Far fewer women were being referred to them than expected. This was especially true in general practice.
Between 2001 and 2005, 87 per cent of GPs referred to NCAS were men. Yet at the time women made up 42 per cent of the GP workforce.
The gender gap is replicated in complaints to the GMC, where in 2001–5, complaints against men made up a consistent 81–83 per cent of the total.
It is a puzzle that has gone largely unnoticed.
The search for explanations
NCAS deputy director Dr Rosemary Field said: ‘There are no firm explanations.’
But NCAS is looking at presenting concerns and work styles ‘in an attempt to better understand the difference’.
Attempts to explain away the gender gap have failed so far. Older GPs are known to be referred more often, so could under-representation of female GPs in the over-50s account for the difference?
Apparently not. Analysis of the referral data shows that women are under-represented in every age cohort. Among the over-45s and in the riskiest group, the over-60s, they make up a steady 14 per cent of GP referrals.
NCAS’s analysis by grade has thrown no more light on the phenomenon.
The great majority of GPs referred are principals, and among these women make up just 12 per cent of cases. There have been far fewer referrals among non-principals, but again women have made up only 18 per cent of the total. Registrars have almost never been referred — just eight cases in four years, two of them women.
Lack of centrally collected data on ethnicity means that similar calculations cannot be made about ethnic origin. But NCAS said ‘referred men and women have very similar ethnic profiles’. Similarly, place of qualification could not explain the difference.
Gender safety gap
NCAS has suggested that women may be more risk averse than men. Dr Field said: ‘It sounds as if there’s something quite helpful in terms of the ways women work or their natural tendencies to seek help.’
The CMO’s report ‘Good Doctors, Safer Patients’ has suggested that a gender safety gap may open up at medical school. Noting in a study of 235 physicians disciplined in the US between 1990 and 2003 that poor performance at medical school was a predictor for future performance concerns, it identified being male as one of four factors likely to make students struggle at medical school.
A study of disciplinary action against Oklahoma physicians also found that being male was the biggest single risk factor.
Overall, the finding that over 80 per cent of complaints or concerns about doctors in the English-speaking world are about men is extraordinarily consistent.
Dr Peter Schutte, head of advisory services at the Medical Defence Union, said sexual impropriety is a largely peripheral issue. Of complaints about inappropriate sexual behaviour, around 80 per cent are made by women about men and most of the rest by men about male doctors. Yet Dr Schutte said that the number of complaints handled by the MDU about sexually inappropriate behaviour was small.
Dr Schutte has one explanation: ‘Communication is an overwhelmingly important factor in the genesis of a complaint.’
That is not enough for NCAS.