How does it feel to work as a doctor in the NHS?
Authors: Mike Pringle
Journal: Journal of the Royal Society of Medicine (2010)

The General Medical Council (GMC) has approximately 225,000 doctors on its register. About 200,000 have applied for licences to practise on their introduction in November 2009. Of these, some will be working abroad, retired or only in private practice. It is not clear how many work – on contract or as locums, et cetera – in the United Kingdom's National Health Service (NHS) but an educated guess suggests it is about 175,000. Of these about one-third are on the Specialist Register, one-third on the General Practice Register and one-third are only licensed.

It is therefore important to track medical careers in the UK, in order to plan medical student numbers, career training places and service sustainability, especially in the NHS. A key group that can be readily identified and followed up consists of those doctors who graduate from British medical schools. This has been the main objective of The UK Medical Careers Research Group1–5 led by Michael Goldacre, building on the seminal work of James Parkhouse.6

It is important not just to record the natural progression of careers, but also to look at the views of doctors and their future plans. The Oxford team has done just that7 in an article in this issue of JRSM. Clearly the absence of doctors who have not graduated from a UK medical school and the inevitable attrition rate – commendably the research team have retained almost seven in 10 of the 1988 graduates in their cohort – means that their findings must be treated with some care.

What does this study tell us about how it feels to work as a doctor in Britain today? The doctors were asked to rate their satisfaction with time available for leisure on a 10-point scale. Overall they rated themselves at 5.4 – at best moderately satisfied. Women were more satisfied than men and, perhaps more predictably, part-timers more satisfied than full-timers. The highest score (median 7.4) was narrowly recorded by part-time male doctors. Those working in Britain but outside the NHS were no more or less satisfied than those within the NHS.

As a general practitioner, it is natural that I would want to see how fundamental career choices influence attitudes. Although the difference was not significant, general practitioners rated themselves more satisfied with time for leisure (median 6.0) than those working in hospitals (median 4.9). General practitioners were more likely to rate their working conditions and support positively; but they regarded themselves as having less good career opportunities than their hospital peers.

Putting aside such sectarian concerns, the most challenging findings for this reviewer concern the respondents' views on the NHS. And the NHS is not viewed very favourably as an organization. When asked if the NHS is a good equal opportunities employer, only 40% agreed in respect to ethnicity, 60% in respect to gender and 16% in respect to disabilities.

What are we to make of such findings? It might be that doctors are idealistic with a high aspiration that no organization could hope to meet. Perhaps they are just wrong – they perceive a problem where none in truth exists. More likely these doctors have seen ingrained disadvantage for those from ethnic minorities and, especially, with disabilities. Certainly it is striking how seldom one encounters doctors with any disability working in hospitals or general practice.

The GMC has faced up to accusations that its processes were inherently ethnically biased.8 The police have faced their demons over ‘institutional racism’. The NHS may need to confront its own standards and behaviour. One of the few positive outcomes from the Modernising Medical Careers reforms has been the introduction of a fairer, transparent, anonymized system for junior doctor placement.

Recent contractual reforms have been designed to make the NHS more ‘family friendly’ in its terms and conditions. These changes are almost certainly not enough. Such a vast employer as the NHS needs to be sure that its equal opportunities employment practices are second to none. Being an organization that delivers care does not excuse it from caring for its employees.