‘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.
