The importance of less than full time employees to the NHS Medical workforce planning is a complex task. Changing patient demographics, rapid advances in technology and increased health service demands and expectations have meant predicting the number of doctors and their eventual choice of speciality [1] has not always occurred with precision. A recent article in the Daily Mail contained a number of provocative statements in respect of the role of women in the delivery of health care. As healthcare professionals working at all levels within the National Health Service (NHS), we welcome the opportunity to correct the many factual inaccuracies contained in the article. Addressing the workforce issues of the NHS simply through the lens of gender is neither sensible nor possible and therefore we aim provide an accurate portrayal of the contribution less than full time (LTFT) employees make to the NHS. There are many reasons why doctors at all stages of their careers choose to work LTFT. This is not confined to the female workforce: 1 in 20 male Consultant Physicians chooses to work LTFT [2]. Although the majority of LTFT workers do so to care for children, many care for sick or elderly relatives, have health problems themselves or, increasingly, work in academic, quality improvement or managerial roles for part of their working time. To restrict the training and employment of doctors to those who can work full-time in a clinical role would be both hugely discriminatory, and lose the richness of diversity in a medical workforce that, if anything, needs to be more reflective of the population it serves, not less. Any attempt to do this would be likely to be illegal. Furthermore General Practitioners are independent and therefore can choose how to structure their careers including additional roles which are professional or as carers. Finally less than 10% of surgical consultants (across all subspecialties) work LTFT, although 35% indicated that they would like to, reiterating the fact that LTFT is relevant to all, regardless of gender [3]. Although it is obvious that there will be more LTFT doctors needed to provide the same level of cover as full time doctors, recent work by the Royal College of Physicians demonstrates it is not a simply a case of two doctors for every one post. The recent Future Hospital report calculated that 150 female or 120 male doctors needed to be trained to provide staffing for 100 full-time positions, i.e. a 25%-50% increase rather than the 200% quoted in the article [Personal Communication Dr. Goddard]. The argument that society should quantify the value of training based on predicted output is something we reject and would render many members of society ineligible for higher education. In the Mail article it was noted that by 2017 there will be more female than male doctors in the United Kingdom. This increase in the female medical workforce brings many benefits. A review of complaints about doctors received by the National Clinical Assessment Service (NCAS) shows that women are less likely to be subject to disciplinary hearings. Over eight years, 490 male doctors were banned from seeing patients, compared with just 79 women. Commenting on the study, Rebecca Field from NCAS said that women take a more caring and cautious
approach to patient care] [4]. According to a report by the General Medical Council male doctors were twice as likely as female doctors to receive a complaint, irrespective of speciality [5]. Increasing numbers of women within the medical workforce is not a new trend, and one we should be proud of, given that in the UK only 24% of MPs and just 19% of FTSE 100 company directors are women. Assertions that female students are now monopolising places at medical school are unfounded - data from the Universities and Colleges Admissions Service (UCAS) demonstrates that in 2012, 53% of places were offered to women; although 42% of female applicants took up places compared to 44% of male applicants. Currently, women make up the minority of the medical workforce. Just under half of registered General Practitioners (GP) [5] are female and amongst Consultant Physicians, one third of the workforce is female [6] Comments that women in the medical workforce tend to avoid the more ‘demanding’ specialties are grossly inaccurate and demonstrate an antiquated and misogynistic understanding of medicine. Specialties such as Paediatrics and Obstetrics and Gynaecology have a balance of genders and yet operate on full-shift on-call rotas [7] which are of identical rigor to surgical rotas. It is worth remembering that for every surgeon operating at 3am, there must also be an anaesthetist and theatre team. We accept that workforce planning in the NHS will remain a challenging process. We can be proud that that we have an educational and employment system that has become progressively more inclusive, ensuring that the bulk of the doctors that we train are motivated to continue working for the NHS and meet the needs of our society irrespective of gender, specialty and chosen lifestyle. References 1. College of Emergency Medicine Statement on Emergency Measures for recruitment. Website last accessed 8th January 2014 http://secure.collemergencymed.ac.uk/Public/Latest%20News/CEM%20Statements/ 2. RCP Registrar, private communication 3. Royal College of Surgeons Workforce census 2011. Website last accessed 8th January 2014 http://www.rcseng.ac.uk/surgeons/surgical-standards/docs/2011-surgical-workforce-censusreport 4. Khan M. Medicine - A women’s world. BMJ Careers 2012. Website last accessed 8th January 2014 http://careers.bmj.com/careers/advice/view-article.html?id=20006082 5. Variations in standards of medical practice. General Medical Council. Website last accessed 8th January 2014 http://www.gmc-uk.org/20131004_Chapter_3_SoMEP.pdf_53704250.pdf 6. List of registered medical practitioner statistics. General Medical Council. Website last accessed 8th January 2014 http://www.gmc-uk.org/doctors/register/search_stats.asp 7. State of medical education and practice 2013. General Medical Council. Website last accessed 8th January 2014 http://www.gmcuk.org/20131004_Chapter_1_SoMEP.pdf_53706030.pdf
This letter is supported by: Damian Roland, Senior Paediatric Registrar, Leicester Hospitals Nikita Kanani, GP, NHS Bexley CCG Board member, Quality Lead FMLM Chris Williams, GP, Inverness Thomas Shanahan, Medical Student, University of Leeds Chris Ferdinand, GP, Lewisham and Chair London AiT/ First5 committee Laura-Jane Smith, ST4 Respiratory Medicine, Homerton University Hospital and Honorary Clinical Lecturer UCL Medical School Colette Marshall, Consultant Vascular Surgeon, Coventry Philip Pearson, Consultant Physician, Plymouth Ruth-Anna Macqueen, StR in O&G, London Elaine Leung, StR in O&G, London Elin Roddy, Consultant Physician, Shropshire Patricia Cantley, Consultant Physician, Edinburgh Jason Sarfo-Annin, Acute Common Care Stem Trainee, Bristol Nathan Cantley- Intercalating Medical Student, Queen’s University Belfast Rosalind Brock, ACCS Trainee, Oxford Alice Roueché, Paediatric SpR, London and KSS Natalie Blencowe, Doctoral Research Fellow and SpR General Surgery, Severn Felicity Taylor, Paediatrician and National Medical Director’s Clinical Fellow Carolyn Johnston, Consultant Anaesthetist, London Lynne Reid, GP, Exeter Pollyanna Jones, Regulatory Performance Manager, Kings College Hospital London Tessa Davis, Paediatric ST6, North Western Deanery Anna Taylor, Intercalating Medical Student, University of Bristol Natalie May, ST6 Emergency Medicine, Manchester Carmen Soto, ST4 Paediatrics, Leicester Kirsty Challen, MRC PhD student, University of Sheffield and ST6 Emergency Medicine, Preston Pierre-Antoine Laloë, Anaesthetic ST6, West Yorkshire Jess Drinkwater, Academic GP, University of Leeds Sharryn Gardner, Paediatric EM Consultant, Ormskirk Sarah Khan, GP and Vice-Chair- Hertfordshire LMC Medical Women’s Federation Rachel Gallagher, Directorate Manager for Trauma & Orthopaedics, City Hospitals Sunderland NHS Foundation Trust Katherine Bowman, Foundation Doctor, Stockport NHS Foundation Trust Thomas Lewis, Medical Student, University of Warwick Trish Greenhalgh, Professor of Primary Health Care, Queen Mary University of London Daniel Sommer, F2 Doctor, Imperial College Healthcare NHS Trust Sukhdip Jhaj, GP, West Yorksire
David Nicholl, Consultant Neurologist and Vice-Chair Neurology SAC, JRCTPB. City Hospital, Birmingham Joan Pons Laplana, Community Staff Nurse, Derbyshire Community Health Services NHS Tanaya Sarkhel FRCS (Tr&Orth) Consultant Orthopaedic Surgeon, Surrey Trust Alan Shirley GP and Training Programme Director for GP and BBT, Sheffield Ranj Singh, Paediatric Emergency Medicine Registrar (London) & Media Doctor Eleanor J Hothersall, Consultant in public health, NHS Tayside Subashini M, Clinical Research Fellow, Imperial College London Amar Shah, Consultant forensic psychiatrist & quality improvement lead, East London NHS Foundation Trust Dr Liam Farrell, retired GP, writer and broadcaster, N Ireland Yetunde Odutolu, ST4 Paediatric, North Western Deanery (supporter, not contributor) James Woollard, ST6 CAMHS, NW London Scheme Felicia Yeung, Medical Student, King’s College London Cameron Stocks, National Director, Medsin-UK Dr Richard Ma. Part time GP Principal London, Part time doctoral student London School of Hygiene and Tropical Medicine. Omer Moghraby, Consultant C&A Psychiatrist, Lewisham CAMHS, SLaM Michael Farquhar, Consultant Paediatrician, London