BMA cohort study of 1995 medical graduates: seventh report
June 2002
Summary
The BMA cohort study of 1995 medical graduates is a 10-year longitudinal study of the career paths of 545 doctors. This is the seventh annual report and provides information on workforce participation, career choice and views about practising medicine.
The cohort is surveyed annually on their activities during the previous 12 months. This report gives results from the most recent survey, which was distributed in August 2001. The response rate was 91 per cent (496/545). The average age of respondent is 31. The majority of respondents (72%) are either married or cohabiting and a third have children.
Main findings
Seven years after graduation from medical school many doctors are working outside the traditional training and career structure. For example, 43 doctors had worked as a locum in hospital medicine and 18 doctors had worked in a non-consultant career grade or non-standard post. Forty-five doctors had taken jobs as research fellows and 35 were studying for a further degree. Among general practitioners, over half (60/107) had worked as locums during the year. Only 37 per cent (40/107) had worked as full-time principals.
In hospital medicine the most frequent reason given for working as a locum was that no SpR numbers were available to continue training. Competition for national training numbers was also the main reason for junior doctors to take up a research post or do a postgraduate degree. In general practice locum work was seen as enabling greater flexibility, especially to combine family commitments with work.
Many doctors continued to face unsatisfactory working conditions, particularly in hospital specialties. Problems included long hours of work (34% of SpRs typically worked more than 70 hours a week) and feeling undervalued and unsupported.
Recommendations
More consultant posts need to be established to provide opportunities for junior doctors to complete their training.
Many members of the cohort have small children and no possibility of continuing training in their chosen specialty. To ensure that patients get the best doctors in sufficient numbers, the flexible working practices and improved access to childcare now available to other NHS staff need to be extended to doctors.
Managerial and professional leadership is required to change the culture of junior doctors’ training. One way of improving working lives is to ensure that all doctors in training have access to an advocate outside of the line management structure, for example, a consultant in another specialty.
Other findings
Workforce participation
The majority of the cohort (94%) spent at least some of the last 12 months working as doctors in the UK. Other activities included working overseas (8%), travelling (3%), and temporary breaks from the workforce for reasons such as maternity leave, further study or ill health (8%). Three per cent of the cohort have left medicine as a career.
At the time of being surveyed, 13 per cent of the cohort were working less than full time (4% of the men and 22% of the women). A further 52 per cent were considering working less than full time in the future (34% of men and 70% of women).
Forty-one per cent still have plans to work overseas in the future – 36 per cent temporarily and 5 per cent permanently.
Career choice
Currently 34 per cent of respondents want to enter general practice. This is greater than the proportion choosing general practice at the time of graduation (18%) but smaller than the proportion needed to sustain the general practice workforce (55%).
Of those doctors choosing general practice, 65 per cent are female. Of those doctors choosing surgery, 81 per cent are male.
Twenty-one per cent of doctors (102/482) had changed their choice of specialty in the last year and 5 per cent were still undecided. The main reason for changing career direction was ‘hours of work and working conditions’, which was a factor for 70 per cent of those who changed in the last year. Other reasons were ‘domestic circumstances’ (43%), ‘enjoyed specialty’ (33%) and ‘career and promotion prospects’ (27%). The specific problem of ‘competition for SpR posts’ was a factor for 22 per cent of doctors who had changed career direction in the preceding 12 months.
Approximately one third of doctors currently training in hospital medicine had found it difficult to obtain a national training number.
Eighty-two per cent of GP registrars (55/67) would be prepared to work as a salaried GP. Thirty-six percent would like to do this as a long-term preference.
Among doctors specialising in hospital medicine, 93 per cent of the men and 81 per cent of the women plan to become a consultant. Reasons for not wanting to become a consultant were hours of work, family and lifestyle considerations. Among doctors planning a career in general practice, 81 per cent of the men and 74 per cent of the women wanted to become principals. Doctors who were considering working as a non-principal in general practice gave their reasons as flexibility, the ability to work part-time and not wanting to be tied to a practice.
Views on practising medicine
Currently 13 per cent of the cohort describe their desire to practise medicine as very strong (compared to 44% at graduation). Fifty-eight per cent considered it to be strong, 25 per cent were lukewarm, 3 per cent were weak and 2 per cent regreted becoming doctors.
For doctors who felt a strong or very strong desire to practise medicine, a common theme was that they enjoyed medicine, just not in the NHS. Finding a balance between work, family and other interests was an important factor influencing a positive view of medicine. Other important factors were being able to pursue specialist training in their chosen specialty and having good training and support at work.
Reflecting the life-stage of many of the respondents, doctors who felt ‘lukewarm’ about practising medicine frequently described having to compromise their original career aspirations because of family commitments. As with previous years, a weak desire to practise medicine was due to onerous working conditions, especially long hours, a lack of support in the workplace, and attacks from the media and politicians.
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