Future career plans of a cohort of senior doctors working in the National Health Service

OBJECTIVE: To report on the future career plans of senior doctors working in the NHS. DESIGN: Postal questionnaires. SETTING: All doctors who qualified in 1977 from all UK medical schools. MAIN OUTCOME MEASURES: Future plans and whether participants had any unmet needs for advice on how to put their future plans into effect. RESULTS: 25% definitely intended to continue with their current employment on the same basis until they retired; 75% hoped for change. A reduction in working hours was the most commonly desired change; but a substantial percentage also wanted changes in job content. 50% of respondents intended definitely (17%) or probably (33%) to work in the NHS to their normal retirement age; and 37% definitely (20%) or probably (17%) intended to retire early. 48% had made plans, in addition to the standard pension, to facilitate early retirement. The main factors given for considering early retirement were family reasons and wanting more time for leisure, a desire to maintain good health, excessive pressure of work, and disillusionment with NHS changes. A reduction in workload would be the greatest inducement to stay. 31% of respondents reported that they had unmet needs for advice about their future plans. Of these, about half were needs for advice about planning for retirement. CONCLUSIONS: Many senior NHS doctors would like to reduce their working hours. Less than a quarter definitely intend to work in the NHS to normal retirement age. Even for senior doctors, advice on career development is needed.     

Career destinations and views in 1998 of the doctors who qualified in the United Kingdom in 1993

OBJECTIVE: To report career destinations and views in 1998 of doctors who qualified in the United Kingdom (UK) in 1993. DESIGN: Postal questionnaire survey. SETTING: This study took place in the United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1993. MAIN OUTCOME MEASURES: The percentage of doctors in each branch of medicine five years after qualification, and their views on their training and career opportunities. RESULTS: The NHS and universities in the UK employed 88% of respondents (men 90%, women 86%). UK general practice employed 24% of respondents (men 19%, women 28%). There were significant differences (P < 0.01) between the percentages of men and women working in the surgical specialties (men 28%, women 10%), paediatrics (men 8%, women 15%) and obstetrics and gynaecology (men 5%, women 10%). Respondents not in paid employment comprised 1.4% of men and 6.6% of women. 45% of respondents agreed that their postgraduate training was of a high standard, with 26% disagreeing and 29% unsure. 47% of specialist registrars felt their training was too short and 78% were concerned about the availability of consultant posts on completion. CONCLUSIONS: Although loss of doctors from the British workforce through emigration or unemployment is not increasing, our findings confirm a substantial shift away from careers in general practice. The number of home-trained GPs from this generation of doctors will be inadequate to meet service needs. GPs and hospital specialist doctors expressed concerns about quality of training, lack of careers advice, the shortness of specialist registrar training and availability of consultant posts on completion of training.     

Loss of British-trained doctors from the medical workforce in Great Britain

OBJECTIVE: To summarize trends over time in the percentage of British medical graduates who subsequently practise in Great Britain in the National Health Service (NHS), in Great Britain outside the NHS, outside Great Britain, or do not practise medicine. DESIGN: Questionnaire-based postal surveys and government employment records. SETTING: Great Britain. SUBJECTS: All British medical graduates of 1974, 1977, 1983, 1988, and 1993. MAIN OUTCOME MEASURES: Type and location of employment at successive years after graduation. RESULTS: Differences in career destination between cohorts were generally small. Combining data from all cohorts studied, 85% of doctors were working in the NHS 2 years after graduation, 82% after 5 and 10 years, 81% after 15 years, and 77% after 20 years. Part-time working was much higher among women than among men. Allowing for loss and part-time working, the whole-time equivalent available to the NHS at 15 years after graduation was 60% of women and 80% of men. More men than women worked in medicine outside the NHS in Britain and abroad. Loss from medicine altogether was small, and higher among women. CONCLUSIONS: Medical workforce planning in Great Britain should assume that 15-20% of home-trained doctors will not be working in the NHS within a few years of graduation. Comparing cohorts at the same career stage showed no evidence of increased loss from the NHS in recent times. Although a higher percentage of women than men were not working in medicine at all, recent trends suggest that this percentage is falling.     

A surgical career? The views of junior women doctors

OBJECTIVE: To explore female pre-registration house officers (PRHOs) views of surgery as a possible career choice. DESIGN AND PARTICIPANTS: In this qualitative study in-depth semistructured interviews were carried out with 15 female PRHOs. They were part of a larger sample of 24 PRHOs (15 women and nine men) who were being interviewed primarily to explore their ways of learning in both hospital and general practice settings. This paper focuses on the responses of the 15 women in relation to surgery as a possible career choice. METHODS: Interviews incorporated a checklist of topics to encourage participants to discuss their experiences of learning and working as PRHOs, including factors which had impacted on future career choices. Common themes were identified by comparing narratives. RESULTS: Only three of the 15 women PRHOs were considering a career in surgery. The importance of positive surgical placements and contact with female surgical registrars and consultants during undergraduate training was highlighted. The changing nature of the surgical PRHO job with its lack of surgical exposure was unlikely to change the future career plans of female PRHOs. Factors such as the perceived difficulties of combining a family with a surgical career and the lack of women in particular surgical specialties were of considerable concern. CONCLUSIONS: Strategies for ensuring that female medical students receive a more positive view of surgery need to be implemented. Surgical PRHO jobs should be re-evaluated to assess the surgical experience being gained by doctors, particularly in light of the reduction in junior doctors' hours. Despite policy initiatives, many newly qualified women doctors have already decided against a surgical career.     

Career choices at the end of the pre-registration year of doctors who qualified in the united kingdom in 1996

OBJECTIVE: To report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1996. MAIN OUTCOME MEASURES: Choices of eventual career expressed one year after qualifying. RESULTS: We report on detailed choices of long-term careers for all specialties. Only 20% of 1996 respondents chose general practice compared with 25.8% of 1993 respondents. The percentage choosing general practice fell more sharply among women, from 34.0% to 25.2%, than among men, from 17.5% to 14.1%. Choices for surgical specialties rose from 16.9% of 1993 respondents to 21. 4% of 1996 respondents. The percentage choosing the surgical specialties rose among women, from 7.8% to 11.6%, compared with a rise among men from 26.1% to 32.2%. The percentage of respondents who definitely or probably intended to pursue a long-term career in the UK was 77.7% compared with 75.7% of 1993 respondents. Most of the home-based respondents who had doubts about practising in the United Kingdom were considering practising abroad. Only 1% made an explicit first choice for a non-medical career. However, in all, 9. 4% said that there was a possibility that they might leave medicine. CONCLUSION: The substantial decline in intentions to enter general practice among newly qualified doctors, seen in the 1993 qualifiers, is continued in the 1996 qualifiers. A shortfall in recruitment of UK-trained doctors to general practice is the likely outcome. The rise in choices for the surgical specialties, particularly among women, may herald a renewed interest in hospital specialist training following the Calman changes. It is worrying that almost a quarter of respondents indicated some doubts about pursuing a medical career in the UK.     

Views of doctors in training on the importance and availability of career advice in UK medicine

OBJECTIVES: To determine whether doctors in their first year after qualification wanted career advice, and, if so, whether they thought they had been able to obtain useful advice, and whether older doctors thought that adequate career advice had been available to them. METHODS: We carried out a postal questionnaire survey of all UK medical graduates of 1988, 1993, 1996, 1999 and 2002, and a 25% random sample of the graduates of 2000. RESULTS: The response rate was 67.4% (24 261/35 976 mailed questionnaires). Of doctors in the first postgraduate year, 95% agreed that: 'It is important to be given career advice at this stage of training.' A total of 38% disagreed with the statement: 'I have been able to obtain useful career advice since graduation.' Of more experienced doctors surveyed between 3 and 11 years after graduation, 34% agreed that: 'Making career choices has been made more difficult by inadequate career advice.' CONCLUSIONS: The great majority of junior doctors want career advice after qualification. It cannot be assumed that they are able to seek it out for themselves satisfactorily. Career advice needs to be planned into postgraduate work and training.     

Career choices of United Kingdom medical graduates of 2002: questionnaire survey

OBJECTIVES: To report the specialty choices of UK medical graduates of 2002, and to compare their choices with those of qualifiers in previous years and with the profile of career grade doctors in different specialties in England. METHODS: We carried out a postal questionnaire survey in the UK and drew comparisons with official data for numbers of specialists. RESULTS: The response rate was 65.3% (2778/4257). A total of 22.7% of the medical graduates of 2002 (28.1% of women, 14.5% of men) expressed a preference for a longterm career in general practice, compared with 25.3% of 1999 and 2000 graduates combined. A total of 31.1% of men and 11.9% of women chose surgical specialties; 0.7% of men and 3.4% of women chose obstetrics and gynaecology; 3.4% of men and 7.9% of women chose paediatrics. There was a large mismatch between the percentage choosing each specialty group and the percentage of senior National Health Service doctors working in the same specialty group. In all, 71% of graduates regarded their career choice as definite or probable and 80% definitely or probably intended to pursue a longterm career in medicine in the UK, compared with 75% of qualifiers in 1999 and 2000. CONCLUSIONS: Career choices for general practice remain low: only 1 in 4 women and 1 in 7 men now choose general practice at this career stage. Very few men choose obstetrics and gynaecology, despite a recent increase in training opportunities. There is no evidence of an increase, compared with recent previous cohorts, in the percentage of junior doctors who do not want a longterm career in British medicine.     

The career aspirations of women doctors who qualified in 1974 and 1977 from a United Kingdom medical school

The career aspirations of doctors who qualified from a UK medical school were examined in relation to firmness of career choice and marital and family circumstances 1 year and 7 years after qualification. Although there was greater certainty of career choice amongst all doctors, the women were consistently less likely to be certain than the men. The men were more likely than the women to be married (and more likely to have children). The main differences in patterns of career choice were the greater popularity of medicine and surgery among the men and of general practice and community medicine among the women. The most plausible explanation for these differences is the different marital and family pressures experienced by men and women.     

Career preferences of graduate and non-graduate entrants to medical schools in the UK

OBJECTIVE: Recent UK policy has been to increase substantially the number of graduate entrants to medical schools. Our aim was to study whether graduate and non-graduate entrants have different long-term career preferences. METHODS: We conducted postal questionnaire surveys of medical qualifiers from all UK medical schools in 1999, 2000 and 2002, surveyed 1 year after qualification, and qualifiers of 1999 and 2000, surveyed 3 years after qualification. RESULTS: By Year 3 after qualification, general practice was the choice of 33% of men graduate entrants and 21% of men non-graduates ( = 12.5, P < 0.001) and of 43% of women graduates and 38% of women non-graduates ( = 1.6, P = 0.2). Surgery was a much less popular choice for men graduate entrants than for men non-graduates; but similar percentages of women graduate and non-graduate entrants chose surgery. A lower percentage of graduate entrants than of non-graduates favoured paediatrics. Other differences between graduates and non-graduates were generally small. General practice was the preferred career for a much lower percentage of those who took an intercalated degree while at medical school, than of those who did not. CONCLUSIONS: Increasing graduate entry to medical school is likely to increase the percentage of doctors who want to become general practitioners, but only modestly so. It may also lead to a decline in the percentages choosing surgery and paediatrics. Otherwise, at least on the current criteria used for selecting students, increasing graduate entry will probably not make much difference to the percentage of newly qualified doctors seeking careers in different branches of practice.     

''We''d like to have a family''--young women doctors'' opinions of maternity leave and part-time training.

Maternity leave and part-time training should facilitate the integration of the family and professional lives of young women doctors - whom the NHS cannot afford to lose as their numbers rise to half the number of the graduates of UK medical schools. Women doctors' planned professional activity is high, but to what extent do the maternity leave and part-time training arrangements assist them in fulfilling their plans? One hundred and forty-five young women doctors reported their experiences of and views on maternity leave and part-time training. Most had children between 6 and 10 years after qualification, to fit with career development. Seventy-one per cent of the confinements had qualified for maternity leave and pay, but there were complaints about the working of the regulations, particularly in relation to junior hospital doctors' short contracts. When asked to comment about part-time training, most (77%) expressed themselves as broadly in favour - only three actively opposing it. It was perceived as difficult to organize by 20% of respondents, as difficult to undertake by 29%, and as being of low status by 15%. This study concludes that the arrangements for maternity leave need to be improved and that the availability and status of part-time training need enhancing - especially to encourage women doctors to enter careers in hospital medicine.     

Stability and change in career choices of junior doctors: postal questionnaire surveys of the United Kingdom qualifiers of 1993

OBJECTIVE: To report on stability and change in career choices of doctors, between 1 and 3 years after qualification. DESIGN: Postal questionnaire surveys. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the United Kingdom in 1993. MAIN OUTCOME MEASURES: Choices of eventual career expressed 1 and 3 years after qualifying. RESULTS: The overall pattern of career choices at year 3 differed a little from that at year 1. For example, choices for general practice increased from 26% to 29%, choices for medical specialties fell from 22% to 18%, and for surgical specialties they fell from 17% to 14%. However, because changes of choice between specialties tended to 'cancel out', the aggregated data masked much larger changes when considered at the level of individual doctors. Overall, 74% of respondents retained their year 1 career choice in year 3 (78% of men, 70% of women). Of doctors who chose a hospital specialty in year 1, 71% chose the same specialty in year 3, 18% had switched choice to another hospital specialty, and 9% had switched choice to general practice. The percentage who changed choice from hospital specialties to general practice between years 1 and 3 was lower in the 1993 cohort than in all previous cohorts. Of those whose year 1 choice of long-term career was general practice, 89% retained that choice in year 3 and 11% switched to other branches of medicine. Even by year 3, less than half of all respondents (and a smaller percentage of women than men) signified that their long-term choice of specialty was definite. In year 3, 78% of all respondents, and 79% of doctors from homes in the United Kingdom, intended definitely or probably to practise medicine in the United Kingdom for the foreseeable future, which represented little change from the figures in year 1. CONCLUSIONS: About a quarter of doctors change their career choice between years 1 and 3 after qualification, and less than half regard their choice in year 3 as definite. Flexibility is therefore needed, well beyond the first post-qualification year, to accommodate changes of choice. Where training opportunities in a hospital specialty are limited, doctors are now inclining, more than in the past, to switch to an alternative hospital specialty rather than to general practice.     

What influences the job satisfaction of staff and associate specialist hospital doctors?

Despite their rising numbers in the National Health Service (NHS), the recruitment, retention, morale and educational needs of staff and associate specialist hospital doctors have traditionally not been the focus of attention. A postal survey of all staff grades and associate specialists in NHS Scotland was conducted to investigate the determinants of their job satisfaction. Doctors in both grades were least satisfied with their pay. They were more satisfied if they were treated as equal members of the clinical team, but less satisfied if their workload adversely affected the quality of patient care. With the exception of female associate specialists, respondents who wished to become a consultant were less satisfied with all aspects of their jobs. Associate specialists who worked more sessions also had lower job satisfaction. Non-white staff grades were less satisfied with their job compared with their white counterparts. It is important that associate specialists and staff grades are promoted to consultant posts, where this is desired. It is also important that job satisfaction is enhanced for doctors who do not desire promotion, thereby improving retention. This could be achieved through improved pay, additional clinical training, more flexible working hours and improved status.     

Anaesthetics: career choices and experiences

At the pre-registration stage, about 4% of doctors who qualified in 1974 and about 5% of 1977 qualifiers gave anaesthetics as a first choice of career. Over the few years after qualifying, both cohorts showed a net gain in career preferences for anaesthetics. The progress of those choosing anaesthetics is described, and also the career paths of those becoming senior registrars in the specialty. Postgraduate qualifications, non-anaesthetic and overseas experience are analysed. Discussion deals with breadth of experience, women doctors and manpower implications.     

社区医生工作满意度的影响因素调查

目的调查分析影响社区医生工作满意度的因素,提出相应的对策,为稳定基层医疗队伍提供理论参考。方法研究者对15名在社区医疗机构工作的医生进行访谈,了解导致他们工作满意度较低的原因,同时查找文献了解相关领域的最新研究结果,提出应对策略。结果影响社区医疗机构医生工作满意度的因素为福利待遇、职业发展、职业风险、工作环境、社会地位,其中福利待遇是最重要的因素。结论社区医生工作满意度低导致了社区专业人才流失严重,卫生行政管理部门应在福利待遇、职业发展、工作环境等方面给予政策支持,激发他们对社区医疗工作的热爱与激情。     

Early medical career choices and eventual careers

The revised structure of hospital specialist training being introduced in the United Kingdom means that a doctor wanting a career in a hospital specialty will need to be confident that his or her early career choice, made within 3 years of qualification, is realistic. Using data from a longitudinal study of the 1983 cohort of UK medical graduates, the early career choices made by over 2000 doctors were compared with their employment 11 years after qualification. At year 11 65% of the doctors were working within the first choice they had expressed towards the end of their pre-registration year, and 79% were employed in their year 3 first choice. There was, however, important variation within this general picture: lower predictive value was associated with choices made by women; choices for hospital mainstreams rather than for general practice; and choices that were less than definite. The recent drop in popularity of general practice as a career choice of new graduates in the UK, and the steady increase in the proportion of women graduates, mean that the predictive value of the career choices of recent graduates may prove to be lower than that of the 1983 cohort.     

Doctors' age at domestic partnership and parenthood: cohort studies

Objective To report on doctors' family formation. Design Cohort studies using structured questionnaires. Setting UK. Participants Doctors who qualified in 1988, 1993, 1996, 1999, 2000 and 2002 were followed up. Main Outcome Measures Living with spouse or partner; and doctors' age when first child was born. Results The response to surveys including questions about domestic circumstances was 89.8% (20,717/23,077 doctors). The main outcomes - living with spouse or partner, and parenthood - varied according to age at qualification. Using the modal ages of 23-24 years at qualification, by the age of 24-25 (i.e. in their first year of medical work) a much smaller percentage of doctors than the general population was living with spouse or partner. By the age of 33, 75% of both women and men doctors were living with spouse or partner, compared with 68% of women and 61% of men aged 33 in the general population. By the age of 24-25, 2% of women doctors and 41% of women in the general population had a child; but women doctors caught up with the general population, in this respect, in their 30s. The specialty with the highest percentage of women doctors who, aged 35, had children was general practice (74%); the lowest was surgery (41%). Conclusions Doctors are more likely than other people to live with a spouse or partner, and to have children, albeit typically at later ages. Differences between specialties in rates of motherhood may indicate sacrifice by some women of family in favour of career.     

Improving nurse retention in the National Health Service in England: the impact of job satisfaction on intentions to quit

In recent years the British National Health Service (NHS) has experienced an acute shortage of qualified nurses. This has placed issues of recruitment and retention in the profession high on the political agenda. In this paper, we investigate the determinants of job satisfaction for nurses and establish the importance of job satisfaction in determining nurses' intentions to quit the NHS. We find that nurses who report overall dissatisfaction with their jobs have a 65% higher probability of intending to quit than those reporting to be satisfied. However, dissatisfaction with promotion and training opportunities are found to have a stronger impact than workload or pay. Recent policies, which focus heavily on improving the pay of all NHS nurses, will have only limited success unless they are accompanied by improved promotion and training opportunities. Better retention will, in turn, lead to reduced workload.     

Doctors' views of their first year of medical work and postgraduate training in the UK: questionnaire surveys

Objective The first year of postgraduate work for newly qualified doctors in the UK, the pre‐registration year, is spent working intensively in training posts under supervision. Our aim was to report the views of pre‐registration doctors on these posts. Design Questionnaire survey. Subjects All medical graduates of 1999 and a 25% sample of graduates of 2000 from all UK medical schools. Main outcome measures Doctors' views on the pre‐registration house officer (PRHO) year, recorded as ratings in answers to questions and statements about the year. Results In reply to the question ‘How much have you enjoyed the PRHO year overall?’, rated on a scale from 0?10 (0 = no enjoyment; 10 = enjoyed it greatly), 44% of respondents (1341/3068) gave scores of 8–10; in all, 83·2% of respondents gave scores in the upper half of the scale (≥6). However, there were criticisms of specific aspects of working conditions. Only a third agreed that their training during the year had been of a high standard. Posts in medicine were rated more highly than those in surgery for quality of training. Differences in views held by women and men junior doctors were few. However, where differences existed, women were slightly more positive about their work than men. Conclusion Most graduates enjoyed the pre‐registration year but there is still considerable scope for improvement in working conditions and training. Men and women gave similar responses, which suggests that later divergence in their career pathways is not attributable to different views formed about work in their pre‐registration year.     

Workforce planning. Catching the drift

NHS workforce planning has traditionally ignored the role of doctors and nurses trained in continental Europe and Scandinavia. At present doctors trained in the European Economic Area make up 10 per cent of senior house officers in England and Wales. But the numbers coming to the UK are falling. Falling medical unemployment in Europe will mean these doctors have less incentive to come to the UK, leaving a considerable gap in the NHS workforce. More local research is needed into working patterns and career plans of European-trained nurses and doctors.