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Abstract
Background The Defence Medical Services (DMS) primarily recruits its trained General Practitioners (GPs) from the NHS and since 1970, the number of men entering medicine has doubled whereas the number of women has increased 10-fold; female GPs will outnumber their male counterparts by 2017. This study performs a quantitative assessment of the potential impact of feminisation of UK General Practice upon the DMS recruitment and workforce planning.
Methods General Medial Council General Practice Certificate of Completion of Training (GMC GP CCT) data were analysed to identify any change in the percentage of male and female GP Specialty Training Registrars successfully completing GP vocational training between 2007 and 2012, thus becoming potentially recruitable into the DMS as independent GPs.
Results A 3% increase was seen in the number of women achieving GMC GP CCT between 2007 and 2012 (p=0.015). The percentage of DMS GP Specialty Training Registrars (GPStRs) gaining their GMC GP CCT in 2012 who were women (25%) was about half that seen nationally (59%). A lack of 2007 by-sex GMC GP CCT data for DMS GPStRs prevented a comparison with 2012.
Conclusions The national increase of only 3% infers feminisation of UK General Practice is not an immediate challenge for the DMS. Nevertheless, as feminisation of the UK GP workforce is expected to continue, the future cohort from whom the DMS will recruit its GPs is likely to contain increasing numbers of women. With the return to contingency, the DMS may wish to consider the implications of increasing numbers of female GPs upon service delivery in the UK and overseas, and explore more flexible medical employment models.
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Key messages
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Since 1970, the number of men entering medicine has doubled whereas the number of women has increased 10-fold.
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Female General Practitioners (GPs) in the UK will outnumber their male counterparts by 2017.
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An increase of 3% was seen in the number of women achieving General Medial Council GP Certificate of Completion of Training (CCT) between 2007 and 2012 (p=0.015).
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In all, 25% of Defence Medical Services (DMS) GPStRs gaining their CCT in 2012 were female compared with 59% nationally.
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It is unlikely that feminisation of UK General Practice is an immediate challenge for the DMS.
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As feminisation of UK General Practice is expected to increase, the DMS may wish to consider adopting more flexible medical employment models.
Introduction
Since 1980, the proportion of female medical students has steadily risen in the UK, USA, Canada and Australia.1 ,2 By 2009, 42% of UK General Practitioners (GPs), 60% of GP Registrars and 57% of UK medical students were women.1 A 15-year follow-up of British medical school cohorts indicates that by 2017, after taking into account career breaks and part-time working, the UK will have more female than male doctors.2
The UK's Defence Medical Services (DMS) primarily recruits trained GPs (serving Medical Officers, Civilian Medical Practitioners and Reservists) from the NHS, especially those in the first 5 years of independent practice. The DMS also provides its own GP vocational training programme for military GP Specialty Training Registrars (GPStRs) congruent with General Medical Council (GMC) requirements and the national GP Curriculum. These military GPStRs work independently as DMS GPs upon attainment of the GMC's GP Certificate of Completion of Training (CCT).
The aims of this study were to measure any change in the relative national numbers of male and female GPStRs completing UK GP vocational training by achieving GMC GP CCT between 2007 and 2012, quantify any change in the relative numbers of male and female DMS GPStRs who achieved GP CCT in 2007 and 2012, and consider the potential inferences of any such changes upon DMS service delivery and workforce planning.
Methods
GP CCT data obtained via a Freedom of Information request were analysed to determine the sex of all NHS GPStRs completing UK GP vocational training in 2007 and 2012. Data were sought from the Defence Postgraduate Medical Deanery regarding DMS GPStRs who achieved GP CCT in 2007 and 2012. Non-random associations between categorical variables in the 2007 and 2012 data sets were analysed using a z-test for difference and Fisher's exact test. All data collection and analysis were undertaken in the UK and there were no exclusion criteria. The main outcome measures were the numbers of NHS and DMS male and female GPStRs who were awarded a GMC GP CCT in 2007 and 2012.
Results
National: The total national numbers of GPStRs achieving CCT in 2007 and 2012, as provided by the GMC in October 2013, are shown in Table 1. DMS: In 2012, 36 DMS GPStRs achieved CCT; 27 were men (75%) and nine were women (25%),3 but as the Defence Postgraduate Medical Deanery does not hold equivalent data for 2007, no comparisons over time can be made. The DMS trained GP strength by sex, as provided by Defence Statistics in October 2013, is shown in Table 2.
National numbers of male and female GPStRs achieving GMC GP CCT in 2007 and 2012
DMS trained GP strength by sex from 2007 to 2013 (numbers rounded to nearest 10)
Discussion
The GMC GP CCT data may include GPStRs whose nationalities preclude their recruitment into the UK Armed Forces. Furthermore, although the award of a GMC GP CCT makes these GPStRs eligible to work as independent GPs within the UK, not all choose to do so. Some travel overseas, start maternity leave or pursue research interests, for example. On 1 April 2013, the percentage of DMS female GPs (22.3%) was more than twice as high as the percentage of women across the whole of the UK Armed Forces (9.8%).4 Nevertheless, the proportion of DMS GPStRs achieving CCT in 2012 who were women (25%) was about half that seen nationally (59%). Although a lack of DMS GPStR by-sex CCT data for 2007 prevents a comparison with 2012, the national increase of only 3% infers feminisation of UK General Practice is not an immediate challenge for the DMS.
As feminisation of the UK GP workforce is expected to continue,2 ,3 the cohort from whom the DMS will recruit the majority of its trained GPs in future is likely to contain increasing numbers of women. In light of known working pattern variations between male and female doctors in the UK, feminisation of UK General Practice may impact upon DMS GP recruitment and workforce planning (Box 1).
Working patterns vary between male and female doctors. In general, UK female doctors:
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Concentrate in family-friendly specialties (especially primary care and psychiatry) and tend not to take up surgery, trauma and orthopaedics and anaesthetics5 as frequently as men.6
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Are more likely to work part-time than their male colleagues.7
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Plan to retire earlier than men, so may be less inclined to accept full-time Permanent Commissions.8
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Contribute 60% of the activity of men in developmental activities such as training, teaching and research roles.9
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Consult in a more patient-centred way, take longer with each patient and see fewer patients per session;9 choose to work fewer out-of-hours (OOH) sessions than men, so may be disinclined to join the DMS whose GPs retain some military-specific OOH commitments.10
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Are 30% more likely to refer their patients to hospital.11 This does not imply lesser professional knowledge; more informed doctors might actually refer more.
DMS, Defence Medical Services; GP, General Practice.
More flexible employment models
The Ministry of Defence is an equal opportunities employer.12 The Sex Discrimination Act 1975 (SDA 75) makes it unlawful to discriminate in recruitment, promotion and training on the grounds of sex, pregnancy and maternity, marital status, civil partnership status or gender reassignment/transgender status. SDA 75 was amended on 1 February 1995 to cover members of the UK Armed Forces in the same way as civilians, paving the way for women on Royal Navy vessels afloat, female Army commanders on the Front Line and female Royal Air Force fast-jet aircrew. Military exceptions to SDA 75 remain where sex is a genuine occupational requirement to ensure combat effectiveness, such as within the UK Special Forces. There are no military exceptions to SDA 75 for work within the DMS.
The UK Armed Forces remain exempt from UK flexible working legislation as such working conditions could compromise military operational flexibility and effectiveness. Such an exemption might prove a disincentive to joining for the increasing number of female GPs from whom the DMS will try to recruit, even though all male and female members of the UK Armed Forces may apply for a variety of employment measures that afford some flexibility within standard military Terms and Conditions of Service (Box 2).12
Examples of employment measures that afford flexibility within standard UK Armed Forces Terms and Conditions of Service:
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Career breaks of between 3 months and 3 years.
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Special unpaid leave of up to 93 days.
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Variable start/finish times of the working day.
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Short-term home working.
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Compressed hours (working longer on some days to allow an earlier finish on other days).
In future, the DMS may wish to consider the inferences of increasing numbers of female GPs upon its workforce planning with respect to military primary care service delivery in the UK and on deployed operations overseas. It may also wish to explore with the Royal Navy, Army and Royal Air Force more flexible medical employment models such as flexible working times, part-time work and job sharing which may further help to balance female GPs’ career and family aspirations.
Conclusions
A statistically significant increase of 3% was seen in the number of female GPStRs who achieved General Practice CCT between 2007 and 2012. A quarter of DMS GPStRs achieving CCT in 2012 were women which is less than half that of the national rate whereas the rate of women in the DMS was over twice that of the Army as a whole. It is unlikely that feminisation of UK General Practice is an immediate challenge for the DMS, but as feminisation of UK General Practice is expected to increase, the DMS may wish to consider adopting more flexible medical employment models, as seen in the NHS, while balancing the need to maintain military operational capability.
Footnotes
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Contributors RDJW conceived the research question, drafted the submission and is responsible for the overall content as guarantor. DJMG obtained and analysed the Defence Deanery's DMS GMC GP CCT data. LEM submitted the Freedom of Information request and analysed the returned GMC data. MW managed the study, collated the individual contributions and monitored the journal submission process.
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Competing interests None.
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Provenance and peer review Not commissioned; internally peer reviewed.