Career preferences of doctors who qualified in the United Kingdom in 1993 compared with those of doctors qualifying in 1974, 1977, 1980, and 1983.

OBJECTIVE--To report the career preferences of doctors who qualified in the United Kingdom in 1993 and to compare their choices with those of earlier cohorts of qualifiers. DESIGN--Postal questionnaires with structured questions, including questions about choice of future long term career, were sent to doctors a year after qualification. SETTING--United Kingdom. SUBJECTS--All medical qualifiers of 1993, comparing their replies with those from earlier studies of the qualifiers of 1974, 1977, 1980, and 1983. MAIN OUTCOME MEASURES--Choice of future long term career and certainty of choice expressed at the end of the first year after qualification. RESULTS--Questionnaires were sent to 3657 doctors. 2621 (71.7%) replied. Of the 2621 respondents, 70.5% (1849) stated that their first preference was for a career in hospital practice, 25.8% (677) specified general practice, 1.0% (25) specified public health medicine or community health, 1.4% (36) specified careers outside medicine, and 1.3% (34) did not state a choice. By contrast, 44.7% (1416/3168) of the doctors in the 1983 cohort had specified that their first preference was general practice. Among the 1993 qualifiers, general practice was the first career choice of 17.5% of men (227/1297) and 34.0% of women (450/1324). Only 7.4% of men (96/1297) stated that they definitely wanted to enter general practice. Only 7.8% (103/1324) of women qualifiers in 1993 expressed a career preference for surgical specialties. Within hospital practice, comparing 1993 with 1983, choices for the medical specialties and for accident and emergency medicine rose and those for pathology fell. Women were less definite than men about their choice of future long term career. CONCLUSIONS--If the 1993 cohort is typical of the current generation of young doctors, there has been a substantial shift away from general practice as a career choice expressed at the end of the preregistration year. General practice was much more popular among women than men. Few women opted for surgery. The sex imbalance in the percentage of doctors who choose different mainstreams of medical practice seems set to continue.     

Career destinations in 1994 of United Kingdom medical graduates of 1983: results of a questionnaire survey.

Cohort studies of doctors'' career choices and career progression since the mid-1970s have shown important changes in the medical workforce, in specialist training, and in employment. Examples of these changes are the increasing proportion of women doctors and of doctors who wish to work part time, the emigration patterns of doctors, and the development of vocational training for general practice. Studies enable the effects of longer term changes to be assessed, and sometimes they inform current debate.     

Career destinations seven years on among doctors who qualified in the United Kingdom in 1988: postal questionnaire survey

ObjectiveTo report the career choices and career destinations in 1995 of doctors who qualified in the United Kingdom in 1988.DesignPostal questionnaire.SettingUnited Kingdom.SubjectsAll doctors who qualified in the United Kingdom in 1988.ResultsOf the 3724 doctors who were sent questionnaires, eight had died and three declined to participate. Of the remaining 3713 doctors, 2885 (77.7%) replied. 16.9% (608/3593; 95% confidence interval 16.1% to 17.8%) of all 1988 qualifiers from medical schools in Great Britain were not working in the NHS in Great Britain in 1995 compared with 17.0% (624/3674; 16.1% to 17.9%) of the 1983 cohort in 1990. The proportion of doctors working in general practice was lower than in previous cohorts. The percentage of women in general practice (44.3% (528/1192)) substantially exceeded that of men (33.1% (443/1340)). 53% (276/522) of the women in general practice and 20% (98/490) of the women in hospital specialties worked part time.ConclusionsConcerns about recruitment difficulties in general practice are justified. Women are now entering general practice in greater numbers than men. There is no evidence of a greater exodus from the NHS from the 1988 qualifiers than from earlier cohorts.

Key messages

• This study reports the career progress to September 1995 of doctors who qualified in 1988
• Loss from the British NHS, at 16.9% (95% confidence interval, 16.1% to 17.8%), was no greater than among earlier qualifiers at the same time after qualification
• The proportion of doctors working in general practice (38%) was lower than in earlier cohorts studied
• In this generation of doctors, women in general practice now outnumber men
• Fifty three per cent of the women in general practice and 20% of the women in hospital specialties were working on a part time or flexible basis

     

B.M.A. Planning Unit Survey of General Practice 1969

A postal survey of 776 principals representative of general practice in Britain is described. Doctors working in health centres are compared both with colleagues in other group practices and with doctors who have no group practice allowance. Young doctors are mainly in group practice, especially health centres; the proportion of doctors who are not in groups is diminishing steadily, and they are mainly older. With some notable exceptions health centres provide most space, equipment, and staff; group practitioners in privately-owned premises spend more of their money on their practices, more often use appointment systems, and tend to make more efficient use of premises and staff. Overall, however, the picture is still one of general practice geared to the needs of practitioners working alone. Premises with space for sophisticated organization and for future teaching needs are unusual.Scotland, the North of England, and Wales have fewer young doctors. Average lists are higher in the North of England, and less money is invested in practice premises.Young doctors look for modern premises and the tools and staff for the job. If their career expectations are to be met the tremendous improvements made in some practices must be extended rapidly to the remainder.     

Further Careers of Young British Doctors

After surveys in 1961 and 1966, further questionnaires were sent in 1969 to those who had responded in 1966. These showed that wastage due to emigration and unemployment of married women doctors was nearly 20%. Compared with 49% of all qualified for three to four years in 1966, 73% had definitely decided on their future career seven to eight years after qualifying in the 1969 survey, the choice tending to be for specialties less popular among more junior doctors. Responsibility for patient care seemed not to be related directly to seniority or to performance in medical school examinations.     

Perceptions of family medicine and career choice among first year medical students: a cross-sectional survey in a Turkish medical school

Public attitudes to family medicine in Turkey have lagged behind its rapid academic development. The effect of undergraduate training in primary care on medical students' attitudes to family medicine has not been assessed. Objectives of this study were to assess the attitudes of first year medical students at Uludag University School of Medicine in Bursa, Turkey to family medicine and to determine their career aspirations. The study was a survey of the first year medical class in 2003-2004. The response rate was 95% (248/261 students). Students were positive about their choice of medicine as a career but had negative opinions of general practice. Female students were more positive in this respect. Initial preference was for specialization in fields other than general practice with little knowledge of the academic specialty of family medicine. Greater undergraduate exposure to family medicine is needed in order to increase knowledge of the field and influence student career choices.     

Career preferences of doctors graduating in 1974.

Questionnaires were sent to all 2348 doctors who had graduated from medical schools in England, Scotland, and Wales in 1974 asking about their career preferences. Most were in their second preregistration post, and the response rate was 86-1%. The most popular first choice of career was general practice (665 of the responders; 32-9%), followed by medicine (454; 22-5%), surgery (321; 15-9%), and paediatrics (129; 6-4%). Only 507 of the responders (25-1%), however, stated that their preference was "definite". First choices differed widely between men and women graduates and between graduates of different medical schools.     

Careers in academic general practice: problems,constraints, and opportunities.

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.     

Part-time medical training: 15 years' experience in the Oxford region.

Part-time training of doctors with domestic commitments has taken place successfully in the Oxford region since 1966; 249 doctors have now passed through such training schemes and a further 120 are currently training part-time. Two training schemes are now offered for doctors at senior house officer and registrar level: one of six to eight sessions a week for those undertaking recognised training aiming for consultant or principal in general practice posts, the other of one to two sessions a week providing ad hoc training for those unable for personal reasons to follow a recognised training programme. For doctors at senior registrar level, part-time training entails five to eight sessions a week. Of the 115 doctors who have left the schemes and are now in career posts in the United Kingdom, 19% are now consultants, 30% in other hospital posts, 27% in general practice, and 18% are clinical medical officers; overall, 71% of those in career posts are working part-time. This experience shows that part-time training can be successful and that there is a continuing need for part-time career posts.     

Effect of doctors' ethnicity and country of qualification on prescribing patterns in single handed general practices: linkage of information collected by questionnaire and from routine data.

OBJECTIVES: To test whether Asian general practitioners who qualified in the Indian subcontinent prescribe items more often, more expensive items, and fewer generic drugs than their British trained Asian and non-Asian counterparts. DESIGN: Linkage study using data collected by questionnaire and from routine sources. SETTING: General practices in England. SUBJECTS: 155 single handed general practitioners: 42 Asian doctors qualified in United Kingdom (group 1), 58 white doctors qualified in United Kingdom (group 2), and 55 Asian doctors qualified in Indian subcontinent (group 3). MAIN OUTCOME MEASURES: Prescribing cost (cost per ASTRO-PU), prescribing frequency (number of items per ASTRO-PU), and generic prescribing (percentage of drugs prescribed that are generic). RESULTS: Doctors in group 1 were significantly younger than those in the other groups and had a higher proportion of patients who were from deprived wards. There was no difference between the groups in the proportion of female doctors and total list size. After adjustment for confounding factors, there were no significant differences between the three groups for prescribing cost (16.58 (95% confidence interval 6.39 to 26.77) for group 1, 17.31 (6.92 to 27.69) for group 2, 17.80 (7.22 to 28.38) for group 3, P = 0.55); prescribing frequency (6.58 (4.60 to 8.40), 6.45 (4.70 to 8.30), 7.89 (6.16 to 9.64), P = 0.34); and generic prescribing (44.44 (38.95 to 49.93), 47.41 (42.12 to 52.70), 44.04 (38.75 to 49.33), P = 0.37). CONCLUSIONS: Asian doctors qualified from the Indian subcontinent did not differ from British trained doctors in their prescribing practice. This study refutes the common belief that Asian doctors are high volume and high cost prescribers.     

Dentistry as a prospective career choice in india

Career choice is a complex decision in a student''s life. The opportunity to participate in dental education in many countries, especially in the developing ones, is limited to a small percentage of the community. There is a wide range of options for students to choose as a career in general family, gender, personal interest; outcome expectancies can affect the decision in choosing it. Many studies showed that many individuals find themselves in occupations not really knowing why they made that particular decision. The changing nature of the dental workforce and the need to retain the services of future members has made it important to understand why current dental students have chosen dentistry as their career. However, the choice of dentistry becomes forceful at times by peer pressure, cultural thrust or inability to procure medicine. It is of interest to evaluate dentistry as a prospective career choice in India. The participants answered a questionnaire based online survey and the results were collected and analysed statistically. Analyses of data from the survey shows that majority (36.72%) of students had chosen dentistry as a career choice having missed entry or selection into medicine.     

Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey

ObjectiveTo determine the career destinations, by 1995, of doctors who qualified in the United Kingdom in 1977; the relation between their destinations and early career choice; and their intentions regarding retirement age.DesignPostal questionnaire.SettingUnited Kingdom.SubjectsAll (n=3135) medical qualifiers of 1977.ResultsAfter about 12 years the distribution of respondents by type of employment, and, for women, the percentage of doctors in part time rather than full time medical work, had stabilised. Of all 2997 qualifiers from medical schools in Great Britain, 2399 (80.0% (95% confidence interval 79.5% to 80.6%)) were working in medicine in the NHS in Great Britain 18 years after qualifying. Almost half the women (318/656) worked in the NHS part time. Of 1714 doctors in the NHS, 1125 intended to work in the NHS until normal retirement age, 392 did not, and 197 were undecided. Of the 1548 doctors for whom we had sufficient information, career destinations at 18 years matched the choices made at 1, 3, and 5 years in 58.9% (912), 78.2% (1211), and 86.6% (1341) of cases respectively.ConclusionsPlanning for the medical workforce needs to be supported by information about doctors’ career plans, destinations, and whole time equivalent years of work. Postgraduate training needs to take account of doctors’ eventual choice of specialty (and the timing of this choice).

Key messages

• A large scale national study in the United Kingdom followed doctors from qualification to mid-career and beyond
• Most doctors had made their choice of eventual career—at least in terms of broadly defined specialty—within 5 years of qualifying
• Eighteen years on, 80% of the doctors were working in the NHS and nearly half of women doctors were working part time
• Almost a quarter of NHS doctors planned to retire early

     

Employment experiences of vocationally trained doctors.

OBJECTIVES--To investigate the expectations and employment experiences of male and female doctors who completed vocational training in East Anglia during 1981-7 and to examine the factors which had influenced those who had changed direction early in their careers. DESIGN--Survey conducted by confidential postal questionnaire. SETTING--Britain. SUBJECTS--281 doctors, 233 (83%) of whom responded. MAIN OUTCOME MEASURES--Ideal choice of work on completion of vocational training; present employment; factors which had restricted present choice of work; factors associated with reported satisfaction with job. RESULTS--77/83 (93%) men and 130/150 (87%) women had hoped to work in general practice (p = 0.75). A smaller proportion of women (71%; 106) than men (89%; 74) were in general practice posts (p less than 0.01); only 6% (nine) of women were on maternity leave or caring for children without paid employment. More women than men were working in medical jobs other than general practice (18% (27) women v 4% (three) men; p less than 0.01). 44/91 (49%) women with children had achieved their employment goals compared with 47/59 (80%) women without children and 55/71 (78%) men with children. 87% (72/83) of men and 65% (98/150) of women had achieved the status of principal (p less than 0.01). 162/193 (84%) doctors who had worked in general practice reported satisfaction with their jobs. Dissatisfaction was linked with doing a job different from that hoped for and with perceiving that the share of practice income did not accurately reflect their share of the practice workload. CONCLUSIONS--Steps need to be taken to retain women in general practice, including a statutory part time pay allowance and incentives for practices to allow flexible working hours for doctors with young children.     

A career structure for general practice.

Training for general practitioners usually provides little experience in research, business management, or dealing with chronic disease. It is these areas that could provide scope for further training after becoming a general practitioner principal and provided career goals. Formally recognised research practices, perhaps with one partner coordinating research but all participating, and district research facilitators could increase both the quality and the quantity of research in general practice. Recognising the different skills of doctors in the partnership and referring patients to the most appropriate partner will improve care for patients as well as provide career development. Further training could be aimed at filling gaps in the practice''s pool of skills. Good management skills are becoming more important as practice teams get bigger and fundholding spreads. Some doctors may wish to become full time or part time managers and the idea of accredited courses for management has been raised.     

Grampian Health Board's joint drug formulary.

OBJECTIVE--To develop a model for creating a joint general practice-hospital formulary, using the example of ulcer healing drugs. DESIGN--A joint formulary development group produced draft guidelines based on an earlier hospital formulary, which were sent to interested local general practitioners for consultation. Revised guidelines were then drawn up and forwarded to the health board''s medicines committee for approval and distribution. SETTING--Grampian Health Board. SUBJECTS--Nine members of joint formulary development group plus local general practitioners who were invited to comment on a list of 11 ulcer healing drugs. MAIN OUTCOME MEASURE--Degree of coincidence of drugs selected by hospital doctors and general practitioners. RESULTS--The ulcer healing drugs selected by the panel of general practitioners and by hospital doctors were highly coincident. The cost of one day''s treatment with drugs varied considerably between hospital and general practice--for example, one drug cost 46p in hospital and 1 pounds in general practice and another cost 1.26 pounds in hospital and 1.01 pounds in general practice. Overall, six drugs cost more in hospital and five cost more in general practice. CONCLUSIONS--A joint formulary for use in hospitals and general practice in a health board can be devised fairly simply by consultation as virtually the same drugs are used in both types of practice. It should influence the health board''s expenditure on drugs and affect the choice of drugs when a patient is discharged from hospital or is referred to any hospital in the region.     

GPs in principle but not in practice: a study of vocationally trained doctors not currently working as principals.

OBJECTIVES--To identify doctors who are vocationally trained but not currently practising as principals in general practice; their reasons for not practising as principals; and whether the prospect of a re-entry course would appear to this group. DESIGN--Postal questionnaire survey based on semistructured interviews. SUBJECTS--Doctors who had been vocationally trained but were not currently practising as principals: 351 possible subjects identified by a process of "networking." SETTING--Trent Regional Health Authority. RESULTS--166 of the doctors who replied fitted the criteria (100 women; 66 men). The out of hours commitment was ranked as the most important factor for not practising as a principal--95 women and 50 men rated it important--followed by difficulty in combining work with family commitments--84 women, 31 men. 82 respondents (49%) said they would be interested in a re-entry course if one were available. CONCLUSIONS--There is a pool of vocationally trained doctors in Trent region who are not practising as principals in general practice. More flexible working patterns and the availability of a re-entry course could make the post of principal in general practice a more attractive proposition to these doctors.     

Deputising services: the portsmouth experience.

An analysis of the deputising service in the city of Portsmouth showed that the workload of doctors was not excessive and there was no evidence that the number of calls was higher than in areas where no deputising service exists. Sixty seven per cent of patients were seen within one hour of requesting a call and 93% within two hours. Seven per cent of patients were admitted to hospital and 88% of these were seen within one hour of requesting medical care. Drugs were prescribed at 65% of all contacts between doctor and patient which compares favourably with prescribing rates for consultations in general practice. A notable feature of the Portsmouth scheme is that all subscribers who use the deputising service have to agree to participate as a deputy, with 90% of deputies being practising general practitioners or eligible to be principals in general practice. This has probably conserved costs and hospital resources.     

Career development of McMaster University medical graduates and its implications for Canadian medical manpower.

A study was undertaken of the career paths and decisions, and the factors influencing the decisions, of the first six graduating classes of McMaster University''s medical school. Climate and geography, preference for urban or rural living and influence of spouse were the factors that most influenced the location of practice, although the graduates who moved to the United States considered economic factors important too. Nearly one third of the specialists were practising in the United States. Personal challenge and positive clinical experience in the field were the major influences on choice of medical field. Graduates entering a specialty were more likely than those entering primary care to consider encouragement of others, a positive example set by medical school faculty members, working hours and research experience in the field as important influences on their choice of medical field. Data are needed on the career decisions, and the factors affecting them, of the graduates of all Canadian medical schools if Canadian medical manpower planning is to be realistic.     

Morale in general practice: is change the problem or the solution.

Despite the pervading gloom about morale in general practice it can still offer a rewarding career. This article, which is the first in a series examining ways to improve general practitioners'' job satisfaction, weighs the evidence for low morale in the profession and examines the factors that cause most dissatisfaction. The main causes of discontent seem to be increased paperwork and out of hours work, and many blame the 1990 contract for their problems. Dissatisfaction was growing before the contract was introduced, however, and some doctors believe that it has had positive effects. Further change seems inevitable if general practice is to offer a stimulating career for life.     

Retrospective analysis of census data on general practitioners who qualified in South Asia: who will replace them as they retire?

ObjectivesTo determine the number and geographical distribution of general practitioners in the NHS who qualified medically in South Asia and to project their numbers as they retire.DesignRetrospective analysis of yearly data and projection of future trends.SettingEngland and Wales.SubjectsGeneral practitioners who qualified medically in the countries of Bangladesh, India, Pakistan, and Sri Lanka and who were practising in the NHS on 1 October 1992.Results4192 of 25 333 (16.5%) of all unrestricted general practitioners practising full time on 1 October 1992 qualified in South Asian medical schools. The proportion varied by health authority from 0.007% to 56.5%. Roughly two thirds who were practising in 1992 will have retired by 2007; in some health authorities this will represent a loss of one in four general practitioners. The practices that these doctors will leave seem to be in relatively deprived areas as measured by deprivation payments and a health authority measure of population need.ConclusionMany general practitioners who qualified in South Asian medical schools will retire within the next decade. The impact will vary greatly by health authority. Those health authorities with the greatest number of such doctors are in some of the most deprived areas in the United Kingdom and have experienced the most difficulty in filling vacancies. Various responses will be required by workforce planners to mitigate the impact of these retirements.

Key messages

• Currently, one in six general practitioners practising full time in the NHS qualified medically in a South Asian medical school; two thirds are likely to retire by 2007
• It is unlikely that doctors who qualify in South Asia will be a source of general practice recruitment in the future
• The posts from which South Asian qualifiers are retiring may be more difficult to fill because they are often in practices in areas of higher need
• There is extreme variation in the proportion of total general practitioners who are South Asian qualifiers; flexibility for policy responses should be maintained