Women doctors and their careers: what now?

Editor—Allen highlights the changing nature of the medical workforce.¹ This has significant implications for workforce planning and service delivery. For example, the wishes of a number of flexible trainees to continue part time working in the early consultant years means that more trainees (and therefore national training numbers) will be needed to fill consultant posts to deliver the whole time equivalents required. This applies particularly in specialties with a substantial proportion of flexible trainees, such as paediatrics, psychiatry, palliative medicine, general practice, and anaesthetics.

Many specialties are well suited to sessional or part time work, be it in the operating theatre, outpatient clinic, or laboratory. The new consultant contract should make it easier to design such working patterns. In practice, part time clinical roles in hospital medicine have long been common, senior doctors taking on professional, managerial, or private practice commitments.² However, a larger cultural change will be required to make the establishment of stand alone part time consultant posts more acceptable. With female consultants now forming a quarter of the consultant workforce—and rising—such arrangements may increasingly become the norm. Creative solutions could include two consultant colleagues job sharing, one with school age children undertaking proportionately more work in school terms, and one without, working more in school holidays, when they are unlikely to wish to take leave. This might also suit those with busy committee roles or external commitments in support of the NHS, which tend to fall within term times, and they could then contribute to clinical care predominantly during school holidays. Shift work should provide opportunities for families to cross cover childcare with day, evening, and night time work.

Part time consultant posts or reduced clinical commitments appeal not only to those with young children but also to those with caring responsibilities for older relatives and those approaching retirement. This may be one way to address some of the concerns about work life balance articulated clearly by hospital consultants.³

Work patterns have changed in recent years for many reasons. Junior doctors work shorter hours. Junior doctors report unemployment, yet the UK seriously lacks senior doctors in comparison with other countries at similar stages of healthcare service health provision. Men and women in medicine increasingly state they want a personal and family life, and, like people in other occupations, doctors seek flexible training, employment, and career development compatible with the different stages in their lives.

Many patients rely on relatives to bring them to clinics; others are themselves at work in the day and prefer evening, Saturday morning, or appointments outside term time. And some doctors prefer to work at times when others in the family are able to provide care for their dependants.

If the investment made in the medical workforce is to be fully realised as benefit for patients then arrangements for career planning and development and the conditions of work must be compatible with the life and work choices of doctors and the population they serve.