The Lady Doctor

“Hi,” I said. “My name is Beth. I’m one of the ward doctors. How are you feeling?”

“A bit sore, I suppose,” he said. “It’s better than it was before I went to surgery!”

“Excellent. I need to take a blood test from you, if that’s all right.” I checked out his forearms. Drainpipes. Fab. “I’m sorry to have interrupted,” I said, making an apologetic face at his family. “It won’t take but a minute.”

“Oh, that’s OK. Hop off,” he told the little boy who had been sitting on his legs. “Look, the lady doctor is going to take blood from Daddy, isn’t that exciting?”

It was quite the coolest thing this particular little boy had seen in his whole life.

And then there was me, getting my tourniquet and needle and blood bottles ready while quietly launching a hissy fit inside my own head. It was 2013. There were women in the Armed Forces, women in the House of Lords and the Senate, women in the Old Bailey and on the Supreme Court, women in our newspapers and on our police forces and fire brigades and in our research laboratories and on our library shelves, women running marathons and shooting guns. There are women in our pulpits if not yet in Lambeth Palace (and we’re working on that one). There is a woman on the British throne and a woman in charge of the US State Department. Elizabeth Blackwell became registered with the GMC in January 1859. Surely, more than a century and a half later, we can stop attaching the ridiculous prefix of “lady” to a job done by millions of women around the world.

For as long as we identify “women doctors” as an exotic subspecies distinct from “doctors”, so shall gender disparity continue to exist and so shall articles such as that written by Professor J. Meirion Thomas in the Daily Mail this week continue to be thought worthy of press time and attention.

Professor Thomas’s thesis is that (1) By 2017, women who practice medicine in the UK will outnumber men who practice medicine in the UK (in 2012, the ratio, based on practicing doctors registered with the GMC, was 57/43 in favour of the men), (2) Because she will also be a wife and a mother, a woman is more likely than a man to work part time, and (3) The confluence of (1) and (2) is destroying the NHS. In approving tones, he quotes the former health minister Anna Soubry, who told the House of Commons in June last year that “women doctors” are a drain on resources. Professor Thomas himself is appalled that over half of all “qualified” male applicants to medical school are rejected.

My reflex when presented with such a thesis is to say, plaintively, that I wish that men wouldn’t presume that professional women are going to go off and have babies. There was a time when I could be heard to joke that I was considering putting “Childfree Lesbian” as one of my primary qualifications. Professor Thomas’s article is far from the first recently to claim that women are going to be the downfall of the NHS. I loathed the idea that at a job interview, men would look at my two X chromosomes and their first thought, before they considered my skills or my experience or how well I might fit into their team, would be, “Well, that one’s going to take maternity leave.” It is an attitude that I loathed then and despair of still, but it is merely a symptom of a larger problem, and to pretend otherwise is a betrayal not only of the Sisterhood but of the thousands of people, women and men, who devote less than full time hours to their primary employment for myriad reasons that include but are far from limited to childcare provision. I choose not to have children and I choose to work full time. I am a single white non-disabled person with no carer or dependent responsibilities and with a proverbial Munro of student debt that needs conquered. It is my joy and my privilege to have made those choices.

And it is my view that people who choose differently or who are compelled by their circumstances to have no such choice are as valuable members of my profession.

Even people who work part time in the NHS because they choose to use the rest of their time to work in their lucrative private practices, as the professor does. Tell me, Professor, if your concern is, as you claim, that the taxpayer should get a proper return on its half million pound investment into a doctor’s medical education, what return exactly is the taxpayer getting during the hours you spend squandering your talents on an institution inaccessible to most of them?

Professor Thomas believes that part-time working is hanging us over the precipice of a disaster in primary care. It’s a disaster, he says, because this is why GPs no longer have the cradle-to-grave relationship with patients that their forebears did and, he says, because this is why out-of-hours provision is in the mess that it is. The loss of the cradle-to-grave relationship has many and complex reasons, the greatest of which might be that we live now in a larger and more mobile society. And although I do not deny that out-of-hours reform in primary care is needed, if it is the fault of a part time female GP, and I don’t think it is, that someone pitched up in ED at 5am on Boxing Day with cold and flu symptoms then it is also the fault of a full time male GP, because if I can be confident in one thing it is that neither of them were at work in their own practice at 5am on Boxing Day. GPs, whether full time or less than, are not on call 24/7/365. I suppose some people dream, mistily, of a time when they were. I ask, and forgive me if I do it with a touch of bite, if this career actually wants to aspire to the rates of suicide, divorce, drug and alcohol dependence, and burnout that it was once infamous for.

(Why do I insist on calling it the correct “less than full time” rather than the colloquial “part-time”? Simply because I wonder whether those who read the article in the Daily Mail this week are aware that there are weeks when a so-called part-time doctor might easily clock in excess of 38 hours. In few other jobs would this be considered part-time.)

And so having given due consideration to Professor Thomas’s thesis, I invite him to consider the following:

(1) that women have the capacity to be every little bit as smart and competent as a man,

(2) that whether individuals of either gender reach that capacity has less to do with raw hours/week of service than it has to do with other factors, such as availability and quality of training and engagement with process,

(3) that not all women work less than full time,

(4) that men work less than full time,

(5) that the process involved in less than full time working is more complex and better planned than not turning up to work on Tuesday afternoons,

(6) and is not the same thing as opting out of evenings, weekends, public holidays, or nights,

(7) that people who choose to work less than full time generally have valid reasons,

(8) that those reasons are none of his business,

(9) that engaged and fully present doctors who work less than full time hours are better doctors than full time doctors who are apathetic towards their jobs and leave bang on 5pm, and

(10) that he is not in fact a feminist.

For remember this: I am not a better or a worse doctor than my less than full time colleagues merely because I work full time. I do not give more or less of myself during my working hours. I am no more or less committed. I am no more or less likely (hint: in this job we are all less likely) to actually leave work on time. I have no greater or fewer training requirements, exam requirements, or CPD requirements. I get neither more nor less screwed by the on-call rota and I do not, proportionally, provide more or less out-of-hours services than those who have chosen, for whatever reason, to not do it on a full time basis.

And for as long as doctors continue to show up for work early and stay late, educate themselves, work as effective clinicians, and make the care of their patients their first concern, it is my view that Professor Thomas has no say in who chooses to work when.

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9 comments

  1. A excellent piece of writing Beth.

    Professor Thomas should also realise that hot all heterosexual married (or unmarried) female doctors chose to have children (hence taking maternity leave), and no doubt some male doctors whose partners give birth will exercise their “right” to take paternity leave.

    1. Of course. I generally presume that, if we’re stereotyping, which he clearly is, I’d get extra points for lesbian, but certainly wherever I have referred to “women”, I am referring unless otherwise specified to all women.

      I will be interested to see how things change once joint parental leave comes into force. It’s one of the few policies of the current government that I actually have time for.

  2. I’m appalled at how little has changed since the late 1960s when I started work as a teacher. When I visited the school I was offered for my first job, the (60-something female, single) said:”I suppose that rock on your finger means you’ll only be here for a year or two before you start breeding – not much use to us.” In those days, of course, I had no choice – my contract ended on the day my first baby was born and that was that.

  3. That “medical big shot” as they would say in the US will not prevail and change a trend: Some professions become “female domain”, in some countries, when men find them less attractive than women in addition to the young women studying on average a little harder at a young age. In France it has been the case for primary and high school teachers one or two generations ago starting with the primary teachers and it now true also for young judges (we have a peculiar French system where at 24 you become a judge for life after passing an exam not that difficult since our law school are very cheap in term of quality and easy success )who had get less and less respect from the population at large since years now, are attracting more and more female.

    I know many doctors’ families where only the girls make the choice to try to enter medical school nowadays when the boys go to engineering or business school or whatever that pays well and is socially rewarding.

    Since many women doctors will want to have children and since many British persons will still want to have British persons even female ones to get the chance to become MDs in GB, what is the point to lament for “the medical big shot”?

    He has to propose solutions, hasn’t he? For myself I would welcome the idea that a woman doctor might make the choice to get some years free of the pressure to work “full time” in order to raise her children if she wants to – or feels she needs to because the father is not willing to help enough. Unless you plan to raise 10 children, it will not take so much in your life

    To have to choose for one’s children a father with little professional ambition just to be free to pursue your career or to have to get a quick divorce as soon the father previously able to share the burden of raising children finds in himself some professional ambition and gets too much involved with his own career to help care for his brood is not an option I would welcome. Women doctor aren’t that smart that everyone of them would be able to choose the right father(s) on that front anyway and it is not very charitable from the colleagues who are fortunate on that score to mock the rest of us ! ;-)

    PS: In France we have, in addition, the problem of many young MDs, both men and women, either not wanting to work as doctors or emigrating.

  4. Oh, darlin’, I gave up when the first person – a lovely old minister – asked me if I’d written my first book “all by yourself.” I just. gave. up.
    For some people, that we walk upright and chew gum at the same time is going to remain a mystery. Whatever.

  5. Wonderfully well-said, Beth. The good professor is an idiot. Sadly far too little seems to have changed since 1973 when I was interviewed for my first post as a newly-qualified librarian, married with two young children. The interviewers seemed far more concerned about my arrangements for childcare than my qualifications and interest in the profession and gave the job to the one (young and unmarried) man out of the three candidates. He stayed for precisely 3 months after which they came back to me and practically begged me to take it. I was there for 24 years!

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