The realities of career breaks and working part time in medicine
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3873 (Published 20 June 2013) Cite this as: BMJ 2013;346:f3873
- Naureen Bhatti, general practitioner; associate director for return to practice schemes,
- Rebecca Viney, associate dean, GP retainer scheme
- 1Professional Support Unit for Health Education North Central and East London, Health Education North West London, and Health Education South London, London, UK
- naureen.bhatti{at}nhs.net
Abstract
Health minister Anna Soubry’s comments on the “unintended consequences” for the NHS of women doctors working part time after starting families drew criticism from doctors. Naureen Bhatti and Rebecca Viney look at the reality of how men and women can take career breaks and work part time in medicine
Earlier this month health minister Anna Soubry caused controversy by appearing to suggest that female general practitioners (GPs) who work part time are a burden on the NHS.1
Responding to a comment about GPs working part time after starting families, Soubry said there were “unintended consequences” of having more female doctors. She later said that she had “not intended to be derogatory,” but simply to point out that “some female GPs work part time due to families.”
Her comments were criticised by Conservative MP Sarah Wollaston, a GP in Devon, who said women doctors add great value in medicine, and by Clare Gerada, chairwoman of the Royal College of General Practitioners.
Vicky Weeks, chairwoman of the BMA’s General Practitioners Committee sessional GP subcommittee, says that blaming the NHS’s woes on female GPs working part time is “not only offensive but simplistic.” She argues that it also “betrays a basic lack of understanding of service provision and [changing] shape of the workforce within the NHS.”
Soubry’s comments misrepresent the reality of how female and male GPs are choosing to work part time and to balance having a family with work in general practice. Firstly, it is not only women who want to work flexibly or have a break from clinical work. Men want to do so too, knowing there is a safe way to maintain or refresh skills.2 Having children isn’t the only reason (box).
Experiences of career breaks
Edward Smyth, general practitioner, south London
After a five year career break I am excited to return to part time general practice. The relative ease of the transition through the London Deanery’s refresher scheme was surprising and welcome. My break has allowed me to refocus personal goals, ambitions, and priorities. I am certainly hoping to combine a part time clinical role with my wider public health and writing interests. Workplace flexibility in reality continues to keep me and my clinical experience within general practice and allows for a stimulating wider career, much of which I believe contributes to patient care.
Penny Newman, general practitioner, Suffolk
I had a senior public health job and decided to retrain as a part time general practitioner (GP). Combining clinical work part time with raising three young girls was hard but the experience I gained with my children was useful for work. Although still a part time GP I now work full time with a portfolio that helps me cross fertilise ideas between sectors and keeps me highly motivated.
Secondly, many GPs are working full time overall but choosing to work part time in clinical general practice in order to have portfolio careers, to increase motivation, and to create a sustainable working life.3 These GPs are supported to take career breaks and work part time by a variety of schemes. A GP induction and refreshment scheme runs throughout England and Wales to provide refresher training for those taking a break from practice.4 Since 1979, a retainer scheme has allowed GPs to work part time in a supported role for up to five years.5
Schemes for flexible working
In addition to these initiatives, London Deanery worked for many years on schemes to allow flexible working in general practice, as well as coaching and mentoring to enhance the careers of doctors in transition. This work is now continuing across Health Education North Central and East London, Health Education North West London, and Health Education South London, the three organisations that have replaced London Deanery.
All these schemes are important because the United Kingdom needs more GPs to help care for the ageing population and to provide more services closer to people’s homes, and it is training too few to meet these needs. The Centre for Workforce Intelligence, for instance, has estimated that the number of GPs currently being trained in the UK is 18% lower than is necessary to meet the health service’s needs.6 The UK government spends £381 000 training each GP and so it makes financial sense to retain GPs and bring them back into practice if they choose to have a break.7 It also makes sense to make long term investments in the workforce—women and men taking career breaks gain wide experience of life outside the workplace and bring this to their clinical practice when they return.
Rising numbers of female doctors
In the past many people who left the profession because of inflexible working patterns did not come back. Many women who achieved success tell stories of never having gone to a parents’ evening or sports day. We can’t return to that.
There are still too few women breaking through glass ceilings in general practice and other specialties. In that context, Soubry’s comments have given the NHS the perfect opportunity to explore how best to release the potential of women, who now make up 77% of the total NHS workforce and more than 50% of NHS doctors.8
Soubry is not the first to raise concerns about how the rising numbers of female medical students and doctors could threaten the profession and the NHS.9 For some years, women have outnumbered men at medical school entry, but they continue to be under-represented in more competitive specialties, academia, and positions of senior leadership.10 Women continue to be held back, not just by a lack of role models but also by a lack of flexibility in working models and low acceptance among employers of career breaks and part time working.11 To tackle this, working models and support for career breaks and part time working need to be improved for women and for men.
We need schemes such as those discussed, not just in general practice but elsewhere in medicine. We need to celebrate and retain our female and male workforce and make the best of their skills by allowing good choices at critical times in their careers to balance work and life. If we want a compassionate workforce we need to treat our workforce with compassion.
Footnotes
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare: NB: I am the associate director for the Return to Practice schemes for London—my job is to advocate on behalf of people wanting to return to practice. RV: I am the associate dean for the GP Retainer scheme for London—my job is to advocate on behalf of people wanting to be retained in practice, when personal factors might normally prevent it.