We need more doctors. The gender bias for female applicants at 18 can be levelled off at 21 years old. Graduate entry to Medical Schools should become the norm. More and more women are outperforming men. (Where are the men? Gender gap hits record at universities The Times 4th Feb 2016) and (Head teachers have clashed over the benefits of single-sex schooling – Sunday Times 31st Jan 2016), but it is from these schools that many doctors come from.
Every now and then, a conflict arises that splits apart not just the country but even individual families — the dispatch of British troops to the Suez Canal in 1956 and to Iraq almost half a century later, for example. Contentious military invasions have that consequence. Yet now a mere industrial dispute — that between the British Medical Association (BMA) and the Department of Health over a new contract for junior doctors — is having a similar effect.
This was seen with excruciating clarity in the letters pages of one national newspaper last week. On Tuesday Dr Russell Hopkins introduced himself: “In 1998 I was elected a fellow of the BMA in recognition of outstanding service.” He then went on to damn the present-day doctors’ union for its withdrawal of labour in protest at what it claims to be a contract enforcing excessive antisocial working hours as “pressing the financial needs of the profession, giving little thought to patient care, ethical practice or the need for out-of-hours care . . . This is not the same organisation I was once proud to serve.” (the shape of the job?)
Two days later a reply appeared from Dr Claire Hopkins: “I read the letter from my father, Russell Hopkins, with some dismay. He has been out of clinical practice for so long that he is disconnected from the problems facing the profession today . . . My father and his generation enjoyed a career where they had respect and autonomy, were lavished with hospitality by drug companies and then retired on final-salary NHS pensions. They would not recognise the job today. As a consultant surgeon I — along with most of my colleagues — support the junior doctors in their decision to strike.” You don’t have to know either Dr Hopkins to wince at such a cruelly personal exposure of intergenerational dispute.
Those two doctors are divided not just by age but also by sex. The latter is, though not mentioned during last week’s strike, a significant factor in the row over “antisocial hours”. The profession has become one in which new graduates are more likely to be women than men. This would have been almost inconceivable two generations ago. Not much observed by the public, a debate has raged for years in the pages of the British Medical Journal about what its disputants refer to as “the feminisation of medicine”.
In 2008 one of its contributors, Brian McKinstry, then a senior research fellow at Edinburgh University, warned: “Increasing numbers of female graduates will create a major shortfall in primary care provision . . . Fewer women than men choose to work out of hours, and the increase in women doctors may have partly influenced the recent abandonment of out-of-hours work by general practitioners in the UK.” That was a reasonable supposition; the consequence has been an increasing pile-up in the accident and emergency wards of our hospitals.
It’s not just a matter of wanting to avoid “antisocial hours” that interfere with family life — an institution to which men tend to pay homage but that women are actually more likely to put ahead of their career. Last year Dr Max Pemberton wrote: “We are facing a crisis in the NHS . . . It’s a crisis caused by having too many female doctors . . . Quite simply, the average male medical graduate will work full-time, while the average female won’t. In fact, a study of doctors 15 years after graduation showed that . . . after career breaks and part-time working are taken into account, women work 25% less than their male counterparts.”
When you consider that it costs roughly £500,000 to bring each medical student up to the status of a fully trained professional, it becomes obvious why governments have been reluctant, especially at a time of vast public sector deficits, to increase the number of medical degrees to fill staffing shortfalls created by the swelling number of “part-time” female doctors.
Or as Dr Chris Heath, a 40-year NHS veteran, wrote to me: “Women doctors don’t like weekend rotas . . . This is one of the reasons why paediatric units are failing: 70% of their junior staff being women and therefore frequently off on maternity leave.” I wonder what Dr Heath would make of Sarah el-Sheikha, who complained in The Guardian that the government’s proposed change will “particularly damage specialities such as anaesthetics, a department that has striven to make itself family friendly”. What about being friendly to the families who need to use the service?
There is a statistical counter-argument to those put by Drs Pemberton and Heath: that opening up the profession to women as equal participants will tend to increase the quality of those graduating — the bigger the talent pool, the better the doctors that emerge. That, however, is no consolation to the patient who can’t get a GP appointment or has to wait longer in A&E during “antisocial hours”.
The societal split emphasised by the doctors’ dispute is not just along grounds of generation and sex. There is also that between private and public sector. While I suspect the overwhelming number of other public sector employees will be supporting the junior doctors in their industrial action, those in the private sector, who do not get time and a half for working on Saturdays, see things differently. So I have received quite a few perplexed letters from airline pilots — who also, in a different way, hold our lives in their hands — pointing out that they don’t get paid different rates for flights at weekends to compensate them for the disruption to their family life. But then how many female airline pilots have you ever met?
Those of us on the profit-making, tax-generating side of the private/public schism are much more fortunate in one respect. While businesses — at least those that prosper — have abandoned the corporate monolith mentality and become much better at encouraging employees to come up with their own ideas, the NHS has moved in the opposite direction.
Its doctors are no longer allowed to be the rather free-wheeling, occasionally eccentric, day-and-night, autonomous professional elite that I recall from my youth — long before anyone had heard of the EU’s working time directive and its average 48-hour week limit. Now, they are monitored incessantly by swollen ranks of administrators, who seem to think the medics should share their bureaucratic fascination with the filling-out of forms. The target-driven agenda of the Blair-Brown years had a rational motivation, as far as the politicians were concerned, but it made doctors feel as though they were wage slaves, being paid for pure hours worked and, yes, forms filled.
In this context, the decision of the BMA to take industrial action (leading to the cancellation of many thousands of operations) becomes less surprising. If you are no longer treated as a professional elite, you will not behave like one.
Funnily enough, some feminist writers have a theory that ties this all together: that when women become accepted into an elite, it ceases to be treated with the same respect as previously.
Perhaps. Though, whether it’s male or female doctors waving placards and chanting slogans outside their hospitals, neither exudes the sense of quiet authority traditionally associated with their position.
I’d better say no more, however, or my daughter might write a letter to this newspaper, shooting me down in flames.
Correspondence from a week later 24th Jan 2016: Misdiagnosing female junior doctors as the cause of A&E problems (And all the NHS ills..?)