No branch of medicine throws the recent, recurrent Too many women doctors? debate into sharper focus than general practice.
Female GP numbers are growing, seemingly unstoppably, and have just topped 14,000. The total has more than doubled since 1983, reaching 42 per cent of the workforce in England last year.
Among young GPs the situation is even more acute. UK-wide, most GPs under 45 are now female. Workforce figures for 2007 show that two-thirds of the GPs in Scotland aged 25-34 are women.
The current situation
According to the National GP Recruitment Office (NGPRO), 61 per cent of registrars training last year in England (62 per cent in Scotland) were female.
Shedding out-of-hours in 2004 has been cited as accelerating the trend. Something Gai Evans, recruitment officer at NGPRO describes as an 'interesting hypothesis'.
Probably the loudest argument heard against women GPs is their readiness to work part time, with more than half of the female GPs in England doing just that.
As long ago as 2002 this led Dr Tony Mathie, then RCGP workforce planning lead, to say this meant that 'we need 150 medical students to replace 100 retiring doctors'.
Dame Carol Black, president of the Royal College of Physicians four years ago and today the government's National Director for Health and Work warned a feminised workforce would lose both status and influence.
Northamptonshire GP Dr Catti Moss warned: 'We could reach the situation in Russia where general practice could be seen as one step above nursing.'
If current trends were to continue, the gender divide could settle at 10:90 in favour of women.
Dr Fay Wilson, secretary to the North West London LMCs, said: 'I'd be worried then about a perceived loss of visibility of men and roundness to the profession similar to in infant school teaching. At 10 per cent, you're unlikely to meet a man in your normal working day.'
Widening gender gap
Everyone knows why there is such an upsurge of women in medicine. They do better in exams from GCSEs to medical school entry through selection for GP training to RCGP membership.
Once they enter practice, women measurably outperform men in communication skills and patient relations. They get fewer referrals to the GMC (20 per cent of the total) and the National Clinical Assessment Service (13 per cent).
However, how much does the widening gender gap matter? After all, more women consult GPs than men, so it's reasonable for the professional ratio to reflect that.
Along with female firm determination in medicine from Dr Moss to Dame Carol, the profession can guard itself against relegation to just-above-nursing status.
But some people believe the trend not only matters but should be stopped.
A question of balance
GPC negotiator Dr Peter Holden said in 2002 that medical school entry should be rebalanced in favour of men.
'There is a perfectly sound case for considering biasing entry,' he said.
Today he is sticking to his guns. 'I was stating the bleeding obvious,' he insists. 'My feelings haven't changed in the last six years. We need to recruit to ensure that service provision can occur with the current gender balance.'
Dr Moss disagrees. Just as many men work part time as women, she said.
'If you look at the time men and women spend in practice there is no discernible difference between the average woman GP in her 40s and the average male GP.'
It may be just that they do different things when they are not in practice.
'Being a school governor or on a community benefit society isn't regarded as legitimate for your portfolio but being the medical adviser for a local hospital or spending 50 per cent of your time at a private hospital is OK,' said Dr Wilson.
Women are less active in medical politics. But Dr Wilson does not accept that women choose this state of affairs. It could be down to male herd behaviour.
'If we look at these areas of advancement, often one group of people are looking for another group of people who are like themselves,' she points out.
Certainly, when Dr Gillian Braunold, national clinical director for the summary care record, proposed last week to her BMA Division that they ask the association to investigate why its committees have so few women, the men 'pooh-poohed' the idea. Dr Braunold was the only woman at the meeting.
And who keeps the practice on the road while the 'chaps go off to their committees'? Dr Wilson asked. The women GPs, of course.
Measurably, when Dr Brian McKinstry, a senior research fellow in the department of Community Health Sciences at Edinburgh University, surveyed all GPs in Scotland in 2005, he found that men contributed over 50 per cent more than women to commitments such as training, teaching and research. Also women publish less than men.
All valid points - but not enough to argue that there are too many women GPs. Yet.
- What do you think? Write to GPletters@haymarket.com
General Practice divide
61% of GP registrars training last year in England were female
Viewpoints on the gender debate
Dr Catti Moss, Northamptonshire GP
'I don't think it'll reach the reverse of the situation I had when I entered practice. As the only woman GP for 11 miles in any direction, my practice list rose. We are not going to have a comparable shortage of male GPs.
'There is the potential that we could reach the situation that arose in Russia where general practice could be seen as one step above nursing. However, there are too many women in general practice like me and like Dame Carol Black for this to happen here.'
Dr Gillian Braunold, GP and national clinical director for the summary care record
'I want to see the BMA set up research into why the committee structure of the association does not reflect the structure of the profession at large.'
Dr Fay Wilson, north west London LMCs' secretary and GPC veteran
'At present, there are more doctors in the workforce than the NHS is prepared to pay for. With the current oversupply then perhaps it's better to recruit women who are more likely to work part time.
'From the government's point of view, it may be possible for women to be paid less.'
Dr Peter Holden, GPC negotiator
'Six years ago Dr Holden said medical schools should actively recruit male students to help solve the workforce crisis and that 'the politically correct brigade' could not 'stifle the debate that has to occur'.
'In 2002 I was stating the bleeding obvious. We can have a free and open policy but with our eyes open. It all comes down to three words: whole time equivalent.'
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