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What do women doctors want? The chance to work part-time
Since the Government has rashly promised us "world-class public services", it will have to do something urgently about Britain's doctors: their morale is low; they frequently work in conditions that force down their standards; they are leaving the profession in droves; and there aren't enough of them to begin with.
The British Medical Association recently completed a survey of young doctors that showed a very significant collapse in their idealism about their careers since 1995. It also showed that life as a GP has become so unattractive that not enough medical students are opting to train for the job; before long, there won't be enough GPs to maintain present numbers, which are already inadequate.
Something will have to be done soon about attracting more doctors and making them happier. Opportunely, the Royal College of Physicians (RCP) is to publish a report next week - Women in Hospital Medicine - chaired by Professor Carol Black, which will contain some detailed recommendations for training and employment. Since more than half of all medical school graduates are women, the question of what women doctors need and want is something the Government will not be able to ignore. It might even find the answers constructive.
I was one of the people who sat on the RCP working party that prepared the report. As I listened to one expert witness after another, men as well as women, it was forced on me, although I thought I knew it already, just how punishing most doctors' schedules are. There was something immensely gallant about the way these women doctors uncomplainingly found time away from their brilliant careers - and these were all successful women - to further other people's interests probably rather more than their own.
The hours of work demanded just to get by as a doctor are extreme; the extra hours needed to achieve something more - to take on extra academic work or to develop a special interest - are punitive. There will always be those few who are willing to dedicate most of their waking hours to medicine, often to achieve great things. But for most doctors, and certainly for most women doctors, something has to give.
Figures from the Organisation for Economic Cooperation and Development strongly suggest that, while British doctors are well paid by European standards, they have to work about twice as hard. Literally: they have twice the workload. In Britain, there are only about 1.8 doctors per 1,000 people, whereas the average in Europe is 3.4 doctors. That corresponds with most people's personal impressions: it is hard to get much time with your doctor. Both GPs and hospital doctors are often desperately hard-pressed for time.
This is bad for the patient and also bad for the doctor; it means increasing strain at work, and increasing misery at home, too. That is because, obviously enough, the populace in general has recently been waking up to the idea that children need their parents; doctor mothers and (increasingly) fathers are less and less prepared to be out of the house for 12 hours a day, in the way that previous generations of doctors were.
The obvious solution is part-time work. Surveys among working women in general are pretty unanimous in finding that women would prefer to work part-time. Men are beginning to feel the same. The trouble is that part-time work is difficult to find, because most employers find it relatively uneconomic. You can impose it on employers, as this Government has tried to do, but those of us with Right-wing views are wary of trying to kick the market; it's usually counter-productive.
However, women doctors are in a powerful market position. They are (like men doctors) desperately needed and therefore, in a real market, they would have the power to renegotiate their terms of employment. Perhaps they don't really sense this, because life under the NHS dries up people's commercial instincts.
For all the reforms and talk of internal markets, the culture of the NHS remains profoundly statist; the state thinks it owns doctors - the Government's suggestions before the election that consultants should be handcuffed to the NHS for the first seven years of their careers is a perfect example of this attitude. Doctors' traditions of public service are easily exploited by this public sector mentality.
My own view - not, I must stress, the view of the RCP working party - is that doctors are effectively enslaved by the NHS. In an open market, women doctors (and male doctors and nurses, too) would long since have been able to insist on the working conditions that they actually wanted, from a position of great market strength.
Admittedly, that would end up being much more expensive for patients, whether we paid through our tax bill or our insurance bill, but we will be paying more in future whatever happens. I am reminded of a Calman cartoon in which a little man walks past a feminist holding a poster saying "Free Women Now!" and asks excitedly if he can have one. Free women doctors now. And men, too. Then perhaps we would have some when we need them.
The Daily Telegraph | Saturday, June 23, 2001
