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CAMHS won't see you now

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)

  • No. I'm lower middle class and had to leave the NHS because I have self respect and don't like getting wallet fucked. No one was paying for my ski holidays.

    You need more poshos who can afford to stay and have a reasonable quality of life.

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  • It would be good to select on the basis of traits like conscientiousness, empathy and emotional intelligence but how?

    Most ways of assessing these can easily be gamed.

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  • you are bang on David and have got the sort of predictable backlash form an upper middle class profession!

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  • Shaba is right …………"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 am not sure that the very clever scientists that we select from, embody all three of these characteristics.

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  • Poorly written article

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  • The job is so poorly paid now and with so much pressure , risk and stress involved that the fear is that the poorest will be encouraged in to ‘fill the gaps’. Cannon fodder and worse thing for the upper classes to orchestrate.

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  • I think Finland leads the way when it comes to education.... no private schools.... and the best results in the world...... perhaps following the Finnish model is the right way to go..... then we wouldn't be having these arguments.... I do agree that we have a self serving 'elite' in the country who have a sense of self entitlement and feel that they know better than everyone else, which is delusional but hey thats the Eton way.... we should have followed Icelands lead and jailed our corrupt banksters....... in general though I think General practice has less of an issue with elitism than the specialities, especially when it comes to private practice.....I dont think you've any chance of talking General practice up as a career now.... its dead in the water in the UK

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  • With the exception of a few orthopaedic consultants and niche interests, medicine is now such a low rent job that it might be good to bring the posh kids down a rungs by joining the rank and file of NHS doctors.

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  • It would perhaps be useful if the aptitude tests used by some medical schools (UCAT & BMAT) focused a bit on the "softer skills".

    Could aptitude tests be the place to start?

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  • I do think that the posh are getting posher and the dross are getting drossier. It's the hardworking middle getting shafted paying for the indulgent lifestyles of both.

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