Intended for healthcare professionals

Editor's Choice

Career trajectories and black holes

BMJ 2009; 338 doi: (Published 11 June 2009) Cite this as: BMJ 2009;338:b2374
  1. Tony Delamothe, deputy editor, BMJ
  1. tdelamothe{at}

    Over the years, a lot of rubbish has been talked about the trajectory of medical careers in Britain, usually with the motive of drumming up special sympathy, or extra money, for some put upon group or other.

    So it’s refreshing to encounter what look like definitive discussions of the topic: a report from the Royal College of Physicians and two studies from the UK Medical Careers Research Group in Oxford. The first study (based on surveys of all doctors working in the NHS who graduated in 1977, 1988, and 1993) found that the key factor determining career progression was working pattern, not female sex. Working part time delayed progression to consultant or GP principal status equally in men and women. Women and men working full time got there earlier—but progressed at identical rates (doi:10.1136/bmj.b1735).

    In his editorial, Graham Winyard endorses the conclusion of the college’s report that “the main challenge ahead is no longer barriers to entry or delays to the career progression of women” (doi:10.1136/bmj.b2223) Rather, it is “to ensure that the increasing proportion of women is effectively, economically, and fairly incorporated into the workforce for the benefit of patients.” As the proportion of female medical school entrants is stabilising at 57-58%, and as many medical graduates of both sexes will want time off to look after children, this challenge is far from trivial.

    The second study looks at the proportion of medical graduates from British medical schools who eventually practise in the NHS (doi:10.1136/bmj.b b1977) All doctors graduating at nine time points between 1974 and 2002 were surveyed. Of doctors from British homes 88% were working in the NHS two years post-qualification; by 25 years, 81% were. These proportions hardly differed between the sexes and, crucially, at no time was there an abrupt departure of doctors from the NHS. Perhaps juniors traumatised by MTAS and MMC will disrupt this reassuring pattern, but I’ll wait for data on their actual behaviour, rather than their threats, before believing it.

    Nigel Hawkes found juniors “forceful and formidably articulate” contributors at a one day meeting on patient safely (in which the BMJ had a hand) (doi:10.1136/bmj.b2286). He wondered whether their assertiveness and unwillingness to defer was a legacy of the failures of MTAS. Whatever the origins, Bruce Keogh, the NHS’s medical director, was keen to harness these to improve patient safety. “Juniors are the best agents for change in our devolved NHS,” he told them. “Here’s the deal. You do it and I’ll promise to implement it. It’s our opportunity to start something.” According to Keogh, England now had the most comprehensive system for reporting mistakes of any country in the world. Too bad that just down the road the parliamentary health select committee inquiry into patient safety was hearing that between 2005 and 2008, 500 or so incident or accident forms from the Mid Staffordshire NHS Foundation Trust vanished into a black hole (doi:10.1136/bmj.b2297).

    Last week, another black hole settled over Whitehall, sucking cabinet ministers into it. Alan Johnson, secretary of state for health for the past two years, escaped but was moved to the Home Office, possibly en route to Number 10 Downing Street were a vacancy to open up. His main achievement at the Department of Health has been to keep the NHS off the front pages.

    Also in recent weeks, Peter Rubin has taken up the reins as chairman of the General Medical Council. In an interview with Clare Dyer he reminds doctors that revalidation starts in earnest in 2011 (pilots are already up and running) (doi:10.1136/bmj.b2360). Before that—by this November—doctors will need a licence to practise in the UK (doi:10.1136/bmj.b2363). Licences will need periodic renewal, and revalidation will be a key part of this.


    Cite this as: BMJ 2009;338:b2374

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