3 June 2009

Men and women doctors trained in Britain follow similar career paths

Research: Retention in the British National Health Service of medical graduates trained in Britain: cohort studies, BMJ onlineResearch: Career progression and destinations, comparing men and women in the NHS: postal questionnaire surveys, BMJ onlineEditorial: The future of female doctors, BMJ online

The vast majority of medical graduates trained in Britain work in the NHS for many years, refuting claims that doctors are increasingly leaving the NHS because they are disenchanted with it, according to a study published on bmj.com today.

A second study also published today shows that direct discrimination is no longer a barrier to the career progression of women doctors in the NHS.

The findings are based on regular surveys of doctors who qualified from UK medical schools over the last 30 years.

In the first study, 32,013 graduates were tracked at regular intervals up to 25 years after qualification. Of these, 94% were from family homes in Britain and 6% were from family homes overseas.

88% of graduates with family homes in Britain were working in the NHS two years after qualification. Subsequent years showed a gradual, small decline: 86% at five and 10 years, 85% at 15, 82% at 20, and 81% at 25 years. Most of the doctors who moved outside the NHS remained in medical practice, either in Britain outside the NHS or in other countries.

Among those with family homes overseas, 76% were working in the NHS two years after graduation and two thirds were still in the NHS 10 years after qualifying.

The percentage of women medical graduates who worked in the NHS was almost the same as that of men, refuting claims that women are much less likely than men to practise. However, a much higher percentage of women than men worked part time, a factor that needs to be fully considered in workforce planning, say the authors.

In the second study, 7,012 doctors who qualified from UK medical schools in 1977, 1988 and 1993 responded to a survey about career progression.

The results show that, although a smaller proportion of women than men progressed to senior posts, and men progressed more quickly than women to these posts, the career paths of women who had always worked full-time were very similar to those of men.

Part-time men and part-time women also had broadly similar trajectories which were slower than those of full-time doctors.

There was no evidence that having children disadvantaged the career progress of women who had always worked full-time, both in terms of the proportion who reached senior posts and the speed with which they reached them.

But there were important differences between men and women, and between full-time and part-time women, in their specialty destinations.

The authors say that, although these data indicate that there is no systematic direct discrimination against women in the NHS, indirect discrimination may remain and might include factors like working conditions that conflict with family life and lack of suitable role models in some specialties.

There can be no doubt that there were real barriers to women in medicine in the past, they add. However, with women now comprising 60% of medical school intake, it is now important to ensure that women wishing to work part-time do not encounter barriers to career progression, such as inflexible career structures, they conclude.

These findings are reiterated in a report published by the Royal College of Physicians this week. Entitled Women and medicine: the future, it states that the main challenge ahead is no longer barriers to entry or delays to the career progression of women. Instead, it sees the new challenge as being to ensure that the increasing proportion of women is effectively, economically, and fairly incorporated into the workforce for the benefit of patients. The report is discussed in more detail in an accompanying editorial.