Published: 26/09/2002, Volume II2, No. 5824 Page 26 27
Practice management remains a largely female profession.So why do male managers earn more? Jennifer Gosling reveals the results of a survey
Primary care prides itself on striving to eliminate health inequalities. But what about inequalities in the treatment of its staff? A survey of practices in London shows that female practice managers are paid significantly less than their male counterparts - a difference of£5,000 a year, on average.
There is of course no shortage of research showing that women are paid at a lower rate than men. A recent study showed that women in Britain are paid 70-80 per cent of the male average wage, though the gap has narrowed by 4 per cent in the last 10 years.
1Practice management is a largely femaledominated profession.A survey undertaken in Scotland in the early 1990s showed women made up 90 per cent of the practice management workforce.
2In London, it is approximately 84 per cent.
3In March 2000, a survey of all general practices in London was carried out, based on addresses supplied by 16 health authorities. A total of 1,666 questionnaires were sent out, and 750 were returned. The survey asked about practice demographics and details of practice managers' experience, qualifications, hours and salary.
The average list size of the practices in the survey was 5,993, with the largest having 23,000 patients and the smallest 600.
Twenty per cent of the practices comprised two doctors, 18 per cent three doctors and 25 per cent were single practitioners. One practice had 11 partners and the remainder had between four and eight doctors. There were a total of 712 male GPs (including 106 part time) and 228 female GPs (122 were part time). Forty three per cent of the practices were previously fundholding.
The results show that of women practice managers working 30 hours or more per week, the majority earn£15,000-£25,000 per year, whereas male practice managers working over 30 hours per week earn on average£25,000 to over£30,000.
Only 5.7 per cent of women managers earn over£30,000 per year, compared with 15 per cent of men. In outer London, in Croydon health authority for example, the salary figures for women are, again,£15,000-£25, 000, while men are paid£25,000-£30,000.
In the inner city, in East London and the City HA, salary levels for men and women are the same as Croydon, but 25 per cent of male practice managers are paid over£30,000 a year, against 13 per cent of women.
Of course, practices come in many sizes, they have different resource levels and require different skills from their managers. But, when the results were moderated for size of practice, women were still being paid less.
The survey shows that male managers are not concentrated in larger practices. There is an even spread, with half the men in the sample and half the women working in practices with a list size of less than 6,500.
But while male managers' salaries in these practices are evenly spread between£10,000£30,000, women's salaries are concentrated in the£10,000-£20,000 salary range. In the larger practices, with list sizes of over 6,500, 44 per cent of women are paid£20,000-£25,000, whereas 45 per cent of male managers in these larger practices are paid£25,000-£30,000. The larger the list size, the larger the discrepencancy becomes.Why should this be the case?
A significant number of women practice managers started out as receptionists, though not all remained in their original practice. Either through an aptitude for administration or a willingness to take on extra work, these women found themselves as de facto managers, though often without a commensurate level of power delegated from the GPs. In the late 1980s and the 1990s, there was a general boom in practice management as HAs began to exert pressure on GPs to take on a practice manager. The introduction of fundholding also contributed to this. The expansion of the number of practice management positions drew in people from outside general practice.Many, but not all, of whom were men and many of whom had previous management experience.
It could be the case that this previous experience exerts a financial premium in recruitment. The survey shows that women coming into practice manager jobs from outside are paid more than their ex-receptionist colleagues. But men are paid more than either of these groups. The results show that 31.5 per cent of male practice managers who came in from other positions in the NHS are paid over£30,000, compared with 13 per cent of women.
Almost a third (32 per cent) of men who came into practice manager posts from the private sector are earning£25,000-£30,000, against 16 per cent of the women who had come in the same route.
The survey looked at respondents' previous experience and its relationship to pay.
Length of time in post seems to have less influence on pay levels than gender.Most of the women had been in post for more than five-and-a-half years, whereas most of the male practice managers had been in the job for a shorter time.
Four per cent of the female practice managers had been in the job for 17 or more years. Only two out of 113 male managers had been in post for more than 12 years.
The survey shows that 49 per cent of women and 8 per cent of men had the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists qualification. Eighteen per cent of male managers had no qualification.
It would appear that women practice managers who were previously receptionists are penalised for having no experience of management beyond general practice.Yet many of these employees have years of experience of practice work, gained at a time when the profession has undergone considerable change.
General practices are, of course, independent small businesses, and may pay their staff whatever they like. But primary care trusts are beginning to insist on basic criteria for the employment conditions of practice staff, often linked to staff budget payments.
All practice staff are expected to have job descriptions, contracts and personal development plans.And it is not outside their sphere of influence to ensure that work of equal value should be paid equally.
Practices should be rewarding knowledge and experience of general practice, as well as paying the premium for experienced managers from outside general practice.
Do GPs really know what they are rewarding in terms of management experience? Are they taking insufficient account of those who have come up through the ranks of practice work? As part of the public sector, general practice should be concerned with equality for employees.And the practice manager would seem a good place to start.
A postal survey of practice managers in London found that women earned£5,000 a year less than men, on average.
Women who had previously worked as receptionists in the practice were particularly poorly paid.
Practice management remains a female-dominated profession.
Primary care trusts should seek to standardise rates of pay and promote greater equality.
Jennifer Gosling is a former practice manager.
1Curtis P. Female graduates lose out on pay. The Guardian [online] 2002 [2002 Mar 8]; http: //education. guardian.co. uk/gendergap/story/0,734 8,664213,00. html
2Grimshaw J, Youngs H.Towards better practice management: a national survey of Scottish general practice management.
Journal of Management in Medicine 1994; 2 (8):56-64.
3The figures in this article are taken from the results of a questionnaire sent to all London practice managers.