Gender, Migration, and Medical Registration in the UK

By Amrita Limbu

Sociologist Margaret Stacey, in her study of the General Medical Council (GMC) Regulating British Medicine referred to medicine as ‘a man’s profession’. Stacey also served as a lay member of the GMC from 1976 to 1984. As the regulatory body of the medical profession, the GMC maintains the UK medical register exercising control of who gets to be on the register. Inclusion to the medical register provides medical practitioners the license to practice medicine, and for the GMC, the register is a way to ensure patients safety by maintaining the professional standards of the practitioners’ knowledge, skills, qualifications, and experience. Historical examination of medical registration in the UK reveals that women faced significant barriers in gaining access to the medical register. Prior to 1860s, women were not permitted to attend medical schools or take licensing examinations.

Several scholars have recounted the narratives of two pioneer women who successfully navigated the UK medical register by exploiting legal loopholes. Elizabeth Blackwell who obtained her medical qualification from America  gained entry to the UK register through a special provision that allowed individuals with a foreign or colonial medical degree and already practicing medicine in England prior to the establishment of the medical register under the Medical Act 1858 to register.[i] Elizabeth Garrett Anderson likewise managed to get on to the register by studying privately for the licensing examination and taking the apothecaries examinations. She was refused admission to the medical schools and refused permission to sit for the examinations by London University and the Royal College of Physician and Surgeons.[ii] The Society of Apothecaries’ charter pertained to the sale of drugs, and as there were no legal grounds to prevent women from selling drugs, they were obligated to admit Elizabeth Garrett Anderson in their examination.[iii] The GMC subsequently closed both the entry pathways taken by the two women.

Following the initial struggles, the numbers of women doctors rose gradually: from 2 in 1871 to 25 in 1881 to 100 in 1891.^[iv] By the end of the 1990s, around half of all medical students and recent graduates were women.[v] Today, 49% of all licensed doctors are women, and they also make up 57% of doctors in postgraduate specialty training at 57%.[vi]

Despite women’s entry to the register, there remains limited understanding of the gender-specific implications associated with registration. Research indicates persisting disparities extending to career progression, specialty selection, and work patterns. Even today, a higher proportion of women doctors work part-time or less-than-full-time compared to their male counterparts; childcare related reasons being the primary factor influencing this work pattern.[vii] And in specialties with larger proportion of women doctors such as obstetrics and gynaecology with 83% female doctors in 2022, trainees spend more time in the same training level and specialty level.[viii] However, the extent to which gender dynamics impact the registration process for women compared to men, and how these factors subsequently impact the career choices of women doctors and their career progression remains underexplored.

Further, when considering the intersections of gender, registration, and migration, the process of registration for migrant women doctors is likely to be more intricate compared to their UK-trained counterparts. Registration for foreign practitioners entails navigating English language requirements and completing the Professional and Linguistic Assessments Board (PLAB) tests, all within the constraints of immigration regulations. Migration poses challenges of time limitations on most visas, cost of visas and extensions, absence of welfare support that nationals benefit from, limited or absent local support network, all of which further complicate the registration process. Additionally, studies have highlighted how women are more likely to sacrifice careers and skills during a migration process at the privilege of their male partner’s careers. When women negotiate with gender to strategize migration, for instance through marriage, they often end up reproducing relations of subordination, putting a hold to their careers.[ix]

Archival research conducted for our project Making it to the Registers shows that during the 1960s, discussions centered around encouraging the employment of women doctors, especially attracting married women doctors back to the profession through part-time appointments or flexible training schemes, less rigid requirement of experiences and shorter training courses.[x] While the GMC has come a long way in inclusion of women to the register, these examples underscore the potentials of policies in bringing about meaningful changes – changes that can enhance the experiences of migrant and refugee women health practitioners’ entry to the UK medical register.

 

The Making it to the Registers team includes Marie-Andrée Jacob, Priyasha Saksena, Nasreen Ali, and Amrita Limbu.

 

[i] Stansfeld, James (1877) Medical Women. The Nineteenth Century: A Monthly Review 1(5): 888-901.

[ii] Haynes, Douglas M. (2017) Fit to Practice: Empire, Race, Gender, and the Making of British Medicine, 1850-1980. Rochester: University of Rochester Press.

[iii] Anderson, E. Garrett (1893) The History of a Movement. Fortnightly Review 53(315): 404-417.

[iv] Stacey, Margaret (1992) Regulating British Medicine: The General Medical Council. Chichester: Wiley.

[v] Stacey, Margaret (1992) Regulating British Medicine: The General Medical Council. Chichester: Wiley.

[vi] GMC (2023) The State of Medical Education and Practice in the UK: Workforce Report 2023. London: General Medical Council.

[vii] GMC (2023) The State of Medical Education and Practice in the UK: Workforce Report 2023. London: General Medical Council.

[viii] GMC (2023) The State of Medical Education and Practice in the UK: Workforce Report 2023. London: General Medical Council.

[ix] Manohar, Namita (2019) Gendered Agency in Skilled Migration: The Case of Indian Women in the United States. Gender and Society 33(6): 935-960.

[x] Wellcome Collection, Employment of Married Women Doctors