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GPs go forth

The gender divide is a result of an inflexible partnership model

Dr Katie Musgrave

Pulse recently reported the pay disparity between male and female GPs.

But isn’t this because women choose to work less, and take the more straightforward option of being a salaried doctor? After all, most of us would prefer to take home significantly less, but forgo the extra workload and business aspects of partnership. Wouldn’t we?

I would argue that women aren’t making this choice.

Rather, we are faced with an inflexible partnership model, which punishes anyone foolish enough to work a half day. Do you know any men who choose to work half days?

To say that the partnership model is flexible is therefore a fallacy, because the ‘flexible’ option of working a half day is an inherently unappealing option.

After all, anyone who works a half day is paid half as much, but their session will inevitably morph into something significantly longer.

So why don’t women with young children manage the full days that many of the female partners before us did? I’d argue that the reasons are twofold - the full day is now too intense and demanding alongside parenting, and the costs of wraparound childcare are prohibitive.

GPs have seen real terms pay decreases since 2004. The costs of housing have never been higher (and my generation haven't benefited from the housing boom). We have significantly higher levels of student debt. Employer pension contributions have increased. My generation of GPs don't expect to be buying the large farmhouses that senior GP partners downsize from. My point is that times have changed. The option of a full-time nanny is simply not feasible for many.

Women are faced with an inflexible partnership model, which punishes anyone foolish enough to work a half day

In a morning, before going to work, I make three children breakfast. I brush their teeth and hair. I run around my house with their clothes and wrestle them into something appropriate. I pack their bags, make packed lunches. I change the baby’s nappy. I bundle them into the car, and drive to meet our childminder near the school. I hand over the baby. I drop my daughter at school, then walk my other daughter to her preschool. Then I dash to the surgery, getting there before 9. Sound exhausting? It is!

I won’t go through what happens at the end of the day: it's basically this in reverse. I couldn’t sandwich in, between these responsibilities, being flat out in a surgery from 7.45am to 6.30pm. It would be the death of me.

What I could manage, however, would be a 9am until 4.30pm day. This would give me the breathing space to get everyone where they needed to be. And the capacity to look after my kids at the end of the day. My husband is a GP partner. He can’t be there at 5pm for a pick up either. For a shortened day, I wouldn’t expect to be paid what a full-time partner earns. But a half day feels unfair, and an insult to my training and experience.

So, what to do? I’d suggest there needs to be a more flexible partnership model offered. Where women (or men) can opt to work shorter days, and be paid fairly for the work they do.

General practice could be a really flexible, family-friendly job. We don’t need every GP there all the time. But everyone needs to feel that their contribution is valued, and fairly remunerated.

The GPs working the longer days should be rewarded accordingly. NHS England could support general practice by offering a contribution to those surgeries who take on a ‘flexible partner’ - akin to the retainer scheme.

We need to find ways to make the best use of the GPs we have; especially all the younger, female GPs who are training. Supporting women to take up partnerships, even while they have heavy childcare responsibilities, would be a smart move. Allowing women to walk away, or minimise their clinical work, is shortsighted and foolish.

We need to break down the gender divide in partnerships, and offer women genuine choices. I’ve seen too many practice websites where the list of doctors is topped by four or five male GP partners, with a smattering of demure, female, salaried doctors, sitting beneath them. It’s 2020, for God’s sake, not the 1950s.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (18)

  • Can’t argue with that.
    Time to end the block contract and pay for the work done.

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  • And there needs to be a guarantee of being able to leave on time. Otherwise everyone with kids chooses less sessions just to cope. Same with the pension fiasco, work is made inherently unappealing despite spending so much on training.

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  • I didn't detect any robust solutions put forward other than chucking more money in. Perhaps this is a projection of the powerlessness you feel. As a partner you have the ability to negotiate, you are not a slave. Although, being agreeable is reportedly a majority female trait. You live with the choices you make; you're not a single mother living on some down-trodden council estate working a couple of part-time cleaning jobs.
    Children change everything in the biggest ways imaginable; to think we can carry on without significant sacrifice is naive. One parent at least will need to make the change and this decision is often influenced by eons of evolutionary nurturing. If this is disagreeable to you then perhaps future life choices should match expectation.
    I feel privileged to be able to earn just enough by working very part-time and give my two children the time and energy they deserve, because we will never get this time back.

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  • The feminists lied to you. They told you could have it all, a career and a family and both would be equally fulfilling. The reality is that full time hours are a grind and children are demanding. No matter your intelligence you can’t juggle all these demands and be happy, it’s inevitable you will fail at one or another. The NHS has remorselessly exploited female agreeability and conscientiousness but the price is unsustainable and working for huge companies is likely to be far worse as they must also pay dividends. Returning to the 1950s model is far more sustainable for all in the long run.

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  • doctordog.

    These ‘woe is me ‘ articles worry me.
    As a partner one should be able to adjust both workload quantity and timing to suit and integrate better with family commitments , rather than be a slave to the 8 to 8 shift.
    As a female GP you are a more valuable member of the workforce than a male GP. If you’re not treated as such, there will be many practices who would .

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  • Echoing the above. Some practices work on the premise that full time equals so many patients per week with part time as a proportion of this. As a partner you have the flexibility to choose when to see these patients and how to structure your working day. And if you end up seeing 75% of what is classed as full time you get 75% of the pay. Explore what practices are doing nearby and find a practice that works for you. At least with the countless other pressures you are in a strong negotiating position

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  • I DON'T ENTIRELY UNDERSTAND THE ARTICLE..

    ANY GP MALE OR FEMALE WHO CHOOSES CAN BE A PARTNER BUT YES THE TERMS AND CONDITIONS ARE CRAP-NOT JUST HOURS BUT LEGAL RESPONSIBILITY.
    THAT IS WHY THERE ARE NO APPLICANTS.
    THE GOVERNMENT ARE NOT GOING TO START PAYING GP PARTNERS MORE OR BETTER HOURS SO THERE IS A SIMPLE LIFE CHOICE-EITHER LESS PAY AND LESS STRESS/LESS POWER OR MORE PAY AND MORE STRESS/MORE POWER.

    THIS HAS NOTHING TO DO WITH GENDER OTHER THAN (USUALLY) WOMEN HAVE TO MAKE THE SAME DIFFICULT DECISIONS IN ALL CAREERS NOT JUST MEDICINE.
    BASICALLY IN EVERY RELATIONSHIP ONE PARENT HAS TO COMPROMISE WHETHER MALE OR FEMALE.

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  • |doctordog. | GP Partner/Principal|28 Jan 2020 8:48am
    "As a female GP you are a more valuable member of the workforce than a male GP"

    - please elaborate...

    |socrates | GP Partner/Principal|28 Jan 2020 9:47am
    "As a partner you have the flexibility to choose when to see these patients and how to structure your working day. And if you end up seeing 75% of what is classed as full time you get 75% of the pay."

    - I don't know what health service you are working in, certainly doesn't sound like the bulk contract of the NHS/socialised healthcare.

    To the author - "After all, anyone who works a half day is paid half as much, but their session will inevitably morph into something significantly longer." - Why do you think that is? Because workload limits are not specified, as it is more cost effective for the state to provide socialised healthcare

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  • Cobblers

    I tend to agree with Last Man Standing (except for the shouting - seriously?) in that I don't follow. Partnership has some advantages but many serious downsides not least last (wo)man standing.

    Salaried is a comfortable, underpaid, overworked, option. What's wrong with being a locum? Set your price, times and conditions. What's not to like? I understand the holidays sick pay yada yada but the flexibility it gives you, you seem to need.

    Man up :-) and get out of salaried.

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  • Most GP partnerships hold unlimited liability.

    That requires a certain amount of availability beyond that of seeing patients.

    The article describes a salaried GP role, with defined workload and hours, not the completely different role of GP partner.

    They are 2 different roles with different pay or profit structures.
    That they are both held by GPs does not make them comparable.

    A better question is whether the customer, HMG, is making best use of tax funding by only pushing extra resources if they are tied to seeing routine patients in extended hours, when gp availability is lower and more expensive than in the day?

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