We are yet to feel the full effect of the feminisation of primary care in the UK and elsewhere. Above the age of 45 years men, mostly working full time, are still the majority, whereas most general practitioners younger than 45 years are female and mainly working part time.11
As older mainly full time doctors retire, unless employment behaviour changes from past patterns, there will be a major shortfall in primary care provision.
This demographic change may also affect education, research, and development. In an American study of women in internal medicine,12
the researchers found that compared with men with children, women with children had fewer publications (18.3 v
29.3; P < 0.001). However, no significant differences between the sexes were seen for doctors without children. In our study in primary care we found that women were contributing about 60% of the activity of men in development aspects of general practice such as training, teaching, research, and committee work.7
It is not clear to what extent this is through choice or lack of opportunity.
Some have argued that the future feminisation of medicine is justified on the grounds that women perform better than men in undergraduate and postgraduate examinations. Although several large studies have shown differences, these differences are very small and of little practical importance.13
Men and women may bring different, complementary skills to medicine. There is some evidence that women engage in more patient centred communication.14
However, women consult for longer with patients,14
and in one UK study of out of hours consultations they were 30% more likely to refer to hospital increasing pressure on hospital services.15
Moreover, recent UK research shows that even full time female consultants see fewer patients than their male colleagues.16
Empathy and communication skills are important, but so are efficiency and the ability to live with risk.
For years women have been unfairly discriminated against in medicine. I fully support their role and the strengths they bring to modern medicine. However, in the absence of a profound change in our society in terms of responsibility for child care, we need to take a balanced approach to recruitment in the interests of both equity and future delivery of services.