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A faulty production line

Why I don't want to become a 'proper doctor'

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‘You’ve been at this surgery a very long time now. What do you need to do to be a proper doctor?’

I raise my eyebrows at my patient, a very pleasant middle aged man, hand him his prescription and, reply, 

‘A proper doctor?’

‘Yes, you know doctor, when are they going to let you have your name on the plaque on the entrance to the surgery with all the other doctors?’

I knew that was coming. I may have been working at the practice longer than some of my colleagues and my qualifications and experience may be equivalent, but my contractual status is not. I’m not a ‘proper’ doctor because I am salaried. 

My colleagues don’t treat me as a lower-status colleague, although I know that many sessional doctors are not so fortunate.

I would have to work full time in general practice and sacrifice my portfolio career to be a partner. The vacant weekly sessions at my practice can only be filled by two full-timers - no flexibility to accommodate part timers. I love having other roles and I’m not prepared to give them up.

In fact I carried out a straw poll of the 86 GP vacancies advertised on a well-known GP job website. Some 66% of the partnership opportunities were for full time appointments with no offer of jobshare flexibility, and only 20% were for part-time appointments.

Furthermore, of all vacancies with the possibility of part-time working, 67% were for salaried posts.

While not a robust piece of research, it does reflect my experience and that of many of my local salaried counterparts. 

Some say that those of us who opt to work part time don’t wish to commit to the responsibility and risk of taking on partnership positions, but many of us don’t have the choice.

A diverse work force and partnership team are strengths. Diversity is likely to attract patients and it brings significant other benefits to practices and patients if those who determine business strategy and service development are representative of the population they serve.

And being able to draw on the additional expertise of partner colleagues with portfolio careers can be hugely beneficial, bringing in significant new skills and experience such as advanced business skills or a special medical interest. How many partners have had the same autonomy, flexibility and opportunity to pursue interests as ‘portfolio’ GPs? Practice viability and resilience may be improved by designing a partnership with diverse skills and expertise. 

I do not understand why any practice would deny itself access to a larger pool of able, committed candidates through refusal to consider alternative ways of working. Practices that cast their net widely by offering part- and full-time partnership posts, or the possibility of flexible working patterns, are surely more likely to get the best catches.

A recently published GP taskforce report has shown that over 20% of all those leaving the workforce between 2001 and 2010 were women aged between 30 and 34. Can we afford to continue to lose these highly-trained, competent doctors now? 

So I turned to my patient and, once again, explained GP contractual status and how this is not related to clinical expertise or standing. I explain portfolio careers. He kindly offers to graffitti my name on the plaque. 

At present, I don’t have a strong aspiration to become a ‘proper doctor’. I did, at one time, and I felt incredibly frustrated at the lack of opportunity for career progression, so much so that I enrolled on a law course with a view to becoming a barrister. However, I’m now content to be ‘improper’ and I know I’m in good company. 

Dr Lisa Harrod-Rothwell is a GP in Essex and former chair of a local CCG.

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Readers' comments (16)

  • Should salaried dr's be allowed on the boards of CCG's?

    Bit naive for member of a CCG to allow this!

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  • General practice with its current funding will and can only work via a partnership model, unless the model changes then we're signing up to a disaster

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  • We've just appointed a new partner (full-time) but were very clear that we would consider all applications. As a practice we felt we were short of around 8 clinical sessions of doctor time, but if an excellent applicant could only offer 4 or 5 we would have been prepared to be flexible.

    I'm sure in this recruitment climate many other practices would also be similarly flexible.

    Perhaps there's a difference between what is advertised (or desired, in terms of sessions) and what may be acceptable. To anyone interested in any post I wouldn't necessarily be deterred by the terms of the job advert - there's no harm in showing initiative and asking.

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  • I'm lucky to be a partner in a practice where all 3 of us work part time in the practice. None of us understand why anyone would do anything else!

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  • Azeem Majeed

    I've been a partner in my practice since 1999 and have always worked part-time in the practice with the remainder of my time spent in academic work. Being a part-time partner does not preclude you from making a significant contribution to the management and development of a practice.

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  • I am a 6 session partner with a portfolio career and there are many more of us out there. Maybe you need to look elsewhere?

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  • Ivan Benett

    Anonymous 22nd at 1.22pm, of course salaried GPs are 'allowed' on CCGs, we are 'proper' doctors too. I totally am with Lisa on this. I gave up my partnership of 25 years to become a portfolio GP. I haven't had so much fun in my career for years. Partnerships are old fashioned, and all I ever hear from partners is moaning. Well you don't have to be a partner if you don't want. It is hugely liberating to release yourself from those shackles.
    So you may not be a rich as if you are a partner, but you'll be free and happy.
    No wonder new GPs don't want to be dragged down by partnership. They want, we want, a flexible time table and to be in control of our career.

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  • Ivan,

    I don't want to be a partner either, but I recognise that General Practice will not function if we all become salaried.

    A lot of your pronouncements now make sense. You advocate perfection, yet you know you will not be responsible for delivering it.

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  • It's all about the plaques. Everyone should get a plaque.

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  • Drachula

    Hi Lisa
    My practice has the sense to want to attract really good doctors, and does not limit itself to full timers. In any case, many doctors are full timers but go and do other jobs, bringing the money into the surgery for the other work. It makes no sense to limit jobs to the (usually) boys who want to be full time in a practice - most of us want some variety in life and I would go utterly bonkers if I went back to doing only the face to face part of the job (as has happened in the past). Thank heavens for teaching, training, practice development and so on, whether or not one chooses to take on the double edged sword of CCG roles.
    A progressive partnership means a healthy work environment and the flexibility to keep oneself well balanced with portfolio roles.

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