Doctors' career choices, destinations, and views about their jobs provide useful insights for workforce planning. We report a survey of all traceable graduates from UK medical schools in 1974.
Participants, methods, and results
We mailed questionnaires in 1998, asking about employment history and current job. In all, 77% (1717/2217) replied (72% (1223) of men and 80% (494) of women). Of respondents, 97% (1673) were in medical employment in the United Kingdom or abroad, and 85% (1460) worked in the UK NHS. The table shows the distribution of their specialties. In NHS general practice, 98% (488) of men and 85% (183) of women were principals; of these, 39% (72) of women and 5% (25) of men worked part time. In NHS hospital practice, 97% (469/485) of men and 76% (114/150) of women whose main paid post was in the NHS (not in a university) were consultants; of these, 26% (30) of women and 11% (50) of men worked part time.
We asked respondents to score five statements about job satisfaction, from “strongly agree” (score 1) to “strongly disagree” (5). The statements were “I find enjoyment in my current post”; “I am doing interesting and challenging work”; “I feel dissatisfied in my current post”; “most days I am enthusiastic about my work”; “I am often bored with my work”).1 We calculated a job satisfaction score by totalling the scores for all five statements: 20 or more represented a positive response, on average, to all statements, and we suggest that this shows a high level of satisfaction.
Respondents rated their job satisfaction reasonably highly (table), with some significant but small differences between occupational groups. Hospital doctors were more satisfied with their jobs than general practitioners; women general practitioners were more satisfied than men (group median scores 19.7 and 18.8 respectively); and part time general practitioners were more satisfied than those working full time (19.8 and 18.9) (all P<0.001). This last finding was mainly explained by the comparatively lower job satisfaction of male general practitioners working full time.
Respondents practising medicine in the United Kingdom were asked whether they intended to continue doing so for at least another five years. Most respondents definitely intended to do so; more NHS hospital doctors than general practitioners were definite (85.8% (580/676) and 77.9% (553/710); P<0.001). Reasons cited for considering leaving UK medicine included dissatisfaction or disillusionment with their job or with the NHS; ill health; stress or pressure associated with the job; and a desire for change, travel, other interests, or to work in a developing country.
Comment
The results provide benchmark findings on the career destinations of doctors who qualified in the 1970s, with which career profiles of more recent generations can be compared. Only a quarter of the 1974 graduates were women.2 Women from the 1974 cohort were less likely than men to hold consultant or principal posts, and few women were surgeons. Many more women than men worked part time. In the future NHS, many more of the senior posts will be filled by women because more women than men now enter medical school,3 reversing the former situation in which men substantially outnumbered women. As the government recognises,4 doctors' working lives need to be balanced with their expectations about raising a family and other interests.
Replies about short term intentions portray a workforce committed to working in the NHS, with stable careers over the next few years. Levels of job satisfaction were generally high. Nevertheless, many respondents commented that they were working close to the limits of what they regarded as a reasonable commitment of their time, and many do not intend to work to the age of 65.5
Table.
Profile of 1673 respondents (graduates from 1974) in medical employment in 1998: specialty and job satisfaction. Values are numbers (percentages of all medical posts) unless stated otherwise
| Specialty group
|
Men
|
Women
|
Total
|
Job satisfaction score*
|
|---|---|---|---|---|
| UK NHS (hospital): | ||||
| Medical specialties | 136 (11.3) | 42 (9.0) | 178 (10.6) | 20.3 |
| Paediatrics | 26 (2.2) | 15 (3.2) | 41 (2.5) | 20.8 |
| Accident and emergency | 10 (0.8) | 1 (0.2) | 11 (0.7) | 18.8 |
| Surgical specialties | 134 (11.1) | 12 (2.6) | 146 (8.7) | 20.5 |
| Obstetrics and gynaecology | 23 (1.9) | 7 (1.5) | 30 (1.8) | 19.6 |
| Anaesthetics | 70 (5.8) | 17 (3.6) | 87 (5.2) | 19.7 |
| Radiology | 29 (2.4) | 10 (2.1) | 39 (2.3) | 19.7 |
| Clinical oncology | 9 (0.7) | 8 (1.7) | 17 (1.0) | 21.0 |
| Pathology | 40 (3.3) | 15 (3.2) | 55 (3.3) | 19.9 |
| Psychiatry | 44 (3.7) | 23 (4.9) | 67 (4.0) | 19.7 |
| Other medical specialties† | 4 (0.3) | 5 (1.1) | 9 (0.5) | 20.3 |
| All | 525 (43.6) | 155 (33.0) | 680 (40.6) | 20.2 |
| UK NHS (non-hospital): | ||||
| General practice | 497 (41.3) | 216 (46.1) | 713 (42.6) | 19.1 |
| Community health | 6 (0.5) | 44 (9.4) | 50 (3.0) | 20.0 |
| Public health medicine | 9 (0.7) | 8 (1.7) | 17 (1.0) | 23.0 |
| All | 512 (42.5) | 268 (57.1) | 780 (46.6) | 19.2 |
| Total of UK NHS hospital and non-hospital | 1037 (86.1) | 423 (90.2) | 1460 (87.3) | 19.7 |
| Outside UK NHS: | ||||
| Other UK public sector | 22 (1.8) | 5 (1.1) | 27 (1.6) | 21.2 |
| UK private medicine | 36 (3.0) | 10 (2.1) | 46 (2.7) | 22.8 |
| Medicine abroad | 109 (9.1) | 31 (6.6) | 140 (8.4) | 21.6 |
| All | 167 (13.9) | 46 (9.8) | 213 (12.7) | 21.8 |
| Total of all medical posts | 1204 (100) | 469 (100) | 1673 (100) | 19.9 (100) |
Percentages may not add up exactly owing to rounding.
Results for individual specialties are based on doctors with NHS contracts in the United Kingdom, including 48 men and 7 women whose main paid post was a university post.
Grouped median score out of a maximum of 25; 1616 doctors (1168 men) gave information about job satisfaction.
Includes doctors known to be working in medicine but who did not state their specialty.
Acknowledgments
We thank all the doctors who have participated in the study.
Footnotes
Funding: The UK Medical Careers Research Group is funded by the Department of Health. The Unit of Health-Care Epidemiology is funded by the South East regional office of the NHS Executive.
Competing interests: None declared.
References
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