Posted by: Witch Doctor | May 8, 2007

MMC, medical women, and the leaking hose-pipe



Think of a garden of flowers that is only magnificent because it is well watered.

Think of the hose that waters the garden.

The hose is full of holes!!!

Think of the careers of women doctors as the leaky hose watering the garden. The hose continually spouts water all along the way. If it trails through weeds before it gets to the flower-bed, the weeds grow rampantly, but that is not what was intended. If there’s a continual never-ending supply of water from the tap, there are not too many holes, and the pressure is such that some of the water by-passes the holes in the hose, then the flowers in the garden at the end of the hose thrive.

If the pressure of water is poor, the flowers die.

Women doctors, as school leavers, get into medicine with outstanding qualifications. At this stage they surpass the male applicants as evidenced by the 60-70% female intake into medical schools. This “superiority” may well continue throughout the undergraduate curriculum. Indeed the female intellectual superiority may continue for life. Who knows? (The Witch Doctor, thinks this might be the subject of another posting).

Anyway, the leaking hose is not The Witch Doctor’s idea. It has been around for some time. And it is not only seen in the UK.

“the “leaking pipe” phenomenon that consists of a disproportionate number of women gradually leaving their progress at each career stage. The percentage of the women among hospital doctors, fall from 50% as minor positions to 25% as consultants (1) and to 8 % as senior consultants (2). Similar leakage is registered in academic career, where females represent only 4% of the senior lectureship. Thus, the inequitable promotion of women in medicine is a general phenomenon, furthermore it seems to be maintained.”(Ref)

Over the years some felt the leaking hose effect was due to sexual discrimination – the old boy network. Maybe it was, maybe not. One thing is certain. It is damned hard to cope with a demanding full-time job which includes nights on call, working weekends and public holidays, exams, research papers, powerpoint and poster presetations, teaching, job applications round the country, MTAS, MMC, CPD, appraisal and the mountain of associated paperwork demands, housekeeping, gardening, home decorating, entertaining, dutifully attending the entertaining of others, (when all you want to do is curl up in a chair and sleep), keeping in touch with friends and family, morning sickness, parturition, breast feeding, toddlers, nappies, parents nights etc etc. Annual leave in effect becomes a “pretend holiday” away from the normal work environment in order to work just as hard “catching up”.

Add to this a partner who is also to be supported going through many of the above demands. Add to this current culture of “get on your bike and go to whatever outlandish place MTAS sends you.” Add also the expectation that a woman doctor in the family will become “Care in the Community” for all ageing or infirm relatives and neighbours. And now, in addition, there is the pressure of paying back student loans. The net result is total exhaustion, and now for some, financial worry. Less spare cash for domestic help and child-care. In these circumstances the concept of a work/life balance becomes a delusion – a kind of sick joke generated by HR departments.


In a way, it is irrelevant whether or not there is or has been sexual discrimination. For women in medicine who are in this situation, the leaking hose in the norm.

However, in spite of this, the flower-patients cannot be allowed to die.

This, the Witch Doctor thinks, is primarily what MMC is trying to solve.

This is the driving force.

And with a 60-70% female intake of medical students, the problem is a major one.

It is necessary to get away from the peripherals of “competencies”, “shorter training”, “talents” and all the jargon and management speak that has been introduced in recent years to try to solve this. Instead, bring the consequeneces of feminisation of the medical workforce well into the open.

Moreno A et al. “UK and Spain: similar data and “leaking pipe” phenomenon of the women in medicine. What’s happening?” Letter BMJ 25 November

The Witch Doctor – Link to a random page


  1. […] had the potential to bring healthcare in the UK to its knees. This would exacerbated by the predominance of women in medicine. We reckoned The Leitch Report, Agenda for Change, The Skills Escalator were all attempts to address […]

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