Is general practice a level playing field for women?

Dr Tonia Myers believes general practice is a fantastic option for women wanting to combine family life with a rewarding career. But Dr Clarissa Fabre says until pregnancies become cost-neutral for a practice the temptation to discriminate will remain.

Clearly there is good evidence some women GPs still face discrimination and indeed exploitation. But in my view this is certainly not ‘institutionalised' discrimination, as occurs in other professions. General practice is a fantastic option for women who wish to combine family life and medicine and have a rewarding and well-paid career.

Compare law and accountancy, where there are few female partners with children and most practices would not contemplate giving equal status to a ‘part time partner'. The high-achieving women are either childless or have nannies working long hours acting as surrogate mothers.

Whilst it's true that few women appear in prominent general practice leadership positions, I suspect this is because of choice – home life over politics –rather than because of sexism.

I feel privileged to work in a profession where I have been a partner for 20 years and raised two children, moving from full time, via a job share, to part time. I enjoy equal status, a full vote and a pro-rata share. I can work flexibly (within reason) and have attended most parents' meetings and school plays while still doing my share of the workload.

However, whilst I chose to juggle partnership with a young family, it was undoubtedly very hard in the early days. I had no special treatment, with 24 hr on call and weekend rota commitments. It was essential to have reliable child care and military planning for school holidays, plus an understanding (accountant!) spouse. For several years, I felt my partnership share did not reflect my contribution, and my nanny earned more than me! Many of my peers did not want that pressure and opted to be ‘retainers' or non-principals.

As one of only two part-time partners (both women) out of seven GPs, I felt I had to work twice as hard and virtually never took a day off sick or for childcare to prove that I was just as ‘dedicated' as my male partners. The fact that we are now the most senior partners and have outlasted five newer partners of both genders is testament to that fact!

But things have changed - perhaps partly because many male GPs now choose to work part-time with portfolio careers. With the out of hours opt-out and a move away from personal lists, flexible working is now entirely feasible and less frowned upon. All part timers of both genders face the same thorny issues -how is workload covered during absence, how are partnership shares fairly calculated etc.?

Getting the right job is clearly the main stumbling block. I was turned down by one practice after being asked about my ‘family plans' (legal in those days) and foolishly telling the truth!

Since I joined my current practice, we have interviewed for eleven partners and I know it is wiser to take the best candidate who applies. If that means choosing a part-time female of child-bearing age over a full-time male, then so be it. This should not be considered a risk, rather an investment for the future.

All GPs should be protected with partnership agreements or BMA contracts with fair maternity and sickness clauses. The practices that flout these guidelines need to be brought into line.

One bugbear of mine is that seniority payments are abated for part-timers, based not on the number of hours worked per week, but on ‘percentage of profits compared to the average GP'. This includes high paid GPs from ‘rogue' PMS practices and dispensing practices, who work less hours than me and still get full seniority. As more women are part-timers and on lower wages, I suppose this may by implication be considered discriminatory.

There is no doubt that women GPs are now integral to most practices, with many patients specifically asking to see a female doctor. Most practices value this, but there is clearly still a long way to go. Nevertheless, I believe that we should be proud of the fact that reputable GP partnerships can be a model for other professions to follow.

Dr Tonia Myers is a GP partner in Highams Park, London,

General practice is not a level playing field for women for the simple reason that women rather than men have babies, and they remain primarily responsible for childcare. In general, women GPs are treated very well by their male colleagues. That is not a problem.

However, when it comes to the specific issue of a woman becoming pregnant and having a baby, the difficulties and inconveniences begin. And, under the current system, the temptation to discriminate against young women applying for partnerships or salaried positions becomes real.

Many young women doctors choose to have a baby during their registrar year. In fact in my practice, we have had four pregnancies in the last 3 years, with one registrar fitting two pregnancies into her time with us. Any pregnancy will be inconvenient for a practice, but it is far less disruptive during the registrar period than when a woman is a salaried doctor or principal.

A major objective of the Medical Women's Federation is to ensure that a doctor's pregnancy is cost-neutral for the remaining partners. This will remove a major disincentive to employing a young woman doctor as a partner.

At present, it is left to the PCT's discretion as to whether they pay the recommended full maternity locum payment of £1500 per week for six months. I've heard of PCTS that will only fund the first doctor if three or four GPs are on maternity leave at once, they.

I believe maternity locum payments should be funded centrally. It is essential that the element of PCT discretion is removed, especially in these times of financial constraints.

Any costs for locums to cover parental leave, over and above costs covered by the PCT, should be borne by the woman partner herself. She will continue to draw her full profit-share during her maternity leave, and the remaining partners should not therefore have to contribute to locum costs.

This proposal might not be popular with some women doctors, but in my opinion this is an essential first step to remove any possible disincentive to appoint a woman partner. The woman GP should not expect to have more favourable financial arrangements for maternity leave than a hospital doctor or salaried doctor (8 weeks full pay and 18 weeks half pay). Each general practice is a small business, and the principle I have outlined above should be written into the practice agreement.

In general, male doctors are sympathetic to their women colleagues. In fact 40% of us are married to other doctors. What is important to remember is that the period of having children is a small fraction of a woman doctor's working life. She will go on to make a full contribution for many years.

Moreover, we must not look at pregnancy and child rearing as a ‘woman's problem'. We all want the best for our children and many fathers are now much more involved in childcare. Our job is to create a working environment which maximizes a woman's contribution and empowers her to develop her career. This will be good for the NHS, good for women doctors and good for our non-child-bearing colleagues as well.

Dr Clarissa Fabre is a GP in Uckfield, Sussex and president of the Medical Women's Federation