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Gold, incentives and meh

Are there too many posh doctors?

Dr David Turner

‘What sort of housing is this?’

I turned to the medical student posing the question, wondering if she was joking. The expression on her face suggested she was not.

‘Erm, this is a council estate… social housing.’

I’d taken a group of students on a home visit, and I admit I was staggered to discover that a fourth-year medical student in London had no awareness of the type of housing that huge swathes of her future patients inhabit.

Last month, a British Journal of General Practice article on the recruitment crisis discussed the fact that in recent years, we’ve made improvements in medicine to address the gender and ethnic diversity balance, but these improvements haven’t been matched by corresponding increases in social diversity.

Most of our current junior doctors went to private schools or selective state schools, which is to say that we have too many posh doctors.

Now, I must declare at this point that I did attend a selective state school, but, in my defence, neither of my parents have been to university, and I don’t come from a background of middle-class wealth and privilege, from which most of my fellow students at medical school seemed to have emerged.

A place at medical school will remain a reward for the most socio-economically advantaged for the foreseeable

Fact: We have a problem with recruitment in general practice, particularly in deprived areas.

Fact: Medical students from less well-off backgrounds are likelier to go into general practice, and, what’s more, likelier to go on to practice in the areas that they come from.

Solution to GP recruitment crisis: Admit more students to medical school from areas with higher levels of deprivation.

It sounds simple, but the reality is that medical schools still admit students almost entirely on the basis of A-level grades.

A wealthy, hot-housed, privately-educated student is going to find getting straight As infinitely easier than someone from a poorer background attending an average state school.

You don’t need to be super intelligent to become a good doctor.

You do, though, need have the ability to work very hard, persevere and show empathy and compassion for patients.

If medical schools started to skew their selection process towards these ‘softer’ markers of what might make a good doctor, not only would we start to turn out more caring doctors - we’d also start to generate more medical graduates who want to be GPs.

I’m under no illusion that this is going to change overnight. A place at medical school is going to remain a reward for the most socio-economically advantaged in society for the foreseeable future. What we can do, however, is talk up general practice and talk down (slightly) a career in hospital medicine simply by asking: ’Where do you see yourself in ten years?’

A hospital consultant working in a crumbling district general hospital at the mercy of non-clinical managers, relentless Government targets and a rota that’s likely to see you working a lot of evenings and weekends - or general practice, where you’ll enjoy a much greater freedom to choose where and when you work, and encounter a wider range of clinical problems than in any hospital speciality.

A bit optimistic? Maybe, but it has to be worth a try.

Dr David Turner is a GP in North West London

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Readers' comments (44)

  • "A wealthy, hot-housed, privately-educated student is going to find getting straight As infinitely easier than someone from a poorer background attending an average state school."

    It's not clear whether the higher grades seen in private schools are correlated primarily with family net worth or something else.

    You will see a high net worth family send a child to a state school and that child perform equally as well as a similar demographic child in a private school.

    In the past, other non-academic factors featured heavily in the selection criteria but if anything these form filling extra curriculars were even more exclusive, wouldn't you say?

    Where is the family income data for current medical students compared to 2010, 2000, 1990, 1980 and does this data even exist?

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  • woke drivel from start to finish

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  • Also, I feel GPs from a more working class background have the backbone to protest more loudly and persistently at the increasing workload and idiotic policies imposed on us than those from a comfortable , part-time , portfolio career background . Just a personal observation.

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  • IF you think university courses should act as part of the diversity approach for the state monopsony employer the perhaps this is the logical approach for communist social levelling.
    It is important to remember however that the role of university medical courses should be to teach medicine, not roll out cannon fodder for the NHS.

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  • Medical schools are too elitist...if we're going down the equal outcome route then surely there's no bother transitioning directly from A-level to FY1. In fact, who needs A-levels...

    An anecdotal story about what you perceive as posh isn't going to persuade anyone to adopt a truly socialist model. Being posh doesn't predict a lack of understanding or humility.

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  • Hard work is needed to get grade As. Medicine is hard work so it is reasonable. People with one life want to see the best and not someone that has failed his/her exams.

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  • I'm sorry David but I think you have over simplified a very complex issue

    Is there evidence that working classed doctors are more prevalent in deprived and under-resourced areas? If so, is this because they choose these areas or because it's the only place which will accept them?

    And it's much easier to be a "champagne socialist" and do your bit for mankind when you have a huge safety net in the bank of mum and dad and their inheritance. So many "posh GPs" end up in challenging areas as they are doing their bit for society

    I came from significant poverty. I never want to go back there so money was very important to me in partnership conversations. I wanted to work in a nice leafy suburban middle classed area but no-one would have me. So I ended up in one of the most deprived areas of the country!

    I agree you don't need academic intelligence to be a good doctor but you do need emotional intelligence, good problem solving skills and resilience.

    I think all universities have become overly competitive for all subjects and it's leading to an increase in mental health issues in the young

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  • we could do with some full time working class grafters on the front line.

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  • @wm 12.13
    Absolutely. I'm glad you didn't try to construct a whole paragraph!
    David is absolutely right about the need for social diversity.
    Though perhaps the best way to gat rid of this inequality is simply to get rid of private schools instead.
    We could start with Eton as a trial as the recent decades output from that school is demonstrably shite for society.

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