Guest post: "Actually, the problem with the NHS is NOT women doctors"
Comments about female doctors prompted satirical outrage, but there's a serious point behind #likealadydoc, says junior doctor Rachel Clarke
Posted on: Mon 18-Jan-16 16:10:36
(75 comments )
It takes a brave – or exceptionally healthy – individual to incur the wrath of over half the country's 180,000 doctors. So Dominic Lawson must have a heart of oak and cojones of steel to have broken in yesterday's Sunday Times the shock revelation that the real cause of the NHS junior doctor crisis is… oestrogen.
That's right. The reason that the NHS is in crisis is the insidious creeping into medical life of ovaries, malign and deadly. No branch of medicine is safe from women and their priorities. Operations are known to have been halted - with the patient actually on the table - when the female surgeon breaks a nail. Chest compressions are being terminated mid-cardiac arrest when the junior doctor thinks her brow has started to glisten unbecomingly. And, perhaps most alarmingly of all, every Boxing Day for the last 10 years, in-hospital mortality rates have soared by 11% as female doctors desert their patients in droves, in pursuit of cheap shoes in the January sales.
Small wonder, as Mr Lawson reveals, a hidden debate is "raging" within the medical profession about this grossly irresponsible "feminisation of medicine". The underlying cause of last week's strike by junior doctors is not, it turns out, chronic NHS underfunding or inadequate workforce planning. No, it's the women like me who are firstly flooding our medical schools, then popping out babies with impunity, and finally abandoning our patients for a lazy part-timer's life.
To conflate the increase in numbers of female doctors with the medical profession's near-unanimous opposition to an unsafe, unfair new junior contract is as sly as it is inaccurate.
Once upon a time, all doctors were men. That changed in 1876 when the law was changed to prohibit the exclusion of women from medical schools and universities. One hundred and forty years later, female doctors have outnumbered men for around two decades. Yet certain commentators from both within and outside the medical establishment still seem wedded to a 1950s view of the workplace in which women should jolly well know their place. They point to the one in five unfilled places in paediatrics, blaming women who work-part time for those gaps. And now they claim the fundamental reason underlying the junior doctors' position is the fact that the women amongst us are reluctant to disrupt our precious family lives by working at the weekend.
Luckily, Lawson's piece ignited Twitter in satirical outrage, and my hashtag, #likealadydoc, immediately went viral with tweets such as these:
'I know how to use gas on the HOB and on a patient in an ANAESTHETIC #likealadydoc #juniordoctors' - @WardyHannah87
'I don't run to cardiac arrests, in case I break a heel. #likealadydoc' - @sbattrawden
'Frying-pan in one hand, bone saw in the other. #likealadydoc' - @roshanaMN
Beneath the scorn, of course, is a serious point. To deliberately conflate, as Lawson appears to, the increase in numbers of female doctors with the medical profession's near-unanimous opposition to an unsafe, unfair new junior contract is as sly as it is inaccurate. I'm far from hostile to weekend working, already spending one in four weekends at the hospital. Nevertheless, I object to the pretence that we can magically provide new 'truly seven day' weekend services without a corresponding increase in the number of doctors. Making us work longer and harder to fulfill an election manifesto pledge might be an attractively cheap alternative - but it's downright dangerous for my patients.
And, to paraphrase a former Prime Minister, when it comes to my patients' safety, this #ladydoc is not, and never will be, for turning.
By Rachel Clarke
I'm a lady doctor - I had my daughter in medical school and have never been entitled to maternity leave or pay, nor do I have any intention of ever working part time. I raise my daughter as a single parent on my F2 wage alone - my ex pays me no maintainable as he wrongly believes I am rolling in it - my budget doesn't stretch to moet, in fact I've knocked my £5 weekly bottle of Pinot Grigio on the head as I am desperately trying to pay off the debts I incurred whilst working on my basic wage during GP placement last block. Articles like this and the junior doctor contract debate piss me off no end for obvious reasons. Thanks very much for your post.
The one good thing about this whole debacle is that it has shown me how many other feminist medics are out there on social media - ours is still a very conservative profession and dealing with low level sexism on a daily basis is not unusual. Hopefully the new wave of junior docs will change things for the better!
There is a link though
Feminisation of profession leads to, surprise surprise, less respect and downwaeds wage pressure
They point to the one in five unfilled places in paediatrics, blaming women who work-part time for those gaps.
I don't work in medicine, but I have friends that do, including my best friend, and they complain that it's hard to fill vacancies mainly because the hospital would rather cut costs by not replacing people who leave.
Lets hope he never meets a #ladydoc when he needs some urgent medical care hey. Wanker.
A doctor friend of mine said it is a problem. She's a woman paediatric consultant. Women, rightly have requested part-time. This has led to men wanting to work part-time as well and onto more requests from women and men who don't have children. That's what she says anyway. Thinking about it, not one of the GPs in my huge practice is full time. A few generations ago there wouldn't have been so many part-timers. Perhaps there needs to be an agreement that all doctors who are trained should put in a minimum of 15 years full time. Oh, no wait, one would have to link that to the training being free; so that one can't possibly work any more.
Young Lawson definitely phrased it very badly indeed and used some very silly arguments but does he genuinely have a point if one takes out the hyperbole. Hmmmmmm
So would your friend say that female and/or males doctors choosing to go part time (in my experience a very low percentage do) is a bigger threat to staffing than the droves of young doctors going or gone overseas or the infinite number of school leavers being well and truly put off going to medical school?
The right wing press are trying to take the spotlight off the government destroying the NHS, so who are an easy scapegoat? Women.
Every significant mentor and role model in my medical career has been a woman. Including the doctor I'm married to. Lawson's article belongs in the bin. I'm so proud of my profession, both the women and men, who have come out with such a strong challenge to this outrage.
My husbands department has no female doctors at the moment yet has an understaffed rota and is overworked..... Whose fault is that? Would it be the trusts budget deficit and chronic funding problems or the fault of the
non existent female medics?
My female obstitrician and my female specialist consultant are both full time (and fab) and a bit overworked.
What a nasty bit of 'journalism'.
BeaufortBelle , no. He really doesn't have a point. Full time in medicine is NOTHING like full time in most other jobs. As a part time GP (supposedly half time)I clock up about 40 hours per week. Working full time and raising a family is near impossible if you want to actually see your kids. Most Doctors qualify when they are 23/24. They would be 39 by the time they'd reach the 15 years full time obligation you mentioned- hardly the ideal time to start a family? The NHS problems are simple- overuse, underfunding. I've seen a complete shift in 13 years as a GP from people self managing their illnesses, to a real blame culture where no-one feels they deserve to be ill. Coupled with the fact that the medical profession have constantly been portrayed as lazy and having lost their vocation. This is causing juniors to leave in droves, before they get to their specialist jobs. Make no mistake, running the NHS into the ground and trying to turn public opinion against it and it's staff can only have one objective- to make privatisation appear much more attractive to Joe public in the near future.
Beaufort Belle - GPs go part time for many reasons but lots have other NHS commitments such as commissioning roles, dermatology clinic, sports medicine clinic or teaching roles - so a portfolio career. I wonder how many of your GP practice do things like this? I think we should also be asking why GP practice is now so stressful and pressured with so much admin that 9 sessions is becoming nearly impossible. I would imagine that many GPs work 7 sessions but spend another 2 unpaid clearing their paperwork! Many have opted to reduce sessions and take a pay cut to avoid burnout as 5 intense 12 hour days in a row with mounting paperwork isn't much fun....
Like in paeds etc it comes down to rising demand and chronic underfunding and a severe shortage of doctors.
An unsafe unfair junior doctor contract is not going to help the recruitment crisis.
I'm a female GP. I work part time because it is arduous & exhausting and increasingly thankless. Nothing to do with my lady parts. Don't get me wrong there are lovely bits and lovely people but it is hard hard work.
I work with men who have also gone part time for this reason- Their willies seemingly unable to shield them from the stress.
What a dick
I'm a acute medical consultant. I work shifts - evenings and weekends. My Fitbit tells me that some days I cover 13km at work in a day. I work a 42 hour week. I bring work home with me as I often lose my admin time having to cover colleagues shifts or because escalation beds are open as the hospital is over capacity. I waited to have children until after I finished all my training and became a consultant. I then only had one child. I took 8 months maternity leave. My childminder sees my son more than I do. I don't when I didn't have dark circles under my eyes... I love my job, I love my son. I do what I have to do.
All women no matter what their career choice are entitled to maternity leave and the option to work part time if they choose. This isn't the problem with the NHS. Women are the backbone of the NHS. Doctors, nurses, HCA's, phlebotomists, OT's, PT's, managers etc.
What most people don't realise is that part time hours in medicine are often more than full time elsewhere. I work a 42 hour week as well - that is considered part time. Full time would be 56, in theory. Once you clock up all the unrecorded and unpaid extra hours you are looking at a 60-70 hour week on average of high intensity working.
I make no apologies for not wanting to martyr myself to my career or the NHS especially given how we have been treated in recent years.
"Feminisation of profession leads to, surprise surprise, less respect and downwaeds wage pressure"
Absolutely spot on.
A friend of mine told me a while ago that once upon a time computer programmers were all women - because they typed punch cards to feed instructions into early computers. Pay was secretarial rate. Then men entered the profession as programmers and pay went up.
I strongly believe that the true aim of the 'junior doctor' reform is downgrading the medical profession to one where doctors gradually converge in status and pay to nurse practcioners and that process has been underway for some years. In my GP surgery getting to see any doctor, is a process of negotiating the referral system to avoid being sent to a nurse practicioner (always a woman) who will inevitably refer for another appointment to a GP for anything requiring a prescription.
The feminisation of medicine seems to be about cutting costs - even in my GP surgery. There is only one partner, a man the rest of the GPs are part time women and change regularly. In fact I think he is the pnly man in the building. It is a new-fangled, Health Centre type surgery built on a PFI contract. I get the distinct impression that refering as many patients to a nurse is part of the solution to getting costs down to pay for the PFI contract. Its is very hard to get to see a doctor at all.
In my view lower wages will coincide with greater numbers of low paid part time women doctors and more medicine being delivered by (mostly female) nurses. Its not the fault of women the NHS is in the mess but the correlation between falling wages and falling status correlates with greater numbers of women in the profession.
Men will continue to dominate the higher pay and higher staus consultant and registrar positions and women who hae to take time off to have children wil see their careers stall in a low pay 'salaried hospital doctor' position. In GP surgeries men will be the partners and women salaried and part time or locum with no career progression. I can see it happening already in my GP surgery.
Out of hours weekends and evening work is often more popular amongst female doctors. If you have DCs with someone who works 9-5 it avoids childcare costs. There is less need for continuity of care if you are dealing with an emergency - no PT guilt. Plus increasingly trusts are covering indemnity for OOH as they can't cover the shifts which means you take home a greater percentage of your pay.
How do you define FT in Medicine anyway? Many GPs work 11-12 hr days so doing 5 days of that nature is quite a busy week. You could easily do 40 hrs in 3 days plus one OOH shift.
Somebody told me about 15 years ago that 'there is looming and serious crisis in training of doctors' because a lot of Asian women train to be doctors (hence taking places at medical school others might have had) but once having got their qualification they become worth more on the marriage market and after marriage never practice.
Disclaimer: my wife was treated by an Asian lady doctor after DS2 was born and her Asian husband was at university with us so clearly not all (maybe hardly any) Asian lady doctors just get married and never practice again.
I wonder if this 'Asian lady doctor' induced crisis is also another one of those myths?
Remember that medicine is a quota subject at universities, i.e. the numbers are vigorously controlled by government. If there was such a staffing crisis due to all those lady doctors wanting to go part-time, wouldn't any sensible government simply increase the training quotas by a proportionate amount?
All these attempts to blame implausible sources for NHS staffing crises just cover over where the real problem lies - underfunding and a political desire to run the NHS down so that it can be privatised.
"Overuse" of the NHS is another red herring. Statistically GP practice is a tiny proportion of the NHS budget (should be more, and it's bloody efficient at what it does, but that's for another discussion). No, the NHS is not struggling financially because too many people are seeing the GP/having free prescriptions/attending A&E too many times. The NHS is one of the most financially efficient healthcare services in the world in every global survey.
The NHS is struggling because it is significantly underfunded per capita compared to health systems in other Western nations; and because the vast vast vast majority of its budget is spent on end of life care, chronic and serious illness mostly in older people (diabetes, heart disease, cancer) and running and staffing hospitals which primarily provide care to those people.
Some interesting figures:
"The NHS is struggling because it is significantly underfunded per capita compared to health systems in other Western nations; and because the vast vast vast majority of its budget is spent on end of life care, chronic and serious illness mostly in older people (diabetes, heart disease, cancer) and running and staffing hospitals which primarily provide care to those people."
Problem is that it is those older people that vote. I suspect the 'solution' will be to make young people pay - just like they have to pay for university but older people got it for free. A co-pay system for young people who hardly use healthcare services will be slowly brought in.
That way 'young' people n the minority will be subject to the tyranny of the older majority in being made to pay because the older people vote for it.
And our demographics are changing - the baby boomers and current pensioners all add up to vastly more older people (who need a lot more care) than either when the NHS was founded OR compared to even a few years ago. People are also living longer, which means that they are also suffering from more and longer-lived chronic and acute conditions that cost more. And medical advances mean more treatments are being used for those conditions and to prolong life which wouldn't have been available in the past. (And if you think that's a bad thing, wait until your great auntie Jean gets chronic leukaemia or similar and see how you feel then...are you happy to withhold her new drugs to save the NHS money?)
Since the proportion of older people in the population is increasing, and it's older people who primarily are the main users of the NHS, and there seems to be no will amongst politicians or the taxpaying public to recognise this and increase spending to compensate, of course financial pressures are growing on the NHS.
Frances - no problem!
ABetaDad1 yes exactly. And the Dominic "son of past Tory chancellor" Lawsons of the world are not as yet going to tell their readers that the solution is to withhold great auntie Jean's cancer drugs and let her and other non-wealthy pensioners die earlier to save money, because that doesn't play so well with the over-50s voters (funnily enough ) - though working in a field where I come into contact with the odd Tory politician means that I do know that some of them are happy to say this in private (!)
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