UK doctors move towards general practice and flexible working

UK doctors increasingly prefer general practice and flexible working

A surge of interest in general practice and a movement towards flexible working are among the findings of a 10 year study of UK doctors’ careers. The study also notes the rise of the so called portfolio career, in which doctors dip among job types and specialties.

The BMA’s cohort study, which was set up to monitor the career progression of almost 600 doctors who qualified in 1995, came to an end last week. As well as chronicling the frustrations experienced by the average trainee doctor, the study, which used a mix of yearly surveys and focus groups to track the careers of GPs and consultants, provides a picture of career trends over the past decade, said Jon Ford, head of the BMA’s health policy and research unit.

"If you read the BMJ obituaries you will see that few of those featured have conventional linear careers," said Dr Ford. He said that unconventional career paths were increasingly common.

The rise in the number of female doctors (women now make up more than half of all medical school graduates), the pursuit of variety, and the growing importance of a work-life balance were some of the reasons given for these changes.

General practice is seen as a more manageable option in terms of hours and opportunities for part time work, and it was these qualities that account for 44% of female doctors and a high proportion of male doctors with children choosing general practice, said Rosemary Crompton of the Economic and Social Research Council’s Gender Equality Network, responding to the results of the survey.

But she warned that flexible working (once dismissed as the "namby pamby" option, one respondent said) represented a "false choice" for many doctors. Doctors with families often felt that working full time in surgical specialties was not a possibility for them and opted for general practice or part time working instead.

She also warned that the "patronage" system, whereby younger doctors—particularly if they are male and educated at private schools and Oxbridge and Cambridge—are taken under the wing of successful senior colleagues and win promotion more quickly as a result, may be limiting the progress of candidates from other backgrounds.

Furthermore, consultants still face "terrible career blockages," said Paul Miller, chairman of the BMA’s Central Consultants and Specialists Committee. Some trainees were stuck in posts for years as they waited for senior colleagues to retire, because the number of available consultant posts available could not match the rapid rise in numbers of medical school graduates.

"A lot of juniors are really lost at the moment," said one respondent to the study. "I know friends who are frustrated and moving on to other things because of it."

Dr Miller predicted that as the NHS started to commission more services from privately backed companies, frustrated trainees could be tempted away from the health service. It might be against doctors’ politics to work for such companies, he said, "but to be honest they’ll probably make better employers."

Nevertheless, other changes in the last 10 years are to be celebrated, including improvements in NHS pay and hours, said Mark Porter, a member of the Central Consultants and Specialists Committee, who instigated the study. Dr Porter recalled his days as a house officer, when he was contracted to work an 88 hour week, although he added that exhausting shift work was now on the increase.

The BMA will be recruiting graduates for a fresh study in summer 2006.

BMA Cohort Study of 1995 Graduates: Tenth Report—June 2005 is accessible at www.bma.org.uk