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A multi-funder study led by researchers at Hull York Medical School (HYMS), the Centre for Reviews and Dissemination at the University of York, and the University of Manchester has concluded that a strategic approach is needed to address discrimination and inequalities faced by medical and dental clinical academics. The comprehensive research data, including a systematic review and primary qualitative research, adds to mounting evidence that poor recruitment and retention rates will continue without interventions to address inequalities and discrimination in clinical academic careers.

The hard-hitting report makes nine broad recommendations for adoption by employers and funders of clinical academic careers. This is the first commissioned research project where key stakeholder funders are working collaboratively to tackle these issues which affect the clinical academic workforce.  

Clinical academics combine clinical practice, teaching and research and are at the forefront of innovations in medicine and dentistry in the UK. For a number of years the clinical academic pipeline has been ‘leaking’, with the age profile of the workforce increasing in line with a decline in NHS and other sources of research funding. In the context of a health service under severe pressures and now responding to the additional impact of Covid-19, securing the future pipeline of clinical academics is essential.

The competing demands of academic and clinical workloads, frustration over the lack of funding and unclear pathways to continue in clinical academic careers were cited as important factors affecting retention. While the proportion of women and individuals from minority ethnic backgrounds in academic medicine has increased in recent years the rate of change remains slow with a gender and ethnic imbalance persisting with greater seniority.

Inequalities and discrimination in relation to protected characteristics such as gender, ethnicity, sexuality, age and disability were also influential in the paths taken by clinical academics, and the opportunities available to them. The maternal wall bias, whereby women are discriminated against due to their maternal status, was commonly reported within the study population. Pre-existing barriers to academic activity were also felt to be magnified during the Covid-19 pandemic, with women reporting that an unequal distribution of labour within the home adversely affected their ability to conduct research.

While there is no quick fix to stem the leaky pipeline within clinical academia, the report points to several individual level interventions that could be taken to turn the tide. The report’s recommendations emphasise:

• The importance of robust evaluations of all implemented interventions to inform how best to support future clinical academic careers.
• The need for stakeholders to work proactively to promote and raise awareness about career options in clinical academia across all demographics.
• Early exposure to clinical academic opportunities to build communities of clinical academics and mentors throughout the pipeline.
• Developing awareness of employment guidance and providing more financial training for individuals and organisations.
• A need for increased training on equality, diversity and inclusion to address issues around discrimination and unconscious bias.
• Working with stakeholders to enhance the experience of all clinical academics through job planning and development.
• Valuing protected research time and an emphasis on streamlining administrative processes.
• At the heart of the proposed interventions is the building of a culture of support, wellbeing and accountability that actively promotes equality, diversity and inclusion in research.

The report has already sparked change across the sector including changes to way in which Athena Swan is recognised.  Through Athena Swan and the three-funder letter, NIHR has recently announced measures to reduce levels of bureaucracy for UK researchers. The Medical Schools Council has also convened a working group including representatives from universities, the NHS and funders to contribute to a project which will raise awareness about clinical academic careers.

Dr Katie Petty-Saphon, Chief Executive of the Medical Schools Council, said:

“For many years the MSC’s clinical academic staffing survey has monitored the stagnating numbers of clinical academics. This important report adds to that data by highlighting the importance of lived experience in understanding the enablers and barriers to recruitment and retention in clinical academic careers.

“The report points to evidence of discrimination and differences in opportunities within the academic and clinical environments which need to be urgently addressed by all stakeholders. It is important that universities and the NHS come together to evaluate the steps they are taking to promote supportive workplace cultures which value inclusion and participation from all clinical academics.

“This is not only important from a values perspective, but is important because diversity positively enriches clinical practice, teaching and research. The fact that the UK has lost talented individuals due to a lack of investment and support must galvanise all stakeholders into action.”

Dave Jones, Dean of NIHR Academy, said:

“This report adds significantly to the evidence base around inequalities still faced by clinical academics and provides a comprehensive list of recommendations for addressing these issues. NIHR is committed to working with other funders and organisations to take the recommendations from the report forward to help reduce the barriers to pursuing a clinical academic career.”

Professor Gabrielle Finn, Vice Dean, University of Manchester and Dr Jess Morgan, HYMS Clinical Lecturer, Centre for Reviews and Dissemination, Co-Principal Investigators, said:

"Our study highlights inequities in the experiences of clinical academics and a lack of high quality research about interventions to address the challenges they face. It adds evidence to the growing body of literature showing the differential impact of the pandemic on women. We offer a detailed intervention plan to address the disparities identified, and the resulting associated attrition. We hope that the adoption of our recommendations will help to repair the clinical academic pipeline and bring about a positive future change in research culture."

The full report can be accessed online here:

Gender inequalities in clinical academic careers

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Notes to editors:

1. Clinical academics are vital to the development of the health service, working to train high-quality future doctors and dentists while also leading cutting-edge innovations to improve patient care. Medical clinical academics make up around 5% of the medical consultant workforce. They are university employees with honorary contracts with a general practice surgery or hospital Trust. 
2. This multi-phasic study sought to explore barriers and facilitators to clinical academic careers, with a focus on inequalities based upon gender and ethnicity. The researchers conducted a systematic review and a qualitative exploration, including interviews and audio diaries. An intervention plan was created to enable clinical trusts, research funders and academic institutions to address inequalities and promote the recruitment and retention of clinical academics. 
3. The total number of full-time equivalent (FTE) medical clinical academics working in professor, reader and lecturer posts in medical schools has been static for the past decade while the number of consultant and general practice roles in the UK has increased substantially. The workforce is also ageing with an increasing proportion of clinical academics in the 56-65 age group. There have been changes to the numbers of the types of posts held with the number of reader/senior lecturer posts falling by 26.8% since 2004, while the number of lecturer and professor level posts has increased. In the context of a health service under severe pressures from an ageing population with increasingly complex co-morbidities, any stagnation in the number of clinical academics will affect patient care.
4. Clinical academic posts are funded by universities, the NHS and other sources such as research charities. In 2019 universities funded 1,513.1 (FTE) posts, the NHS 1,216 (FTE) posts, and 418 (FTE) posts were funded from other sources such as research funders like NIHR. NHS funding for clinical academic posts has fallen by 11.5% since 2011.
5. Demographic data collected in the most recent iteration of the Medical Schools Council’s Clinical Academic Staffing Survey shows that 33% of medical clinical academics are female.
6. The study discussed was funded by the NIHR Academy, Academy of Medical Sciences, Cancer Research UK, Health Education England, Medical Research Council, and Wellcome Trust. 
7. The study was led by Professor Gabrielle Finn, Honorary Researcher at Hull York Medical School and Vice Dean for Teaching, Learning and Students at the University of Manchester, and Dr Jess Morgan, HYMS Clinical Lecturer, based at the Centre for Reviews and Dissemination. 
8. For more information about this news item please contact Lucy Chislett, Communications Officer on lucy.chislett@medschools.ac.uk.