Women in leadership breaking glass ceilings in ophthalmology

Professor Dame Carrie MacEwen's speech from a panel discussion at the Royal College of Ophthalmology Annual Congress, Belfast, on 20 May 2024.
When I was invited to speak here today, the mission I was given was to reflect a little on how I became a healthcare leader. It’s a wonderful invitation but I have to say, it’s a slightly disconcerting request! 

I find it quite difficult to look at my career this way, so I’m not sure I can entirely fulfil the ‘how I did it’ brief. I had no grand plan, and I wasn’t really conscious of forging a leadership path at the time. 

All I ever wanted was to be a doctor. I was ambitious certainly, but my ambition was to do a good job and be the best doctor I could be. I was very interested in teaching and how to support medical students and those doctors who were junior to me. I didn’t think about leadership as a standalone concept, and I certainly never foresaw myself taking on roles outside those relating directly to clinical practice. Perhaps if I was of a different generation I might have thought differently – but I was focused on following the well-trodden, traditional path through medicine – training and then providing a service. 

And I have to say that’s served me well. Now, I can see that the leadership opportunities that came my way did so because I was focused on the importance of being a good, credible clinician. I got to know my field well, and I because I wanted to make improvements, I did various very simple research, quality improvement and audit projects that related directly to patient care and outcomes. Many of these were novel and I presented my research widely as it added value. Looking back, while I was just seeking to improve services, it got me noticed.

So, when people ask me about how to become a leader the first thing I always say is you should get really good at your core job. In medicine the challenges faced by clinicians can only really be fully understood by clinicians and most positive changes in clinical service are achieved with small steps – led by the doctors who deliver that care. But the doctors who are most successful in creating change are those who are inspiring, compassionate, team-focused – there is far more to being a good doctor than excelling in technical knowledge and skills. What you might call cultural competence – empathy, respect, communication – these are all component parts of a good doctor, and it’s no surprise that they are also component parts of a good leader too. Leadership is a philosophy and a mindset, not a role. Don’t fixate on the title or the destination – simply focus on being the complete doctor and enjoy the journey.

I recently heard of the 'planned happenstance' theory, which certainly applies to me – it means that one is curious and prepared to be flexible about what opportunities may develop as a result of chance, luck or serendipity. Instead of meticulously planning your career and path to leadership, focus on developing the skills and attributes that can help you take advantage of opportunities that come your way, and never turn down an opportunity. 

I couldn’t have foreseen the satisfaction I would gain from my current role at the GMC, for instance. Many of my friends and colleagues expressed surprise (and in some cases dismay!) when I took it on – yet it’s one of the most rewarding roles I’ve held. It was the result of a series of unforeseen circumstances.

This doesn’t mean you shouldn’t think about what you want or think about why you want to lead – particularly – what you want to change. But by focusing on observing others and developing your skills you will set yourself up for success and increase your chance of putting yourself in the right place at the right time. Curiosity is chief amongst these - it stimulated my interest in research, it made me ask questions, and drove me to find answers.  Always think critically, query accepted practice, question accepted beliefs, and challenge, challenge, challenge – but not without thought for solutions. We can all complain – it’s not the same! 

Not everything should be left to happenstance of course, women should be able to challenge the circumstances that may hold them back. The playing field still isn’t quite level.

66% of ophthalmology specialists on our register are men. We’re not quite as skewed towards men as surgery – but in terms of rankings we’re up there. Other specialties – paediatrics, pathology, public health - look an awful lot more balanced in terms of numbers (whether they’re balanced in terms of regard would be another question entirely of course).

Things are better than they used to be, partly because of the advances in, and greater acceptance of, career flexibility.When I was training, it wasn’t considered acceptable to reduce hours or take time off for caring responsibilities. I personally took the decision to wait until after I’d completed my training to start my family. I saw other women who did have children walk away from medicine during training when they couldn’t make it work. I remember thinking it entirely unreasonable that women were forced into making significant life choices that men were not.  

I took on the role of Associate Dean for Less than Full Time Training for East of Scotland when the idea of flexible training was just starting to become a viable prospect. I was actually one of the first LTFT associate deans in the UK and I spent much time persuading consultant colleagues (usually male) in many specialties of the benefits of flexibility, helping to deliver balanced rotas and providing pastoral care for trainees who weren’t being supported by their clinical departments. I think with hindsight, this is one of the career moments I am proudest of. I hadn’t seen it as a leadership role at the time – I simply saw it as facilitating a necessary change, but now I can see that it was. I was certainly called upon to use all of my leadership skills. I know that, together with my colleagues across the UK, I made a difference.

Thankfully, LTFT training, is now fully accepted, due, partly to the passage of time and greater awareness of work-life balance, but also greater numbers of female medical leaders who trained this way themselves. They can empathise, and they recognise the value of keeping talented female doctors in the profession and facilitating their progress. 

We still need employers to walk the talk and ensure family friendly policies are firmly in place – and made to work.

I’m optimistic about what is to come. Data tell us that the future is female.

60% of medical students are women. It seems extraordinary now that when I began my medical studies in 1975 the number of female medical students was capped in most universities at about 30%. Fortunately, the Sex Discrimination Act, which was passed in that same year, put an end to that and the numbers climbed steadily since. 

The health service has become increasingly dependent on women over the course of recent decades and with more men retiring, at some point soon there will be more female doctors than male. 

There’s work to do to fix the bugs in the system that disadvantage women and create artificial barriers. We cannot fix these overnight - but key stakeholders – and I include the GMC in that – have a role to play to help move things along. 

In the meantime, my message to all female doctors who want to lead is to trust in yourselves, and remember that we are all equally entitled to rise to the top, based on our own individual drive and merit. 

Be ready for anything that may come your way!

And remember that by being the best clinician you can be you are already leading and making a difference. See the true value of what you do each day when you go to work, and others will see it too.