NHS surgeons

We examine how the length of parental leave and rates of progression after having children vary by specialty, gender and other staff characteristics.


The employment rates and hours of mothers in the UK fall after their first child is born, while average wages stagnate. Changes for fathers are minimal and their wages continue to grow (Andrew et al., 2021). While the NHS performs relatively well at retaining female staff after maternity leave (Kelly and Stockton, 2022), Dacre et al. (2020) document substantial gender pay gaps in medicine, with a switch to part-time working and institutional training and pay structures important factors in explaining the gap. In addition, men and women continue to choose different medical specialties, with women in general, and mothers especially, being under-represented in higher-earning specialties such as surgery and cardiology.

Nursing and midwifery are heavily female-dominated occupations, but men are over-represented at the most senior levels of the profession (Punshon et al., 2019). There is a paucity of prior quantitative evidence on how gender and parenthood influence career progression in these professions.

In this report, we examine how the length of parental leave and rates of progression after having children vary by specialty, gender and other staff characteristics among doctors, dentists, nurses and midwives in the English NHS. Career progression has a direct impact on pay and can affect other job characteristics, such as shift pattern and location stability. The analysis of length of parental leave augments our previous work on rates of maternity leave and contracted hours upon return to work (Kelly and Stockton, 2022). This provides context for the environment in which women in different occupations and medical specialties make decisions and progress through their careers.

There are multiple possible causes of variation in progression rates and working patterns by gender and parenthood. Documenting and understanding that variation helps assess whether the gaps should or could be narrowed, and what policy levers might be most appropriate. Where there are cultural or structural barriers for certain groups, such as women in general or mothers in particular, this not only raises equity concerns for those affected but could suggest that the NHS is not making the best use of the talent it has (or could have). More broadly, the NHS is a very large employer and its success on equality has an important benchmarking role and can potentially influence conditions in the rest of the labour market.

Our analysis uses the Electronic Staff Record (ESR), the monthly payroll of directly employed staff in the NHS, from 2012 to 2021. This provides detailed information on the pay, hours, progression and parental leave absences of NHS staff. We analyse doctors of all grades and all registered nurses/midwives in the acute (hospital) and community sectors. We examine three points of progression: for doctors, progression from early to late specialty training, and completion of specialty training; for nurses and midwives, progression from Agenda for Change band 5 (the entry point for newly qualified nurses/midwives) to band 6. We provide extended results which show how patterns in surgery, a field with few women, compare with those in other fields.

Key findings

1. The length of maternity leave taken by female medics is shortest in male-dominated specialties including cardiology and surgery, and longest in more female-dominated specialties including community/public health, geriatric medicine and paediatrics. For example, the median length of maternity leave in surgery is 43 weeks, compared with 48 weeks in community/public health. This adds to previous research, which showed that women in male-dominated specialties have fewer children and work more contracted hours when they return from maternity leave.

2. Patterns are similar for nurses and midwives, with leaves typically shorter in branches of nursing with a higher share of men (psychiatry) and longer in the most female-dominated branches (obstetrics and gynaecology including midwifery, and children’s nursing). The average maternity leave is 41 weeks in psychiatric and mental health nursing, compared with 48 weeks in obstetrics and gynaecology.

3. There is little variation in the length of paternity leave. Across different staff characteristics, specialties and occupations, the vast majority of fathers take two weeks – which corresponds to the period of occupational paternity pay.

4. Women doctors and nurses/midwives remain less likely to progress than their childless male colleagues for several years after returning from maternity leave. This is true at every transition we analyse – from early to late specialty training and onward to specialty doctor or consultant for doctors, and from band 5 to band 6 for nurses/midwives. Among men, the differences in progression between fathers and childless men are much smaller.

5. Part-time working and absences can explain some, but not all, of the slower progression of mothers, with the proportion explained varying across different transitions. These factors can explain most of mothers’ slower progression for doctors, but only about half for nurses’/midwives’ rate of progression to band 6.

6. Part-time working and absences explain much less of the gender gap in progression rates in surgery than in other specialties. Mothers working in surgery – whether as doctors or as nurses – take shorter periods of maternity leave and work closer to full-time hours after returning from maternity leave than mothers in other fields of medicine or nursing and midwifery. Nevertheless, they progress more slowly than their childless male colleagues. So part-time working cannot account for the difference in progression rates in this case, and the causes must lie elsewhere.