Medical Women’s Federation was formed. If we think about society at that time, we were in the midst of World War I. So during the First World War, lots of the men who were doctors had gone out into the frontline, and that meant that back in the UK, we didn’t really have that many doctors. So women were finally allowed to step up and be medics in that time because we needed to have medics. But then when it was the end of the world war, and men were coming back, it was expected that these women doctors would give up their posts for the men because they had been out in the war, and now they were coming back.

Some women were actually allowed to go and be doctors for the army, but they were never treated the same as the male doctors. They weren’t given the same roles and responsibilities, and were definitely treated as sort of second class to the men. So it just brought about lot of societal changes. And so a group of women formed the Medical Women’s Federation because they wanted to support women in medicine, but they also wanted to support women and girls in general society.

So they used to go out and do talks at schools. They used to do their own research because there wasn’t much research about menstruation or menopause or things that are women’s health. So they really championed all of that as well. Then since 1917, the Medical Women’s Federation has been the largest body of women doctors in the UK and the voice of medical women on medical issues.

Rachel: But how was the representation of women in medicine have grown since then? Is it just been exponential? Or was it really, really slow start, and it’s just sort of blossomed in the last few years?

Nuthana: When you look at the data of women in medicine, in 1922, 5% of doctors are women. Whereas now 2020 to 60% of doctors are women, which is fantastic. We have made lots of progress. But when you then look at the grades of those women, it’s more junior women. And if you look at seniority, women are still genuinely outnumbered, and particularly in academic positions or positions of leadership. There isn’t as much representation of women, so I think there’s still quite a lot to do in that space.

Rachel: Nuthana, you’ll be the first trainee who’s been vice president of the Medical Women’s Federation, so congratulations. I’m really interested in what your experience has been and what Chloe’s experience has been in coming up through the ranks. Chloe, what decade were youa junior doctor? I was a junior doctor in… 1998 was my first house job.

Chloe: Yep, so pretty much exactly the same. Okay, I came to the UK from South Africa and I did some my sh o year and 1988 started becoming a registrar 99 Yeah, very contemporaries Rachel.

Rachel: Yeah, okay. I must say it was it was shocking. I mean, I think I just thought it was normal. But we had one consultant. He was a surgeon who was incredibly sexist, misogynist openly on ward rounds, you know, just ribbing us for being girls, being doctors, and just being really, really rude, but we just sort of, it’s like, ‘Oh, we’ll just avoid this man,’ you know, ‘he’s always like that. We know he’s horrible to work with. We just have to put up with it’. And then I think we were definitely treated very much differently by the nursing staff as well. And I’m just wondering, was that your experience as well? Certain personalities were very sexist, everyone knew you just had to shut up and put up.

Chloe: It’s interesting you say that because I’ve often thought that I only really started to be really aware of gender as a problem when I moved into leadership, but when you say that, I think I just thought that that was what life was about. Like, I didn’t see that that was a problem or abnormal. That’s just how it was women were seen as mad and as unreliable, and the hierarchy was a male dominated hierarchy. The male doctors were poured cups of tea by the nurses and the female doctors were questioned. I thought that that was just how life was, but I think when I really became aware of sexism, I was aware of it as registrar, but I think when I became a consultant, I really started to feel that much more so when I moved into leadership position.

Because I took the role of the chair of the British HIV Association very young, much younger than anybody else. And I think that the combination of ageism and sexism is a particularly pernicious combination. I think I experienced both, and I think what happened then is that I ended up having to manage situations and lead. When you have to lead, you need to have some levels of confidence and assertiveness and clarity and firmness. And those qualities are not necessarily wanted qualities in a woman. I think when women shows those qualities, they’re seen as contravening gender norms, and if you don’t show them, then you’re weak and useless.

I really experienced sexism to the point that I actually ended up joining in the Medical Women’s Federation and standing for vice president because I just felt like, well, I’ve experienced— this is a problem. You know, the experiences that I went through, I really felt really shocked. It was sexism for men, for women. It was all in one mess. As a leader, there were two key things that happened there. One was that I’m an academic, and I presented data on a novel therapy in HIV abroad. It was the first time a drug had ever been used in this way. And I go here to give a lot of interviews, press interviews, including a television interview, and it was trolled. It was trolled all on the basis of what I look like.

Actually my wife saw it, and she said to me, ‘Don’t look at it. You’ve been trolled’. And I said, ‘Well, what do you mean?’ I thought I gave a… I was describing the drug, you know, everything. ‘What did I say that was wrong? I thought it was okay.’ And she said, ‘No, it’s not about what you said. It’s all about what you look like’. It was just 115 comments or more, 150 comments about my face, my hair, my clothes. You know, lesbian.

There was even a transphobic remark — ‘is that he or she’ is an example. They did not take anything I said seriously, these comments. It was not about what I said; it was purely— all they could see was a woman, a nonconformist woman. That’s all they could see. I just thought if when a woman speaks about science, that is literally all that people can see. There’s a serious problem in our society, and I wanted to be part of the solution. So that was experience one.

Then the other one was, when I was the chair of this organisation, there was a conference, and a senior woman got on the stage and basically experienced an extreme slur from another senior male doctor who was known to be a misogynist. But basically, he insulted her appearance and basically sexualised what she was wearing. He was xenophobic; he was misogynist, it was quite shocking. It was on the stage. I immediately sounded the alarm, made a complaint, and I was being flooded from the junior doctors — the men and the women — very upset, etc. What happens if I get on the stage? Then I sort of sought support from my senior colleagues, the women, and they just said to me, ‘It’s banter.’ Like, ‘Why are you doing this? It’s just this person. That’s just how they do things, as banter;. They resented the escalation. And it wasn’t everybody, but it was some people.

They wouldn’t sort of support the message that I tweeted out. It was like I’d done something wrong, and I was making a big deal of things, and I was creating a problem. I was devastated. I mean, I would never have kept quiet, and I did. You know, I really call this out. But it was a huge personal consequences for me. You know, I felt very estranged and isolated, and I really questioned, you know, everything. I watch sexism; I tried to call it out, and then I’d experienced some sort of ostracisation, I guess. I think that’s when you realise that you’re sort of caught on both sides.

The men weren’t happy about it either, that I called it out. That was just, ‘There she is being strident, being this… You know, the words that are applied to women that are not used for men, bossy, strident, so it was very tough. That inspired my journey into the Medical Women’s Federation.

Rachel: Podcast listeners won’t be able to see they’re shocked and horrified looks on my and Nuthana’s face because that’s just awful. Do you think if a man had called that out, he would have been ostracised as much?

Chloe: That would have been, you know, a robust conversation, making a good point, standing up for what’s right. It’s just what I did was challenging, and it was clearly challenging all around. It really exemplified for me what the problems are. And that internalised misogyny, and these pervasive norms about what a woman should be, the prohibitive — what one shouldn’t be, one shouldn’t be assertive, strident, it’s not nice. You know, women shouldn’t criticise, shouldn’t be so critical.

People said to me, ‘Why don’t you speak to him first? Why don’t you take him aside’? I said, ‘This is a public stage. People are watching this young. Woman in the audience are thinking, “Is this gonna happen to me if I get on the stage”’? There’s things that have to be called out and there’s time for a quiet word, and there’s time for ‘This is not okay’. And, you know, why as a female leaders is it not for me to say ‘this is not okay’?

Rachel: Why do you think the women, the senior women, were not prepared to call it out? Do you think it was because they genuinely believed it was banter and they genuinely believed it was okay? Or do you think it was because they were just scared of calling it out themselves, and they’ve had to adapt themselves so much just to fit in?

Chloe: I think it’s hard. I think people have relationships, and nobody is one thing. Just because someone behaves badly and says something that’s really inappropriate and unacceptable, it doesn’t make them entirely bad. They have really good qualities in other ways, but they’ve also said this thing, which is unacceptable. And I guess some people may have seen this person as a whole person rather than a statement, and may have felt that I wasn’t doing that. I was responding to a statement rather than to a person. But I think that in a public situation, the things that shouldn’t be said and shouldn’t be allowed. I think it’s complicated.

Rachel: Hard, isn’t it? I know, when we were chatting earlier, you said that there are real barriers to progress for women that we we possibly don’t see. I mean, there’s some obvious barriers to progress, which is the fact that if a woman wants to have a child, she has to have the baby and take maternity leave, that is if you’re not adopting, whatever. So there’s that spirit. Then often, the woman is the main caregiver staying at home. So there’s that sort of obvious barrier. But I know there’s some other ones. What what barriers have you perceived? And what have you experienced, Chloe?

Chloe: I think what’s really interesting, there’s a lot of social theory and being an academic, I could actually— I love this stuff. But anyway, I’m not going to try not to be exceedingly boring.

Rachel: That’s fine.

Chloe: But what I’ll tell you is that there’s all these concepts is almost metaphors to describe what the barriers are. And what’s interesting to me, and I’m going to mention them, is almost all of them are metaphors, which are about precarity. Most of them are about glass, okay, and they’re about falling. It’s like having these horror dreams where you fall, you crash. This is what the words are, and language is so important. Our language defines our thoughts and our world.

Basically, we think about the leadership theories, what we know is that women are less likely to apply in medicine for leadership positions, okay. And that also, women are less likely to apply for specialties which are male-dominated. So for example, things like surgery, orthopaedics, ophthalmology, and these are often the most lucrative specialties. So this is also important. The senior roles actually are important, they allow additional payments. We know that these can inform and contribute to the gender pay gap. Women are less likely to apply for Excellence Awards, both locally and nationally, and therefore, if you don’t apply, you don’t get them. There is this gender pay gap, which is a real proxy for inequity.

But if we think about what these barriers are, we all heard of the glass ceiling, haven’t we? The glass ceiling, which is the barrier, the invisible barrier that prevents women from applying for these roles? And yes, you’re right, Rachel, there’s all these things around the motherhood penalty, and caring responsibility. But I think that the biggest barrier people talk about the biggest barriers, the ‘broken rung,’ and this is about not applying for these roles because you think you’re not going to get them.

The theory is that sometimes it’s about simple things like how these roles are advertised and the language of the roles, and if the job description is littered with terms like robust, ultra, competitive, ‘in order to do this, we require strong leadership.’ If it’s full of sort of male gender norm words, women look at it and think, ‘Oh, this isn’t for me’. You know, requires robust leadership. And if you think about, you know, ‘building a team,’ ‘collaborative,’ ‘creating together,’ women can see themselves in the role. There’s there’s lots of reasons people don’t apply. But I’ve just given a simple practical example.

Then the glass cliff. And I think I’m afraid we’ve many of us have seen in the UK, the glass cliff very recently, I won’t specify. But the glass cliff is a situation when, basically, in corporations, it’s when the corporation is in freefall, things are catastrophic. Investors are devastated and whoever’s been leading has been a complete disaster. ‘We need a total change. Let’s bring in a woman’, okay.

That’s when they’re willing to countenance the idea of a female leader. But of course, when you come into a complete disaster situation, the likelihood of failure is extremely high. Then, of course, when you fail, it’s all put on the woman. ‘We can’t do this again. This is what happens when you bring in a woman. It’s a disaster. They’re completely not up for the job. They’re not fit for the role’. And obviously, that’s really damaging. It’s not an accident that when things are catastrophic is the time that a woman gets in. This is a pattern that’s called the glass cliff.

Then there’s a glass slipper, which is about how the slipper that you wear you don’t fit into. There’s a particular slipper, which is your gender roles, and how you don’t put yourself into things that you don’t think you fit into, you’re going to be recognised by your qualities. And you know, this role has got nothing to do with your qualities. And it’s about how stepping outside of your gender norm leads to social penalties. I think that’s what I was describing in my example.

When you behave with the leadership traits, strong, competent as a male roles, and you’re not being collaborative, perhaps I should have sat down with everybody and said to them, ‘what do you think I should do rather than taking action’? You know, perhaps that would have been more acceptable. But I think there’s often that paradox of women who behave in an assertive way in a way that a man might behave in a situation may be respected, but not liked, necessarily. When you’re authoritative or dominant, and there’s all of this precarity theory, it’s amazing how precarious these words are and how precarious women feel about their leadership roles. Women feeling they’re on eggshells in these situations.

There’s one quote that I’ve heard, which I just absolutely love, and it’s from Melissa Marchonna. It says, ‘You should teach your daughters to worry less about fitting into glass slippers and more about shattering glass ceilings.’

Rachel: I love that.

Chloe: And I’m not sure how we do that.

Rachel: I’m really interested in this thing about women not applying for jobs and things like that because I’m also reminded of a friend of mine who works for an organisation, and she was recruiting. She said she was really shocked recently. So they had completely blindly looked at CVS. She thought, ‘Well, there’s no gender bias here’, and she’s a real women’s advocate. Something like only 20% of the people they shortlisted were women. She immediately went, ‘There is something wrong here because I know that’s ridiculous. I know it should be at least 50% for this role’. I don’t know whether it’s a lack of confidence. But the problems that women have with applying for roles, if they don’t think they’re good enough, is that learned behaviour, or is that ingrained in who we are?

Chloe: It’s learned behaviour. I’ve helped a lot of women to apply for National Excellence Awards, and you read the applications. Everything’s about we, we, we. It’s just because we see things differently. We are socialised to be different, and we see the world differently. A man will tell what they’ve done. And a woman, it’s like, you have to suck it out of the sentence in the passive voice. It’s not comfortable. I think women are worried about being seen to be pushy, and they don’t even imagine they could be in the role. They have to be tapped on the shoulder. It’s a lot about the job descriptions, but it’s also about what women write in application.

Nuthana: I remember it was at a previous Medical Women’s Federation Conference where somebody stood up and said that when you look at job applications, women won’t apply for a role unless they tick nine or 10 of the 10 boxes. Whereas men will apply if they tick five of the boxes. So we’re taking ourselves out of the game there by not applying because we think, ‘Oh, well I only tick seven of the 10 boxes, so I won’t apply’.

I think a lot of the thing that’s annoying is with the things they say or with the Excellence Awards, women aren’t applying, so of course more men are getting them, but we need to be encouraging the women to apply. Just being told that information, I then was like, ‘Right well I’m gonna start applying for things where I do tick just five of the boxes rather than 10’. But if we don’t know that and we’re not encouraging women, then they’re not going to be applying for the role. So I think there’s system changes that need to be made, but as individuals as well, there are things that we can do.

Rachel: It’s interesting, Nuthana, because obviously you’re a trainee, I presume you’ve been brought up in a slightly different decade to me. Because when I grew up, it just had that inbuilt gender bias and must have done because when I got married, off to uni, I never once thought that my career would be any different from my husband. Maybe I was just really, really naive.

But you know, fast forward 10, 15 years, I’m the one part-time. I’m the one taking the bulk of the child care. I’m the one having to sort everything out. I’m the one taking the career break. And we grew up in houses where that’s the role modelling we’d had. Our mothers had both stayed at home looking after the kids, and it was just accepted and ingrained. That is what you do. Now, I still see, if I’m honest, the younger women in medicine still doing the bulk of the childcare, the bulk of the emotional load, even if they have a full time job. I’m curious as to has it changed? And if it hasn’t, why is that?

Chloe: I mean, one thing I’ll say is during code, I mean, there was study after study, country after country, women doing upwards of two thirds of the unpaid work. And in this country, our country, there was an advert, at some point in the pandemonium of it all, depicting life in COVID house as it is, and it was a cartoon from the government. Basically, the pictures were of a man lying down on the sofa and a woman handing him food. Then there was a picture of women with the children doing this, the man working at his desk. And obviously, there was like a massive public outcry. Because this is actually the vision of, you know, what life should be in the UK coming from the government. Somebody actually thought this was a really good depiction, And the problem is, it was very true to life. That’s exactly what was happening.

But that’s not the ideal, but I think this is what people are experiencing. I think part of the problem is that parental leave is a big problem. Shared parental leave is a big problem. And there are countries in Scandinavia that have schemes where it’s use it or lose it, and you get equal parental leave. It’s divided up, and you take it, or you don’t take it, and the one goes off, and the other one goes off. And it’s a fair system. There’s an expectation of parity. Our system is not like that — the onus falls on the woman. There’s a huge motherhood penalty, where you leave off and then you come back, and your husband has advanced three years or two years, two years ahead, they’ve applied for a registrar post. It adds up; then there’s a second child who happens again.

Each time you are out of the workforce, you have to catch up. You lose confidence; your head’s in a different place, then you come back. I’m saying this, I’m completely ignorant. I’ve haven’t had children. I have animals, speak from my experiences and animal mother of five. But I think it’s a problem; it’s a penalty. And each time it adds up, and then you get back, and you think, ‘Well, there’s other people applying for roles. But it’s too early. I haven’t actually been here for two years’. It adds up.

Rachel: Is that your experience, Nuthana, in terms of yourself, your colleagues? What are your expectations?

Nuthana: Sadly, I feel like things haven’t really changed. I guess it’s still a societal thing that it’s still very much expected that when it comes to things like childcare, that women will be more responsible. As Chloe said, because we have a system where women get maternity leave, men get two weeks of paternity leave. You’re forcing women that have children to take more time off work.

The British Medical Association, they did a whole survey on sexism in medicine, and there were quite a few doctors who were women and their partners were doctors. And they said, ‘He knows that I’ve got all this increased clinical workload because he’s a doctor, I’m a doctor, but I’m the one that’s expected to do all the homeschooling and everything at home.’ It just shows that there’s still so much to do, to change, in medicine and in wider society.

Rachel: It’s interesting, because in my work with sort of other organisations outside of medicine, the COVID thing has massively put women back because whereas women would get childcare to go to work, and I think one thing about being a doctor is you have to, mostly, unless you can consult with them, you got to get childcare to go to work. A lot of places that now working from home, their partners has gone, ‘You don’t really need childcare. You can go pick up the kids from school and keep working’. And you cannot concentrate on working while your children are at home. You just can’t.

Then if you’re not going into the office, I did hear someone talking about this. It’s a massive problem for particularly women and people with disabilities because they’re choosing to stay at home, because it’s not easy to go into the office. But what happens is you have the meeting, and then it might be the meeting online, but then what happens after the meeting? Everyone goes and talks in the coffee room or in the office, and the people that are at home miss out on those informal chats, that stuff that goes on. I guess it doesn’t happen so much that things happen at the golf course or in the pub after work, but it might do. you know, the women, you gotta go home or if you’re part-time, you miss out on that. So there’s all that really intangible stuff, I think, that just rules women out of it.

Chloe: And I think you’ve touched on intersectionality, how different parts of someone’s identity can become additive or multiplicative in terms of making them feel othered or isolated. So being a young woman, you would experience ageism and sexism. Being a disabled woman, you would experience ableism and sexism. Being young, disabled woman, you would experience all three, and being a black, young, disabled woman, you would experience all four. Each of these things compounds, the experience of being other and sort of also compounds that amount of stereotyping that you will experience because you’re being stereotyped in four different directions. I think that that’s a very important thing that you’ve mentioned.

Rachel: So we’ve talked about a lot of problems, the glass ceiling, the glass cliff, the glass slipper, which I’ve not heard of before, but that concept so rings true. What can we actually do about this? Because we’ve all identified it as a problem. And I would really hope that I wasn’t behaving in a way that was sexist towards other women, but I know that there’s a lot of stuff around unconscious bias. That’s the problem with unconscious bias. It’s unconscious; we don’t know we’re doing it. So in Medical Women’s Federation, what are you saying people could do should do? I know we’ve got two levels, we’ve got the organisation level, but you’ve also got an individual personal level as well.

Chloe: I’m the lead for Equality, Diversity and Inclusion for the Faculty of Medicine at Queen Mary, and what I can tell you is, the work is — it’s glacial progress. But that’s not because of Queen Mary. That is because this work is glacial and because it’s all structural. It’s about process, building in things like citizenship, which is where, you know, women often do a lot of the mentoring within universities, the supporting, and that’s unpaid work like in the home. And it’s often unrecognised. So building in categories that recognise and value that work and give it a name. And building in is one of the categories that is part of the promotion process to make visible what has been seen as invisible or not valued.

So it’s about building structures and into recruitment, how you write job descriptions, making people aware that if they use certain words, people are less likely to apply. There’s many things you can do. But it’s all about process and structure. I have very little faith in individual change because I feel that we, unconscious bias, once we start to say, ‘Oh, we all have it’, we all feel like we’re helpless. I think we have to change the structures to make them unconscious bias proof. Because we can do that with our rational minds while we’re trying to do something positive.

Rachel: Chloe, it does strike me that part of the challenge of inclusion and diversity is actually convincing people that it’s needed because, presumably, what you got to convince is the white males in charge that it’s needed, right?

Chloe: Correct.

Rachel: How do you do that?

Chloe: Well, I think it’s about humility, more than anything. My experience is, you’ve got to try and maintain some equanimity and not personalise people’s views and to see people as on their journeys. We’ve all been socialised in a certain way, and you’re describing things which actually are quite threatening to masculinity, in a sense, because people are thinking, ‘All these women are coming up with space for me, are they going to be prioritised’? People have their own fears, and I think it’s just about being respectful. The way I think about it is assertive diplomacy — doing EDI work as assertive diplomacy. And if you go overboard, it can’t be heard because people just see you as a zealot, and there’s no point.

Rachel: Is there something as well about it isn’t just about being nice to everyone and making people feel good. But actually, the performance of the organisation is going to be better if we get this all right. Because there’s there’s huge amounts of evidence for that, isn’t there?

Chloe: There’s huge amount of evidence, and I think it’s not pleasant to be the bleeding heart. Because I’m on the executive board, and I sit there as my job to call things out. And I also want to be taken seriously as an academic. But you have to be very committed to do this work, but it’s very rewarding because when a process changes, and you understand that you actually safeguarded a process, it’s invisible, bless your progress. But it’s really gratifying when things start to change.

Nuthana: I guess, I think, yes, there are lots of system changes that need to be made. But that doesn’t mean that at an individual level, are powerless to do anything.

So I think on an individual level, just thinking about things like if you’re organising teaching sessions, for example, junior doctors organising teaching. If you’ve got colleagues that are working less than full time, and it is generally women who are more likely to be working less than full time, although at the moment, I have lots of male colleagues who do that as well for for various reasons, and just being mindful of the fact that people work on different days and trying to alter when you have your teaching so that it’s not the same people missing out on those opportunities. I think that’s something that’s really easily done, and yet most departments don’t think about doing it.

Another thing is things like conferences. I did a project with my sister a couple of years ago while we were looking at the Royal College conference panels, and the majority of Royal Colleges, they have got more male speakers than women speakers, and more speakers with white skin than those from minorities. Just being mindful of that. I think, if you’re organising a conference, think about who is going to be on your panel. But also, if you’re going to a conference, delegates have a lot more power than they think they have. Conferences aren’t going to run without delegates. So pointing it out and speaking up and saying, ‘Oh, I’ve noticed that this panel isn’t very diverse. Can you do something about this’?

I think, as clearly said, accepting humility, and that we’re learning and that we are making changes is really important. It is difficult because we don’t know what our unconscious biases are. But I think if you really reflect on ‘in what ways might I be privileged’, because all of us are in different ways.

I don’t think I really thought about this until about a year ago. I had an experience where I was working with two colleagues who happen to look very much like me. They were also women, and they also had brown skin, but I speak with a British accent, and they don’t. I was noticing that I was being treated very differently by members of the MDT compared to them. So there’s a lot of bias going on here that I don’t think I had picked up on before.

I think we do all have different privileges, and just spending a bit of time thinking about what our unconscious biases might be, and in what ways we have privilege, and how we can do something to help those who don’t share those same privileges with us. I think it’s how each of us as an individual can make a difference.

Chloe: I think, honestly, the younger generations are very articulate around language and privilege. They understand these terms. I think it’s interesting how young people have grown up with #MeToo movement; they’ve grown up with Black Lives Matter movement. The word intersectionality as part of their lexicon. They know what it means. They understand additive; they understand privilege — that’s going to make a better world. This knowledge coupled with the change that’s taking place is going to pave the way. I mean, there’s a hell of a long way to go. Let me tell you.

Rachel: Of course, the gender pay gap in medicine; I don’t think it’s closing very much is it? In fact, it’s probably getting worse from COVID. Yeah. Which is thoroughly depressing. We had Dame Jane Dacre on the podcast, really early episode, actually, she’s, she’s amazing. I’d love to finish off because I know we’re nearly out of time asking you because we talked a lot about unconscious bias and the things that we do, but what about the conscious stuff? What about the blatant overt sexism that we see thing that close already talks about? When you call it out? You’re told it’s just banter? Have you got no sense of humour? What do you do about the mansplaining? In meetings, or the people, you know, the man that’s just sort of jumping in with the women’s idea and the women’s trying to be collaborative? You know, what do we do about that without being called stripy hormone or women?

Chloe: I think it depends how bad it is whether you have to call it out. With the mansplaining, sometimes maleally ship is helpful. You know, and like pointing out to people in the meeting that you feel you’re being mansplained and explaining what you feel is happening to colleagues afterwards, quietly, and then, sometimes bystanders show up in the meeting, asking actively for bystandership. When you hear this again, would you be able to say something like, Chloe has made that point, unfortunately, at the moment, men have power, you know, predominantly, and it’s going to take understanding that feminism is everyone’s problem before things improve.

It can’t only be women that are feminists, nothing will change unless everybody understands why change is needed. So it’s about bringing people along. And I think it’s also about realising that you don’t actually have to tackle everything in real time live. You can interrupt a conversation, you can delay, you can cause sort of a disturbance at that meeting changes track, you can come back to something, you can discuss it afterwards. There’s many ways to act.

I think we often criticise ourselves because we don’t, in that moment, know what to say. And actually, action doesn’t, isn’t limited to an instance. And if you haven’t dealt with it in that moment, you’ve done nothing. It’s about how you manage the situation in totality. So if you take an action, you think about it for a week and then go to two colleagues and say, ‘This is my experience. May I ask you what was your experience? Would you be willing to say something’? The next meeting will go differently.

There’s sometimes, you have to call it out, but sometimes, and I think language is very difficult for me because I’m trying to make structural change. I’m trying to win big things that will allow EDI representation on board, things that are going to really make a difference if someone uses a word, or whether I challenge that word, and be seen as the PC police the word police or whether I let the word pass and try and focus on the theme. I think it’s about weighing up. But it’s also about a threshold, when it’s just constant barrage. I think doing it calmly is the best way. And I guess also just accepting that people may not agree.

Rachel: I think that’s really wise about often dealing with it there. And then you don’t get a good outcome do you. Because people get back to the corner, even if they know they’ve done something wrong. They’re automatic can be defensive, isn’t it? And then nobody’s better or worse, if you’re mature, and just actually then call out later when no one’s going to be embarrassed by it. That might be better. But if someone says something absolutely outrageous.

Chloe: Now, I think, to the listeners, what I would say is, I don’t want to put myself on some sort of a pedestal or for people to think that I think I get it right. I think it’s sometimes I get it right. Sometimes I time it right. Sometimes I know what to do, and I’ve learned certain techniques, but it’s often feels very unpleasant. And you often feel that you failing to deal with it, and you haven’t done it right, and you could have done something better, and that other people expect you to do it better. Because you’re a person, you know, you’re running an amazing podcast, and you speak up, and you should be able to do it better, you’re articulate, you know I should be able to do better throughout is it’s hard. And it’s uncomfortable. And hard and uncomfortable is hard and uncomfortable. And you just have to know that you tried to do your best. And with the best that you can.

Nuthana: I think Chloe made an excellent point there that feminism is everybody’s issue. And I hope that your male listeners are listening and still listening to this bit of the episode and haven’t thought, ‘Oh, this is all about women’s, it’s nothing to do with me.’ Because I think having allies is really, really important. And it is only if men and women work together on this that things will improve. So just trying to be mindful of it and being supportive.

In a meeting, if you notice that one of your colleagues is being treated in a certain way. And people aren’t listening to what they’re saying or that they’re kind of not really speaking up because they don’t feel confident enough to speak up about something, just being inclusive and saying, ‘oh, shall we go around to make sure we’ve heard from everybody’? Or ‘hang on a second, don’t interrupt this person, they were saying something.’ I think it doesn’t have to be the person that it happens to that calls it out, all of us have a responsibility to call things out and make things better for everybody.

So you know what, what I would say is don’t feel like you as an individual can’t make a change. Because you’re modelling to people, there’s that phrase isn’t there, that whatever you permit you promote. So we all have responsibility to model and model the behaviour that we want to see.

Rachel: I think as well, remembering that this also applies at home in the domestic situation as well. I think the amount of women who self-sabotage because of the G word, guilt. ‘I should be doing the target’, ‘I should be doing all the housework’, ‘I should’, and they don’t then ask for the equality that they need with their partners. ‘Actually, we are working the same, we need to divide this emotional load. And just just be very clear about it’.

Because if you’re not asking, then just the assumption is that you will — nine times out of 10 I think the assumption is that the women will just get on and do it because of the way we’ve been brought up, the way our own gender stereotypes work. And it’s this ticker tape of the scripts in our heads: ‘I should do’, ‘I should do, I ought to’. We can be our own worst enemies. So just catching yourself, catching yourself doing it to yourself almost — does that make sense?

Chloe: Oh, yes. So well, that’s picking up on the unconscious thoughts and unpacking them and thinking, ‘Why am I feeling this responsibility? Why do I think this is my responsibility? There’s two of us here, who says that we shouldn’t be sharing this’? Trying to trace that back interrogate the thoughts, I guess.

Rachel: Brilliant. So we’re way over way over time. Quickly, I’d like to ask how does the Medical Women’s Federation help people with this? What are you guys doing that’s going to sort of help support people in this.

Chloe: A mixture of things, I guess. \We have conferences twice a year, discussing different, various different topics. On the podcast, I try and discuss different topics to try and encourage medical women in their careers. We’re also doing various research projects, looking at different aspects of women in medicine. So lots of different things.

And I would just like to quote our immediate past president, Professor Nina Modi, who made the point that there are 500,000 Women doctors in the UK, and if every single woman doctor was part of the Medical Women’s Federation, they wouldn’t really be able to ignore us. There’s so much power that that would be able to have to make difference.

So I would just like to point out that that is a very good reason why you should join the Medical Women’s Federation. And for men, even though you can’t join, if you are really good at being an ally, then you do get to become an honourary member.

Rachel: That’s wonderful. We’ll definitely put all the links in the show notes so people know how to access that. So Chloe, what are your top three tips?

Chloe: My top three tips are, don’t fall foul of the broken rung, get on the ladder, apply, read through the male-dominated language to try and see yourself there. Don’t be afraid to use allyship if you need it in order to change ingrained behaviours. And don’t see an ability to interrupt sexism in the moment as a failure. There’s no time limit at which point you can’t address that. When you know better, do better, and understand, help people to see that when they know better that they should do better, as Maya Angelou said.

Rachel: Love her. Thank you. Nuthana?

Nuthana: Don’t know if they’re all top tips, but I guess mine would be equality is an issue for everybody. So don’t think that it isn’t for you. Another one is that as well as trying to make system changes, there are differences that each of us can make as an individual. So don’t underestimate the power that you have. I guess my third one is just understanding a bit of the context of the past and where everything has come from, and how we’ve ended up in this situation is quite helpful to then see what still needs to be done, and what differences still need to be made. I think we all have a responsibility to kind of make things better for those that come after us.

Rachel: That’s just been so helpful. So if people wanted to get ahold of you guys, how can we do that?

Chloe: I guess at the Medical Women’s Federation would be a good starting point. But I’m at Queen Mary University of London.

Nuthana: I am on Twitter, @drnuthana, and the podcast is The Medical Women Podcast, and it’s on all platforms wherever people might want to listen.

Rachel: Great. So give that a listen. Join the Medical Women’s Federation. Contact these guys if you want to know more about anything. Thank you so much for coming on. That was just absolutely fascinating, and I’m sure trying to get you guys back at some point. So thank you for being here.

Thanks for listening. Don’t forget we provide a self-coaching CPD workbook for every episode. You can sign up for it via the link in the show notes. And if this episode was helpful, then please share it with a friend. Get in touch with any comments or suggestions at hello@youarenotafrog.com. I love to hear from you. And finally, if you’re enjoying the podcast, please rate it and leave a review wherever you’re listening. It really helps. Bye for now.