JRSM >
Volume 101, Number 4 >
Pp. 191-200
UK Medical Careers Research Group, Department of Public Health, Oxford University Old Road Campus, Headington, Oxford OX3 7LF, UK
Correspondence to: Trevor Lambert trevor.lambert{at}dphpc.ox.ac.uk
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 TOP SUMMARY IntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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Design Postal questionnaire.
Setting All doctors who qualified from all UK medical schools in 1977; and Department of Health employment data.
Main outcome measures Career destinations of medical qualifiers from 1977.
Results 72% responded to the questionnaire. Using all available evidence, including that on non-responders, 76% of the cohort, comprising 77% of the men and 74% of the women, were working in the NHS 27 years after qualification. Approximately 18% were in medical jobs either overseas or outside the NHS. Of respondents in the NHS, 89% of men and 51% of women had full-time contracts. NHS doctors rated their job satisfaction highly, with a median score of 19.5 on a scale from 5 (very low satisfaction) to 25 (very high satisfaction). Satisfaction with time off for leisure was much lower, with a median score of 4.6 on a scale from 1 (low) to 10 (high). Of those in the NHS, 67% agreed that they worked longer hours than they thought they should; and 40% agreed that their working conditions were satisfactory.
Conclusions 27 years after qualification, the percentage of women who were working in the NHS was similar to that of men. Although these senior doctors had high levels of satisfaction with the content of their jobs, they were not so satisfied with their working hours and working conditions. Our results can be used as benchmarks, against which the career pathways and satisfaction levels of more recently qualified doctors can be compared.
| Introduction |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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| Methods |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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The survey instrument
The questionnaire comprised structured, ‘closed’ questions and statements, a few ‘open’ questions, and a request for ‘free text’ comments on any aspect of the respondents' career or work. Topics covered by our questionnaire included current employment, previous jobs since our last survey, levels of satisfaction with their job and with time available for leisure activities, views about different aspects of their jobs, future career plans and retirement intentions.
The statements used to assess job satisfaction and satisfaction with time available for leisure, and the calculation of scores based on them are described in Appendix A. To assess doctors' views on working conditions and career opportunities, we invited them to respond to various attitude statements by scoring their views on a five-point scale from strongly agree to strongly disagree.
Definitions and data analysis
We focus mainly on respondents who were working in the NHS, defined as holding either a substantive or an honorary NHS contract (the latter are predominantly those with substantive clinical academic posts). In the analysis, we aggregate specialties into broad groups based on those initially defined in the Todd Report.3
Response rates, demographic data and details about posts held were summarised using descriptive statistics. Differences in the distribution of career destinations were assessed using 
2 tests. Distributions of job satisfaction and leisure satisfaction scores were compared using Mann-Whitney U tests. In making multiple similar comparisons, we regarded the attainment of a significance threshold of p
0.01 as evidence of significant difference.
Data from the Department of Health's employment record; capture-recapture analysis
As we have done previously,4 data about whether the doctors were currently employed in the NHS were obtained from the Department of Health's employment record. These data, and those from our survey, were analysed using capture-recapture methods.5 The combined data provide a more reliable whole-cohort estimate of NHS participation than that available from either dataset alone. We have previously demonstrated6 that this method produces results which are consistent with those obtained by exhaustive tracing of non-respondents by personal follow-up.
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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Career destinations of respondents
Of respondents, 97.3% (2118 doctors) were in medical jobs, comprising 92.6% (2017) who were in the UK and 4.6% (101) who were overseas; 86.7% (1888) were in NHS medical practice; 5.9% (129) were in other UK medical jobs; 0.6% (13) were in non-medical jobs; and 2.1% (46) were not in paid employment. Three doctors provided information that we could not classify and were omitted from these calculations.
Of the 1888 doctors in the NHS, 50.2% (948) were in hospital practice, 45.8% (864) in general practice, and 4.0% (76) in public health medicine or community health. 54.5% of the men and 41.8% of the women were in hospital practice; 43.6% of the men and 49.6% of the women were in general practice; and 1.7% of the men and 8.6% of the women were in public health medicine or community health. Comparing the NHS doctors in these broad career destinations, the differences between men and women were significant (22=67.5, p<0.001). The percentages of men and women working in medical jobs, but not in the NHS, were similar (men 10.7%, women 10.3% of all respondents).
As shown above, a significantly and substantially higher percentage of men than women respondents were in NHS hospital practice. Furthermore, considering specialty destinations within NHS hospital practice, there were also significant differences between men and women (210=77.0, p<0.001). For this calculation we included the 11 hospital specialty groups listed in Table 1, that is, all of the categories listed under ‘UK NHS’ except general practice, community health and public health medicine (comprising 682 male and 266 female respondents). The specialties that showed significant male-female differences, based on analysis of adjusted residuals, were the surgical specialties (25.7% of the men were in hospital practice, 5.6% of the women), paediatrics (4.8% of men, 8.6% of women), pathology (8.7% of men, 13.2% of women) and psychiatry (7.3% of men, 19.2% of women).
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In Table 2 we give our best estimates of the career destinations of the whole cohort, not just the responders, expressed per hundred original qualifiers. The basis of the calculations is given in Appendix B. These revised estimates suggest that, of the whole cohort, about 94% were working in medical jobs, with 4% currently not employed in medicine and 2% deceased.
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Full-time and part-time working
In both the NHS and overall, about a quarter of the doctors who told us about their working pattern worked part-time (those in the NHS: 24.0% [421/1752]; all in medical employment: 24.7% [482/1955]). Of the 1284 men in medical posts who told us, 88.6% were working full-time in their current post and 11.4% were working part-time. Of the men in the NHS who told us about their working pattern, 89.2% worked full-time. Of the 671 women in medical posts who told us, 49.9% worked full-time and 50.1% worked part-time; and, of those in the NHS, 50.7% worked full-time.
Achievement of senior career posts
In NHS general practice, 98.0% (534) of the men and 91.4% (288) of the women were principals (21=18.8, p<0.001). In NHS hospital practice, 98.0% (653) of the men and 73.6% (220) of the women were consultants (21=140.4, p<0.001). Of women working in hospital practice but not in consultant posts, 19.1% (57) held non consultant career grades and 7.4% (22) held other hospital posts.
Comparisons between early career choice and eventual destination
We compared respondents' original first choice of specialty at one, three and five years after qualification (i.e. what they had told the Medical Careers Research Group about their career hopes in 1978, 1980 and 1982) with their eventual specialty 27 years after qualification in 2004 (Table 4). Taking all specialty groups together, 50.3% of respondents who chose each specialty group in year one were eventually working in it in year 27. Of those who chose each specialty group in years three and five, 70.0% and 78.1% respectively were eventually working in it at year 27.
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21= 51.6, 32.1, 8.8 for Years 5, 3, 1 respectively; p<0.001, p<0.001, p=0.003 respectively).
Differences were evident between mainstream specialties in the degree to which early choice was related to later career destination (Table 4). Early choices for general practice were more highly predictive of later specialty destination than were choices for specialist practice combined (21 values gave p=0.02, p<0.001, p<0.001 respectively for Years 5, 3 and 1). Within specialist practice, differences by specialty were statistically significant both overall and separately for men and women in each of the three years (p<0.001 for 29 test in each case). Analysis of standardised residuals show which specialties, within hospital practice, were significantly different from the rest (Table 4).
Satisfaction with job
NHS respondents rated their job satisfaction highly with an overall median score of 19.5 on a scale from 5 (very low satisfaction) to 25 (very high satisfaction) (Table 5). Job satisfaction was rated a little more highly by those in UK medicine outside the NHS (21.2) and those in medicine outside the UK (21.0), both comparisons with NHS doctors (p<0.001).
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Satisfaction with time available for leisure
The scores of NHS doctors for satisfaction with time available for leisure activities were distributed bi-modally and were low with a median score of 4.6, on a scale from 1 (very low) to 10 (very high). NHS doctors were significantly less satisfied than those in UK medicine outside the NHS (7.3) and those in medicine outside the UK (6.4) (both comparisons p<0.001).
Within the NHS, part-time doctors were much more satisfied with their leisure time (Table 5, median score 6.6, and Figure 1) than were full-time doctors (4.1, p<0.001). Full-time GPs were more satisfied (4.4) than full-time hospital doctors (3.9, p=0.01). Within the group of full-time hospital doctors, the scores for men and women were the same (3.9); and, similarly, within the group of full-time GPs, the median scores for men and women were the same (4.4). Among women part-timers, GPs had a similar level of satisfaction (6.9) to part-time women hospital doctors (6.8, p=0.7). Among male part-timers, GPs appeared more satisfied (6.3) than hospital doctors (5.3) but numbers were small and the difference was not statistically significant (p=0.4). Figure 1 illustrates how levels of satisfaction with leisure time varied for full-time and part-time hospital doctors and GPs working in the NHS.
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Overall, 69.0% agreed that they had had good career opportunities to date and 65.4% were positive about opportunities for career development. 39.3% agreed that the prospects for improvement of the NHS in their specialty as a whole were good while 34.2% disagreed. Differences between men and women on these statements were small.
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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Strengths and weaknesses of study
This is, we believe, the most comprehensive study ever undertaken of a cohort of UK doctors who qualified in the 1970s. It also covers the longest period after qualification that has been studied by our group. Our findings, particularly those using capture-recapture, provide the most comprehensive and precise estimates available on the participation of a cohort from this generation in the NHS. It updates our findings on this cohort when surveyed in 1995.7
A limitation of our study is that, although the response rates are high for this kind of survey, responder bias needs to be considered. It is evident from the comparison of Tables 1 and 2 that we achieved a higher response rate from those working in the NHS than from others. We are confident that, when the capture-recapture analysis is included, our estimates of NHS participation are accurate. We cannot be so sure about the distribution of the others, notably about the estimates for those working in medicine outside the NHS compared with those not in medicine. Our findings from responders suggest that, of those not in the NHS, a considerably higher proportion is in medicine outside the NHS than are not in medicine at all. This corresponds with evidence from other surveys that, if doctors leave the NHS, they are much more likely to continue to practise medicine (in the UK, outside the NHS, and abroad) than to leave the profession.10
Policy implications
In addition to documenting the careers of the cohort itself, our results provide findings on career pathways and job satisfaction that could be compared, in future, with the career pathways and satisfaction of later generations of doctors. For example, we have shown that almost four-fifths of the cohort of 1977 who chose general practice in year 3 (roughly the stage at which young doctors now are being encouraged to make their specialty choice in the UK) were working in it 25 years later. In hospital specialist practice, about two-thirds of the cohort who chose a hospital specialty group was working in it eventually. Thus, while in many cases the doctors made early choices that were later sustained, a sizeable minority of doctors followed different paths to their choice in their early years. This is relevant to current debate in the UK about whether the new postgraduate training scheme, Modernising Medical Careers, will provide enough flexibility to accommodate a degree of uncertainty among junior doctors about the careers that they will eventually want to follow.
The percentage of women who eventually practised medicine in the NHS was fractionally smaller than that of men; but the similarities between men and women in this respect are much more striking than the differences. This should allay concerns sometimes expressed about increasing the intake of women to medical school, that many more women than men might give up practice. They do not; and, when they do for family reasons, they generally return to medical work.7 However, almost half of all women in the cohort – typically now in their early 50s – practised part-time. Clearly, workforce planning needs to take this into account.
Future research
The NHS doctors rated their job satisfaction reasonably highly, but satisfaction with time available for leisure was often fairly low. Dissatisfaction among senior doctors may have important implications because it could provide motivation for them to reduce their working hours substantially and/or retire early.11–13 It is also possible that, although the great majority of these doctors are in very senior and distinguished posts, some have further ambitions for the development of their careers. We explore their future plans in the next paper.
Another possible area for future research would focus on the fact that a higher percentage of women than men in hospital practice are not at consultant level. We do not know whether this is by choice or whether some women feel disadvantaged in this respect. This should be a topic for further study, particularly of younger generations.
Not surprisingly, a higher percentage of women than men entered general practice; but the difference, in this generation, is not great. The gap has widened substantially since then: in recent cohorts, about double the percentage of women than men expect to enter general practice.8 A much higher percentage of men than women entered the surgical specialities: in recent cohorts the gap is narrowing but it is still very wide.9 The current reasons for the gap between men and women in specialty choice warrant more detailed investigation.
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DECLARATIONS
Competing interests None declaredFunding The UK Medical Careers Research Group is funded by the UK Department of Health. The Unit of Health Care Epidemiology is funded by the NHS National Centre for Research Capacity Development
Ethical approval This study was approved by the Central Office for Research Ethics Committees (COREC), REC 04/Q1907/48
Guarantor KT
Contributorship All authors contributed equally
| Appendix A: Calculation of satisfaction scores |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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A2. Leisure satisfaction score
The questionnaire included the question: ‘How satisfied are you with the amount of time your work leaves you for family, social and recreational activities?’. Respondents were asked to score their answer on a scale from 1 (not at all satisfied) to 10 (extremely satisfied).
| Appendix B: Calculations undertaken to construct the ‘hypothetical cohort’ of 100 qualifiers for Table 2 |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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Specialty groups within the NHS
The percentages from the survey were scaled in order to redistribute the percentage in the NHS (76.1%, given by the capture-recapture analysis) according to the distribution of the specialty groups within the NHS (as provided by survey responders, Table 1).
Deceased
All deaths known to us have been included, without scaling.
Employed in medicine outside the NHS, and not employed in medicine
After allowing for those in the NHS and those known to have died, 22 doctors per 100 qualifiers remained. We distributed the remainder – doctors in the UK in medical practice, outside the NHS, those in medicine overseas and those not in medical employment – according to the distribution of these three groups in the responder population.
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| Acknowledgements |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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TOPSUMMARYIntroductionMethodsResultsDiscussionAppendix A: Calculation of...Appendix B: Calculations...AcknowledgementsReferences |
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