For several years NHSreality has been advocating “graduate entry” to medical schools rather than undergraduate entry. It is simply better value for money, and it means that the gender recruitment gap is reduced or negated. If we add to that virtual medical schools run from centralised Deaneries, then teaching and learning can be in the communities that doctors live in and come from. Instead we have high performing female suburban school students ruling the roost for places as undergraduates, and, in general, they do not wish to work in the shires. Paediatrics is a case in point…
By 2017, for the first time, there will be more female than male doctors in the United Kingdom.
Although I am a feminist — in the NHS hospital in which I work as a surgeon, some of the best doctors are women — this shift of the gender balance in medicine is a worrying trend.
I believe it is creating serious workforce problems, and has profound implications for the way the NHS works.
For many years — until the Sixties — fewer than 10 per cent of British doctors were female. Then things changed. For the past four decades about 60 per cent of students selected for training in UK medical schools have been female.
This is understandable in academic terms because girls achieve slightly better A-level grades than boys. They also mature earlier and may present themselves more impressively to medical school selection committees at the age of 17.
The effect is beginning to be seen. In 2012, a total of 252,553 doctors were registered with the General Medical Council. The male-to-female ratio was 57 to 43 per cent.
However, in its annual report last year, the GMC documented the changes in the UK medical register between 2007 and 2012.
The most significant change was that the number of female doctors under the age of 30 had increased by 18 per cent, while the number of males decreased by 1 per cent.
Indeed, in this age group, 61 per cent of doctors are now women and 39 per cent men.
In the age group 30 to 50 years, over the same period, the number of female doctors increased by 24 per cent compared with 2 per cent for males. In this age group, men still outnumber women by 54 per cent to 46 per cent — but that ratio will soon reverse.
I fear this gender imbalance is already having a negative effect on the NHS.
The reason is that most female doctors end up working part-time — usually in general practice — and then retire early.
As a result, it is necessary to train two female doctors so they can cover the same amount of work as one full-time colleague.
Given that the cost of training a doctor is at least £500,000, are taxpayers getting the best return on their investment?
There is another important issue. Women in hospital medicine tend to avoid the more demanding specialities which require greater commitment, have more antisocial working hours and include responsibility for management.
nstead of taking on a specialist career, many women prefer to look for a better work-life balance when they have young children of their own.
A section in the GMC’s 2013 report is illuminating. It lists the number of female doctors by speciality for 2012, and shows how many are attracted to general practice rather than other areas of medicine: general practice 29,272; anaesthesia 3,118; paediatrics 2,477; psychiatry 1,778; general medicine 1,054; general surgery 467; trauma and orthopaedics 191.
Compare this with the number of male doctors by speciality, and you can see the huge difference in general surgery as well as trauma and orthopaedics — both of which involve the complex, antisocial hours that deter so many women: general practice 31,711; anaesthesia 6,940; paediatrics 2,578; psychiatry 3,302; general medicine 3,737; general surgery 3,779; trauma and orthopaedics 3,629.
Dame Carol Black, former president of the Royal College of Physicians, pointed out this growing discrepancy in 2004, when she controversially suggested that the feminisation of the medical profession would lead to its degradation.
She said the issue was not whether women doctors could do their job properly, but whether they were willing to devote time and effort, beyond their clinical responsibilities, to activities such as committee work and research.
Politicians are concerned, too. In a Commons debate in June, Anne McIntosh, a Tory MP, said that women doctors who had received expensive medical training but went part-time after starting a family were a huge burden on the NHS.
In reply, Anna Soubry, then a health minister, agreed that they were a drain on resources.
Within hours, after angry responses, some from the British Medical Association and the Royal College of GPs (two professional bodies opposed to any meaningful reform of general practice), Ms Soubry was forced to retract her comment and apologise.
Of course, it is perfectly reasonable that women should have career breaks to have children. But is part-time working on such a large scale in the public interest, even if it is considered perfectly acceptable by our ultra-politically correct NHS management?
GPs are very well paid. Their average salary is around £103,000 — quite sufficient for a woman doctor who is also a mother to be able to afford quality childcare at home.
But the salary also means that part-time working still allows for a comfortable lifestyle.
In addition, doctors tend to marry within their own socio-economic group and, in many cases, the wife is the secondary earner. This also encourages less demanding part-time work.
A female junior surgical trainee told me recently that when she went to medical school, some female students announced from the start that they intended to be part-time GPs when they qualified.
But in general practice, part-time working and job-sharing have an effect on patients.
They can deprive them of continuity of care, which is the service they most value. That once key value of the NHS — the cradle-to-grave relationship with patients — has become a thing of the past.
Indeed, I believe that current general practice fails to meet the needs of the modern health service and its patients.
That such a great and growing number of GPs are part-time is a major problem, but it is not the only one.
Because GPs tend to work in small group practices, there is a danger that these can become backwaters, isolated from the nourishing influences of mainstream hospital medicine.
Failure to keep up with the latest developments is a real risk. The perfect solution, suggested by health minister Lord Darzi in 2007, was ‘polyclinics’ — super-surgeries in which GPs and hospital consultants would work together. Sadly the idea was not implemented.
In truth, general practice is organised for the convenience of doctors — particularly, I suspect, for female GPs — and not their patients.
No wonder many people, faced with a medical problem, ignore their local surgery and go straight to A&E — one reason why emergency medical services are at breaking point.
The problems with A&E are very much in the public eye. Not so the issue of part-time working — but it certainly should be, as it is linked.
In the UK we have a serious shortage of medical school places, with the result that more than half of male applicants with the required grades are rejected. As we have seen, many women who take up medical school places subsequently work part-time and, on the whole, tend to avoid A&E.
We make up the shortfall in medical manpower by importing about 40 per cent of the doctors we need. Most now come from austerity-stricken EU countries.
Does this make economic sense?
We need accurate data on the extent of part-time working in order to allow public debate which could then inform medical school selection.
For my part, I believe medical school places should be given to those most likely to repay their debt to society.
Last year (2013) the U.S. businesswoman Sheryl Sandberg published a book called Lean In. It should be compulsory reading for female medical students.
Her thesis is that too few women make it to the top of any profession. She acknowledges the conflict between professional success and domestic fulfilment, but says women should commit more professionally and not ‘lean out’.
How do we persuade female doctors to ‘lean in’? It is a question we urgently need to address.