Letters

Are part time doctors better doctors?

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7138.1169a (Published 11 April 1998) Cite this as: BMJ 1998;316:1169

Doctors need flexible training and flexible jobs

  1. Ilfra Goldberg, Associate dean, postgraduate medicine, Thames Region,
  2. Ri Hornung, Dean of postgraduate general practice, South Thames
  1. Thames Postgraduate Medical and Dental Education, University of London, London WC1N 3EJ
  2. Norfolk and Norwich Hospital, Norwich NR1 3SR
  3. King's College Medical School, Weston Education Centre, London SE5 7DF
  4. Goodinge Health Centre, London N7 9EW
  5. St John's Health Centre, Twickenham TW11 9HG

    EDITOR—Gibson raised some serious points for further discussion about part time working in career grades.1 Kumar contributes nothing to an informed debate on this topic, and his argument runs counter to the views of respected national bodies such as the Royal College of Physicians.2 He states: “Part timers are no good for any medical specialty where there may be a need for quick action….” He says that he works 50 hours of the 168 in a week. This means that, for the remaining 118 hours, someone from his team has to be available, or there is no one to undertake the responsibilities. A team provides continuity of service to patients, and part timers can be highly effective members of a team.

    Overall, some 8% of specialist registrars are training on a flexible basis; in Oxford, Kumar's region, this proportion is 15.3% (Department of Health, annual medical workforce census). It is therefore unfortunate that he should seek a confrontation at the very time when flexible and full time training are so much more closely integrated and flexible training leads successfully to consultant posts. The same constraints that lead doctors to ask for flexible training are often still present when they seek a career grade post, and these doctors will seek part time consultant posts.

    In some specialties, including general practice, the shortage of doctors to deliver the service is severe. We need to facilitate training and career grade opportunities for young doctors who might otherwise leave, temporarily or permanently, by providing flexible (part time) opportunities. As Allen says: “… a radical assessment is needed of how we are to make use of the talents of the brightest and best of successive generations of young people who enter medicine. Assumptions still predicated on a medical workforce made up of men working full time mainly in one specialty for 40 years are hopelessly misguided….”3

    References

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    Service depends on teamwork

    1. Anna Lipp, Senior registrar in anaesthetics
    1. Thames Postgraduate Medical and Dental Education, University of London, London WC1N 3EJ
    2. Norfolk and Norwich Hospital, Norwich NR1 3SR
    3. King's College Medical School, Weston Education Centre, London SE5 7DF
    4. Goodinge Health Centre, London N7 9EW
    5. St John's Health Centre, Twickenham TW11 9HG

      EDITOR—Kumar seems to think he can personally provide continuity of care while he is only working 50 hours a week.1 Who manages his patients when they are ill during the remaining 118 hours? No individual doctor, full or part time, can be available for all the hours their patients may need them. A continuous service depends on a team of health professionals working together and communicating effectively, whether or not their consultant is present. Perhaps the wisdom that part time doctors acquire during their “non-working” hours is the realisation that they are not indispensable but part of a team, both at work and at home.

      References

      1. 1.

      Fulfilled doctors are better doctors

      1. Cynthia Sahleen-Veasey, Medical student,
      2. Lesley Morrison, General practitioner
      1. Thames Postgraduate Medical and Dental Education, University of London, London WC1N 3EJ
      2. Norfolk and Norwich Hospital, Norwich NR1 3SR
      3. King's College Medical School, Weston Education Centre, London SE5 7DF
      4. Goodinge Health Centre, London N7 9EW
      5. St John's Health Centre, Twickenham TW11 9HG

        EDITOR—The London initiative zone educational incentives programme (LIZEI) is using education as an incentive to attract general practitioners to enter, stay in, or return to, general practice in inner cities. The essence of the programme's approach is flexibility. Providing opportunities for doctors to develop their skills and interests enhances their enjoyment, and thus the quality, of their work.

        Kumar obviously disagrees.1 The number of hours a doctor spends in contact with patients, rather than the quality of work done within those hours, seems to be the issue for him. Continuity of care is important and cannot be maintained if a doctor is not available for a sufficient number of hours. It is simply not true, however, that someone who has gone through medical training while giving low priority to other aspects of his or her personal development is therefore a better doctor. As Gibson argued, the opposite is usually the case.2

        Patients benefit from having doctors who are fulfilled in their personal lives. Would Kumar suggest that children of doctors remain relatively unparented, or would he prefer medicine to return to being the exclusive domain of men? He failed to mention who looks after his children while he is pursuing his many, varied, and time consuming activities.

        One of us (CS-V) is a mature medical student, and the other (LM) is completing a year as a returner in general practice. We both have children and have both explored other interests before settling on our career paths. We are both sure that we are doing what we are doing—combining work and family—because we want to and not because we are fulfilling the expectations of others. We noted with interest that, in the survey reported recently in Career focus, 95% of medical students considered flexible training a good idea.3

        A scheme proposed at Guy's and St Thomas's Hospitals offers students leaving school and selected for admission to medical school a place which would then be kept for them until they were 21 years old. In the intervening time, they would be encouraged to pursue their own interests with a place guaranteed at the end. In case they realised during that time that medicine was not for them, they could withdraw with no recrimination. This is an excellent proposal.

        Doctors have the same needs as anyone else to be good parents and fulfilled people. If a lack of flexibility in working practices and attitudes does not allow these needs to be expressed, doctors, and consequently patients, will suffer.

        References

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        Continuity of care is likely to suffer

        1. Chris Manning, General practitioner
        1. Thames Postgraduate Medical and Dental Education, University of London, London WC1N 3EJ
        2. Norfolk and Norwich Hospital, Norwich NR1 3SR
        3. King's College Medical School, Weston Education Centre, London SE5 7DF
        4. Goodinge Health Centre, London N7 9EW
        5. St John's Health Centre, Twickenham TW11 9HG

          EDITOR—Kumar says that his comments may not be applicable universally.1 There is no doubt in my mind that the strongest feature of British primary care has been its intention and often its ability to provide continuity of patient care. This is now being undermined as low morale, exhaustion, and frustration sap the patience of many. Canaries taken by miners down the pit quickly detected poor air quality, and, similarly, the most sensitive and creative people in today's work environments are often the first to start wilting. I know many practices that are now surviving on the backs of the booming locum industry—a phenomenon also repeated in the teaching and nursing professions.

          The increases in numbers of job sharers and “portfolio practitioners” may be good for the health of the particular people, but they are going to make it much harder for those left in the job to ensure continuity. If the people of Britain think that it is difficult to see the same doctor more than once—they haven't seen anything yet.

          Footnotes

          • * We received eight other letters, six of them from doctors working flexibly. They all agree that “part time” merely describes the way that all doctors work, to a greater or lesser degree. The debate should consequently not be about whether part time or full time is better, but how flexible training and work patterns can be developed that accommodate different doctors' different needs in a changing society, and therefore offer patients better care and greater continuity.

          References

          1. 1.