Medical women: internet resource
July 2008
Flexible training and flexible working
Reports of the BMA 1995 cohort study - read more here - highlights the fact that the key reason that almost three quarters of doctors either work less than full time or would like to do so is a desire for improved work-life balance (see reference 21). Furthermore, the most common reason for changing career was hours of work and working conditions.
In 2008, the Medical Women's Federation (MWF) published 'Marking part-time work' which 'demonstrated the need for more flexible thinking on the organisation of work and rotas' (see reference 56).'The traditional model is not suitable for the 21st century and medicine could learn from the corporate world, in which teamworking, rota design and career development are now intrinsic tools in ensuring the best possible use of resources' (see reference 56). The report recommends that 'the medical profession need to promote more positive attitudes to part-time working through mentors, role models and case studies'.
The increased use of flexible working and family friendly policies has much to offer the NHS in terms of improved staff retention among both male and female doctors (see reference 5). There is, however, stigmatisation attached to working part time (sometimes referred to as less than full time), and researchers have suggested that attitudes of some in the medical profession are that one cannot be a ‘real doctor’ unless one works full time (see reference 29).
A recent BMA survey of doctors in Northern Ireland, as presented in Equality and diversity: improving the working lives of doctors (2006) - read more here (see reference 30) found that more than half of female doctors agreed that or strongly agreed that they were more likely to be viewed as less committed by their peers if they participated in any work-life balance policies, such as flexible working or working part-time. For male respondents the corresponding proportion was only 41 per cent.
A survey of GPs in Melbourne (Australia) found that a ‘generational’ pattern toward part time practice existed. Male GPs, those over 55 years and full-timers were more likely to hold negative views towards part-time practice. The authors noted that with the increasing numbers of women entering general practice, these attitudes would need to change. Others have found that childcare responsibilities preclude many GPs from entering into a practice partnership (see reference 31). Similarly, within the hospital sector, there are relatively few opportunities to work part time as a consultant, (see reference 11) a situation that needs to be addressed.
The new GP contract has gone some way towards overcoming problems regarding flexible working. Also, schemes, such as the Flexible Careers Schemes (FCS) for hospital doctors and GPs, have demonstrated that those who work flexibly stay in post, feel valued and have better morale. The FCS is part of the Improving Working Lives initiative; it allows part-time doctors and those on a career break to keep up to date with their profession, and has helped to break down employers’ fears about allowing flexible working (see reference 32). As noted in the general practitioners section, the BMA is concerned that indications suggest that funding for the FCS is not being extended. Primary care trusts should support practices in encouraging flexibility, and such schemes should be established throughout the medical profession.
There are also problems regarding continuing professional development and fulfilling training requirements for those who work part-time and take time away from their professional commitments to have a family (see reference 33).
In its 2001 report the Royal College of Physicians suggested that training requirements should be based on competency rather than length of time served (see reference 11). It also highlighted the benefit that improved strategic planning would bring in helping to provide flexible training for the medical workforce and ensuring that development opportunities exist for those working part time.
These problems affect both doctors and patients: the MWF states that virtually all those who train flexibly go on to make a long-term and often full-time commitment to patients within the NHS (see reference 34). Improvements to the current situation are being made.
New arrangements, agreed by the BMA, the UK Departments of Health, Conference of Postgraduate Medical Deans (COPMeD) and NHS employers, effective from 1 June 2005, allow all doctors in training to apply for flexible working. Flexible training will become integrated into mainstream full-time training, and the option to train flexibly will be included as one of the Improving Working Lives (England) standards. This includes targets to apply across the UK, initially of 5 per cent flexible trainees, rising to 20 per cent subject to demand (see reference 35). Read more on flexible training.
It is hoped that women will be able to make career choices on the basis of their skills and preferences rather than as a result of perceived or actual barriers related to their gender (see reference 36). This calls for changes in attitudes, good support, role models and more flexible working conditions. At present, patients cannot always have an appointment with a female doctor if requested. More flexible schedules could increase the availability of female doctors, offering both doctors and patients the option they desire.
Since 1999, the BMA’s junior doctors committee (JDC) has organised an annual one day event for flexible trainees and those interested in flexible training, to debate relevant issues. Reports of this forum since 2003 can be found at: www.bma.org.uk/ap.nsf/Content/Hubjuniorsflexibletraining .The JDC has also set up a working party, to collect examples of best practice and publish guidelines to promote the development of uniformity and equality of access, pay, funding and training for flexible trainees.