This site is intended for health professionals only

At the heart of general practice since 1960

Read the latest issue online

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

Rate this article  (3.49 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (44)

  • WhoamI | Locum GP 04 Dec 2019 11:35am

    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.

    Good comment whoam. So true.
    We need people who will stop saying how hi when told to jump. People who demand to be treated as professionals and not low rent protocol monkeys

    Unsuitable or offensive? Report this comment

  • Cardiff in the late 70s, my intake was roughly 2/3 regional accents, and the general impression was that a lot, like me, were state educated. But in those days, fees were free and grants were grants, not loans.

    Unsuitable or offensive? Report this comment

  • The reality is the UK needs as many doctors as possible whatever their background. Swale and Thanet has over 40% of their GPS over 55 years with incredibly high patient numbers.
    If we really want to make things fairer then we extend the GP training program to 4 years, and the last year means a commitment in an area of unmet need to get their full accreditation.
    Even if they went into a leafy suburb after this then they had helped a bit in the areas that need it the most. And maybe maybe they may stay around in the areas that are desperate for a GP including ones who "sound like Prince William"

    Unsuitable or offensive? Report this comment

  • @John Taylor
    Ha Ha good one. Its amazing how easy it is to barinwash people into thinking that the global economic crisis of 11 years ago was created by the British Labour Party.
    Try reading more widely- its good for you.

    Unsuitable or offensive? Report this comment

  • |Angus Podgorny | GP Partner/Principal|06 Dec 2019 9:11am

    So criticising Corbyn's economic policies = believing that the global economic crisis was created by the BLP??? I see no indication that John Taylor believes that.

    And taking down the generally better performing private schools as a 'solution' to inequality? By pulling everyone down to the same low standard?

    John, take no heed. Angus has been criticised for being an anonymous Labour schill before. He/she has never responded with anything rational. The Left has no grounding in facts/history/evidence and can only resort to name-calling, and appealing to emotions and impulses.

    Unsuitable or offensive? Report this comment

  • Chris
    Fair enough on first point- it was an indirect link- but lets face it- thats what Tories do ie blame others for that which they do themselves.
    Second point- Finland has an excellent education system which is purely state funded and no private schools. Future brain surgeons and lawyers go to school with future cleaners and carers- result is healthy and successful society.
    Thirdly I think the only person that has ever accused me of being an anonymous labour schill.... is yourself.
    I am not a member of the Labour Party and have never voted for them.
    Currently I do believe that a vote for the Conservative party is a vote to destroy not only the NHS (a Labour idea that I do care about a lot) but core democratic principles.
    Finally- you claim that I am anonymous. I admit I do have a pseudonym. How is it that I can't find you on the GMC website then?

    Unsuitable or offensive? Report this comment

  • Yes, there are too many posh doctors. Current social trends, politically driven, will make this a continuing and increasing problem, as only the affluent will be able to afford tertiary education for their children.
    State education is being deliberately tailored to basic standards of literacy and numeracy only, with no emphasis on training in criticism, problem solving or even the least understanding of statistics and probability. One cannot start a course in medicine without a good background in these areas.
    Meanwhile, those in schools where progression to A-level is the norm can only achieve well with support from their families, not easily available when both parents have to work full time just to pay for housing and food.
    The problem of posh doctors cannot usefully be solved simply by changing entry standards, but needs to come from the earliest years of education, and a society that supports all to achieve well; our continuing obsession with extreme wealth, and deference to the powerful rich, will maintain these ancient inequalities. Start voting for fairness now!

    Unsuitable or offensive? Report this comment

  • This is very true and I hope Dr Turner takes this view across to the RCGP and they can push this forward as a national policy with universities.

    Entrance to Medical Courses should not be based on A levels alone and this is depriving this country of Good Doctors and particularly good GP’s.

    I feel that it is just not the wealth but the policy of A levels dictating who becomes a doctor is the problem. As Dr Turner says you don’t need to be very intelligent to be a Doctor and there
    Should be other ways to assess one’s suitability to become a Doctor.

    Unsuitable or offensive? Report this comment

  • Should Carr-Hill formula include not only patient demographics, morbidity eyc, but also doctor's posh factor? What impact on funding should it have?
    It's a very good and thought provoking article. But it takes us to questions with no answers

    Unsuitable or offensive? Report this comment

  • We need to stop Universities interviewing applicants. Many applicants have had a lot of "coaching".This is potentially biased and unfair. A better method would be to put the applicants who attained BBB at A-level into a hat/ computer and pull the names out randomly.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say