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General practice’s gender problem

It is a truth universally acknowledged that, when a male GP works part-time so he can pursue roles within the CCG, the RCGP, or the BMA, he is a leader; but that when a female GP works part-time so she can spend time with her family, she is singlehandedly destroying the NHS.

Has general practice become the dumping ground of the NHS because it is seen as ’women’s work’?

Of course, plenty of women take up leadership roles, and plenty of men have childcare responsibilities, but the mainstream media narrative is that the feminisation of medicine is creating a workforce crisis, with the blame aimed squarely at part-time female doctors rather than the politicians and managers who have failed to anticipate the problem and expand medical school places as a result. The shrill, haranguing tabloid think-pieces about lazy part-time female GPs rarely engage with wider issues, such as the vexed question of why women are more likely to work part-time in the first place, and whether this is due to biological urges or social conditioning or the calamitous cost of childcare.

I don’t have a vested interest in this debate: I don’t have children yet, and I work full-time (albeit part-time in a clinical role, and part-time undertaking a paid Fellowship). However, over recent weeks I have increasingly been wondering whether general practice does have a gender problem, albeit not the one that the Daily Mail keeps talking about.

Looking at the wider employment market, rather than just the medical profession, it is recognised that female-dominated jobs typically attract lower pay, status and respect than male-dominated ones. Indeed, research has shown that, when an occupation becomes female-dominated, average wages drop. One profession that has become female-dominated in recent years is general practice. GMC statistics show that 51% of doctors on the GP register are female. The gender split is likely to widen in future: approximately two-thirds of current UK GP trainees are women.

Has general practice become the dumping ground of the NHS because it is seen as ‘women’s work’, and is hence undervalued? It is not hard to see the parallel between the mindless drudgery of domestic wife-work and the avalanche of unpaid, unfunded tasks being dumped into GPs’ laps.

Within the home, the emotional labour of remembering family birthdays and organising playdates typically falls to the female partner; perhaps the medical equivalent is the assumption that GPs have the time and desire to mop up their patients’ social problems, performing boiler checks and food bank referrals. And why shouldn’t we agree to perform unfunded post-operative reviews, when otherwise, surely, part-time female GPs would just be in the kitchen at home baking cakes?

Those three hated words which so devalue our time, ‘GP to chase’, cast the modern GP as a medical secretary, rather than a highly-trained professional with a CCT just as valid as that of the hospital consultant who is trying to delegate their work to us.

What is the answer? I don’t pretend to know how to address the systematic, ingrained sexism which still permeates society. But within general practice, women and men alike must learn to say the magic word: ‘no’. No, we will not prescribe Calpol for an afebrile child ‘for nursery’. No, we will not complete that 10-page insurance form for the ‘suggested fee’ of £30. No, we will not agree to monitor complex secondary care drugs without additional funding. Enough is enough: male and female alike, GPs must fight back and grow a pair. 

Dr Heather Ryan is a GP registrar in Liverpool. You can follow her on Twitter @DrHFRyan