Fairness first

It may be 2020 but according to the Fawcett Society’s 2020 Sex and Power Index, women are still largely missing from the top jobs in Britain.

The MDU’s chief executive, Dr Christine Tomkins is one exception. For the last ten years, she has been at the helm of the UK’s largest and oldest medical defence organisation, her medico-legal career following clinical practice as an ophthalmologist. She now leads an organisation of 475 people, where there are plenty of visible female role models in senior roles such as the head of medical advisory services, the head of claims and the head of legal services. And along the way, she has been instrumental in introducing family-friendly working practices to the organisation.

Her guiding principle is that ability should be what really matters within any organisation, so it's important to ensure a level playing field for everyone, whether in the MDU or the NHS.

When it comes to her own career, which began at Manchester Medical School in 1974, Christine does not believe being a woman held her back. Though like many female doctors, she has encountered some sexist attitudes.

She remembers: “I was in a district general hospital doing my training in general medicine and a consultant said to me: ‘What are you doing at medical school. You should be out there having children and improving the gene pool!’ I just laughed and replied: ‘Well, I think I can do both’.

“As far as patients are concerned, I never had anyone say they didn’t want a woman to treat them. Pre-registration, I would often be called nurse and that was understandable because these were elderly patients who had that stereotype in their head. I also remember one lady who, despite being very ill, asked me: ‘don’t you have any men to help you?’ so I reassured her that yes, there was a whole team looking after her.”

Representation and role models

Like many specialties, ophthalmology has long been dominated by male doctors – a workforce census by the Royal College of Ophthalmology in 2018 showed only 31% of the consultant workforce in the UK was female, though 49% of specialty trainees in full time training were women, which suggests the gender balance is starting to shift.

However, Christine was unaffected by assumptions about her choice and she was encouraged by a strong female role model during her training. “Ophthalmology is a meritocracy,” she says. “I didn’t come across any feeling from any of my colleagues that being a woman was in any way relevant. What mattered was your technical ability. I worked for Joan Noble who was a consultant ophthalmologist at Manchester and it’s very encouraging to have someone like that as your teacher who can make you see what is possible. Of course, she was supportive of me and she taught me a lot.”

Christine found similar support when she left clinical practice in 1985 to join the MDU as a medico-legal adviser. The organisation was then celebrating its 100^th year and male led but she was pleased to find that it was not hidebound by tradition. “We had some very eminent women doctors on our council at the time like Dame Josephine Barnes and Dr E Mary Cooke,” she points out “and again, what mattered most at the MDU was your ability to do the job. Overall, I found an open-minded organisation where the focus was on the best way to provide medico-legal assistance, support and advice for our members.”

Flexibility through home working

One example of this readiness to consider new ideas was the MDU’s early adoption of home working in the early 2000s, a development where Christine was a pioneer: “When I had my third baby in 1990, the advisory caseload was going up, so I said: ‘Look, if you get the files to me, I can deal with them at home and look after my baby’ and so a white van used to come to my house with the files and return the next day to collect the ones I had completed. That showed home working was doable so we looked at the practicalities to make it work on a bigger scale.

“Overall, I think family-friendly working arrangements have made the MDU a better place for everybody who wants an interesting, challenging job with a good work-life balance. It also makes it easier for men to share domestic responsibilities which has to be a good thing because it is exhausting for women to try and do everything themselves. The biggest thing that made it possible for me to succeed was all the help and support I had from those around me.”

Equal pay

Christine believes that organisations can only benefit from the success of women as it enables them to draw on a multitude of skills and perspectives. She reflects: “This isn’t to imply that men can’t do this but I think women’s experiences mean they approach problems in a different way to others in the room.”

But while Christine welcomes more women breaking through in leadership roles, such as within the royal colleges and women represent 48% of all licensed doctors, she says there is more work to be done to ensure equality of opportunity within the profession as a whole.

“We still have a gender pay gap,” she notes. "In its interim report last year, The Gender Pay Gap in Medicine Review led by Dame Jane Dacre found that on average, male doctors in the NHS earned 17% more than their female colleagues and in general practice the pay gap is 33%. Women are under-represented in senior grades – they make up two thirds of doctors in training grades but under half of consultant grades – and over-represented in lower-paid specialties.

“At the same time, we have more to do to understand the underlying reasons for these differences and address them so women have the chance to achieve their potential. This is not a question of men versus women but making sure that medicine is a sufficiently rewarding and flexible career for everyone. It’s about how we succeed as a profession.”

Interview by Susan Field.