Here is a regurgitation of one of the Witch Doctor’s posts in 2009. It is becoming more relevant as time goes by since the The Skills Escalator is now seldom mentioned, polyclinics have died, Remedy UK has ceased to exist and politicians are in the process of going full circle as they are becoming attracted to the continuity of care that GPs once provided.
One of the problems with the Female Variety of The Humankind is that they are unpredictable.
Especially when they have a partner who may have to move around the country to follow a career.
Especially when they have a partner who is financially secure.
Even more so when they have a partner and children to consider.
Even more so when they have a partner and children and aging relatives to consider.
Even more so when they have a partner and children and aging relatives and exams and all sorts of other hoops to go through to further their own careers.
There are just not enough hours in the day.
And they don’t want more hassle.
Nowadays, 60%, 70%, sometimes 80% entrants into medical school are female?
The Witch Doctor would really like to know why this is so.
If this is so, it is very worrying.
We need to know if males are choosing other careers. In The Witch Doctor’s opinion this would be a disaster for patient care as well as the profession.
Regarding most female doctors with family commitments, The Witch Doctor can tell you what used to happen.
1. A few female doctors would have a clear plan of their career path shortly after they graduated and they would stick to this with tenacity whatever hurdles came their way. If they wanted to be a consultant brain surgeon, then they became a consultant brain surgeon and that was that!
2. The majority of women, however, decided for a broad base to their training – one that would allow them mobility in the future and the potential for part-time work if necessary. This usually consisted of going through GP training or obtaining an MRCP as soon as possible. An anaesthetic qualification was also popular from time to time.
3. Most women continued to work full time until they had children, they then took a break, perhaps joined the retainer scheme and kept ticking over on a part-time basis until they were ready to increase their sessions. Women went into general practice in droves because the route to being an independent practitioner there was shorter than in the hospital specialties, and GP qualifications meant they could pick up work in any part of the country. Many never took up full time work again and the majority of hospital doctors with children picked up sessions as Clinical Assistants, Staff Grades, Hospital Practitioners within various specialties. Some resumed work as full time registrars and continued to a consultant post. Once appointed some decreased their consultant sessions to become part-time.
4. A few gave up medical work completely and never returned.
5. Of the women who built up some kind of “work portfolio” for themselves, many would have been put off by the hassle of administration. Sessional work with minimal administrative responsibility, and minimum requirement for any more examinations suited them just fine.
It has to be remembered that full time in medicine used to mean just that – there was no respite. Even you were off duty there was reading, teaching preparation, exam marking, writing research papers, keeping up to date, thinking about an elusive diagnosis. A consultant or GP had 24 hour responsibility for his/her patients and family and personal life had to be worked round that.
That was the way it was.
How is it now?
The European Working Time Directive may enable more women doctors to work full time without all the crippling extra hours that were necessary before.
However, a longer time to train as a GP might not appeal to women doctors so much. Conventional practices are reticent about taking on new medical staff while the effect of polyclinics is being determined. Polyclinics will welcome a few female GPs on a sessional basis particularly if they are cheap to employ eg “competency qualified” rather that fully fledged GPs.
Litigation is becoming commoner. Defence fees are going up.
Silly sites like Iwantgreatcare may prove to be demoralising.
Will suspensions and GMC referrals increase as a result of revalidation?
Are there, at this very moment, precedents being set that will result in a formal complaint on any matter that is unrelated to medical practice being taken up by the GMC?
Is the door now wide open for vexatious complaints?
Childcare is expensive and women worry about the safety of their children when they are working.
Is it all worth it?
Women are unpredictable.
Women who can afford to, may get fed up going through all the bureaucratic hoops of ticking boxes for CPD, appraisal and revalidation and may leave medicine for ever.
The problem is that no one knows the effect of having nearly 80% intake of women into medicine in the current climate.
The current medical climate is oppressive.
Women do not like to be oppressed.
So how can a medical workforce be planned?
In The Witch Doctor’s opinion, at the present time, it can’t.
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