To report on what doctors at very different levels of seniority wrote, in their own words, about their concerns about the European Working Time Directive (EWTD) and its implementation in the National Health Service (NHS).
All medical school graduates from 1993, 2005 and 2009 were surveyed by post and email in 2010.
Using qualitative methods, we analysed free-text responses made in 2010, towards the end of the first year of full EWTD implementation, of three cohorts of the UK medical graduates (graduates of 1993, 2005 and 2009), surveyed as part of the UK Medical Careers Research Group's schedule of multipurpose longitudinal surveys of doctors.
Of 2459 respondents who gave free-text comments, 279 (11%) made unprompted reference to the EWTD; 270 of the 279 comments were broadly critical. Key themes to emerge included frequent dissociation between rotas and actual hours worked, adverse effects on training opportunities and quality, concerns about patient safety, lowering of morale and job satisfaction, and attempts reportedly made in some hospitals to persuade junior doctors to collude in the inaccurate reporting of compliance.
Further work is needed to determine whether problems perceived with the EWTD, when they occur, are attributable to the EWTD itself, and shortened working hours, or to the way that it has been implemented in some hospitals.
To report on doctors’ views, from all specialty backgrounds, about the European Working Time Directive (EWTD) and its impact on the National Health Service (NHS), senior doctors and junior doctors.
All medical school graduates from 1999 to 2000 were surveyed by post and email in 2012.
Among other questions, in a multipurpose survey on medical careers and career intentions, doctors were asked to respond to three statements about the EWTD on a five-point scale (from strongly agree to strongly disagree): ‘The implementation of the EWTD has benefited the NHS’, ‘The implementation of the EWTD has benefited senior doctors’ and ‘The implementation of the EWTD has benefited junior doctors’.
The response rate was 54.4% overall (4486/8252), 55.8% (2256/4042) of the 1999 cohort and 53% (2230/4210) of the 2000 cohort. 54.1% (2427) of all respondents were women. Only 12% (498/4136 doctors) agreed that the EWTD has benefited the NHS, 9% (377) that it has benefited senior doctors and 31% (1289) that it has benefited junior doctors. Doctors’ views on EWTD differed significantly by specialty groups: ‘craft’ specialties such as surgery, requiring extensive experience in performing operations, were particularly critical.
These cohorts have experience of working in the NHS before and after the implementation of EWTD. Their lack of support for the EWTD 4 years after its implementation should be a concern. However, it is unclear whether problems rest with the current ceiling on hours worked or with the ways in which EWTD has been implemented.
Health Services Administration & Management; Medical Education & Training
Medical schools need to ensure that graduates feel well prepared for their first medical job. Our objective was to report on differences in junior doctors’ self-reported preparedness for work according to gender, ethnicity and graduate status.
Postal and electronic questionnaires.
Medical graduates of 2008 and 2009, from all UK medical schools, one year after graduation.
Main outcome measures
The main outcome measure was the doctors’ level of agreement with the statement that ‘My experience at medical school prepared me well for the jobs I have undertaken so far’, to which respondents were asked to reply on a scale from ‘strongly agree’ to ‘strongly disagree’.
Women were slightly less likely than men to agree that they felt well prepared for work (50% of women agreed or strongly agreed vs. 54% of men), independently of medical school, ethnicity, graduate entry status and intercalated degree status, although they were no more likely than men to regard lack of preparedness as having been a problem for them. Adjusting for the other subgroup differences, non-white respondents were less likely to report feeling well prepared than white (44% vs. 54%), and were more likely to indicate that lack of preparedness was a problem (30% non-white vs. 24% white). There were also some gender and ethnic differences in preparedness for specific areas of work.
The identified gender and ethnic differences need to be further explored to determine whether they are due to differences in self-confidence or in actual preparedness.
medical education; junior doctors; preparedness for work; gender; ethnicity
Less than one-third of newly qualified doctors in the UK want a career in general practice. The English Department of Health expects that half of all newly qualified doctors will become GPs.
To report on the reasons why doctors choose or reject careers in general practice, comparing intending GPs with doctors who chose hospital careers.
Design and setting
Questionnaire surveys in all UK medical graduates in selected qualification years.
Questions about specialty career intentions and motivations, put to the qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, and 2009, 1 year after qualification, and at longer time intervals thereafter.
‘Enthusiasm for and commitment to the specialty’ was a very important determinant of choice for intending doctors, regardless of chosen specialty. ‘Hours and working conditions’ were a strong influence for intending GPs (cited as having had ‘a great deal’ of influence by 75% of intending GPs in the first year after qualification), much more so than for doctors who wanted a hospital career (cited by 30%). Relatively few doctors had actually considered general practice seriously but then rejected it; 78% of the doctors who rejected general practice gave ‘job content’ as their reason, compared with 32% of doctors who rejected other specialties.
The shortfall of doctors wanting a career in general practice is not accounted for by doctors considering and rejecting it. Many do not consider it at all. There are very distinctive factors that influence choice for, and rejection of, general practice.
career choice; general practice; medical education; workforce, medical
Recruitment of adequate numbers of doctors to psychiatry is
To report on career choice for psychiatry, comparing intending
psychiatrists with doctors who chose other clinical careers.
Questionnaire studies of all newly qualified doctors from all UK medical
schools in 12 qualification years between 1974 and 2009 (33 974 respondent
One, three and five years after graduation, 4–5% of doctors
specified psychiatry as their first choice of future career. This was largely
unchanged across the 35 years. Comparing intending psychiatrists with doctors
who chose other careers, factors with a greater influence on
psychiatrists’ choice included their experience of the subject at
medical school, self-appraisal of their own skills, and inclinations before
medical school. In a substudy of doctors who initially considered but then did
not pursue specialty choices, 72% of those who did not pursue psychiatry gave
‘job content’ as their reason compared with 33% of doctors who
considered but did not pursue other specialties. Historically, more women than
men have chosen psychiatry, but the gap has closed over the past decade.
Junior doctors’ views about psychiatry as a possible career
range from high levels of enthusiasm to antipathy, and are more polarised than
views about other specialties. Shortening of working hours and improvements to
working practices in other hospital-based specialties in the UK may have reduced
the relative attractiveness of psychiatry to women doctors. The extent to which
views of newly qualified doctors about psychiatry can be modified by medical
school education, and by greater exposure to psychiatry during student and early
postgraduate years, needs investigation.
To investigate the geographical mobility of UK-trained doctors.
Cohort studies conducted by postal questionnaires.
A total 31,353 UK-trained doctors in 11 cohorts defined by year of qualification, from 1974 to 2008.
Main outcome measures
Location of family home prior to medical school, location of medical school, region of first training post, region of first career post. Analysis for the UK divided into 17 standard geographical regions.
The response rate was 81.2% (31,353/45,061; denominators, below, depended on how far the doctors’ careers had progressed). Of all respondents, 36% (11,381/31,353) attended a medical school in their home region and 48% (10,370/21,740) undertook specialty training in the same region as their medical school.
Of respondents who had reached the grade of consultant or principal in general practice in the UK, 34% (4169/12,119) settled in the same region as their home before entering medical school. Of those in the UK, 70% (7643/10,887) held their first career post in the same region as either their home before medical school, or their medical school or their location of training. For 18% (1938/10,887), all four locations – family home, medical school, place of training, place of first career post – were within the same region. A higher percentage of doctors from the more recent than from the older cohorts settled in the region of their family home.
Many doctors do not change geographical region in their successive career moves, and recent cohorts appear less inclined to do so.
Cardiology is one of the most popular of the hospital medical specialties in the UK. It is also a highly competitive specialty in respect of the availability of higher specialty training posts. Our aims are to describe doctors’ early intentions about seeking careers in cardiology, to report on when decisions about seeking a career in cardiology are made, to compare differences between men and women doctors in the choice of cardiology, and to compare early career choices with later specialty destinations.
Questionnaire surveys were sent to all UK medical graduates in selected qualification years from 1974–2009, at 1, 3, 5, 7 and 10 years after graduation.
One year after graduation, the percentage of doctors specifying cardiology as their first choice of long-term career rose from the mid-1990s from 2.4% (1993 cohort) to 4.2% (2005 cohort) but then fell back to 2.7% (2009 cohort). Men were more likely to give cardiology as their first choice than women (eg 4.1% of men and 1.9% of women in the 2009 cohort). The percentage of doctors who gave cardiology as their first choice of career declined between years one and five after qualification: the fall was more marked for women. 34% of respondents who specified cardiology as their sole first choice of career one year post-graduation were later working in cardiology. 24% of doctors practising as cardiologists several years after qualification had given cardiology as their sole first choice in year one. The doctors’ ‘domestic circumstances’ were a relatively unimportant influence on specialty choice for aspiring cardiologists, while ‘enthusiasm/commitment’, ‘financial prospects’, ‘experiences of the job so far’ and ‘a particular teacher/department’ were important.
Cardiology grew as a first preference one year after graduation to 2005 but is now falling. It consistently attracts a higher percentage of men than women doctors. The correspondence between early choice and later destination was not particularly strong for cardiology, and was less strong than that for several other specialties.
Cardiology; Career choice; Workforce; Medical education; Hospital medical staff
To report on doctors’ family formation.
Cohort studies using structured questionnaires.
Doctors who qualified in 1988, 1993, 1996, 1999, 2000 and 2002 were followed up.
Main Outcome Measures
Living with spouse or partner; and doctors’ age when first child was born.
The response to surveys including questions about domestic circumstances was 89.8% (20,717/23,077 doctors). The main outcomes – living with spouse or partner, and parenthood – varied according to age at qualification. Using the modal ages of 23–24 years at qualification, by the age of 24–25 (i.e. in their first year of medical work) a much smaller percentage of doctors than the general population was living with spouse or partner. By the age of 33, 75% of both women and men doctors were living with spouse or partner, compared with 68% of women and 61% of men aged 33 in the general population.
By the age of 24–25, 2% of women doctors and 41% of women in the general population had a child; but women doctors caught up with the general population, in this respect, in their 30s. The specialty with the highest percentage of women doctors who, aged 35, had children was general practice (74%); the lowest was surgery (41%).
Doctors are more likely than other people to live with a spouse or partner, and to have children, albeit typically at later ages. Differences between specialties in rates of motherhood may indicate sacrifice by some women of family in favour of career.
The percentage of newly qualified doctors in the UK who want a career in general practice declined substantially in the 1990s. The English Department of Health expects that half of all doctors will become GPs.
To report on choices for general practice made by doctors who qualified in 2000, 2002, 2005, 2008, and 2009.
Design and setting
A structured, closed questionnaire about future career intentions, sent to all UK medical graduates.
Questionnaires sent 1 year after qualification (all cohorts) and 3 years after (all except 2008 and 2009).
Percentages of doctors who expressed an unreserved first choice for general practice in the first year after qualification, in the successive five cohorts, were 22.2%, 20.2%, 23.2%, 21.3%, and 20.4%. Percentages who expressed any choice for general practice — whether first, second or third — were 46.5%, 43.4%, 52.6%, 49.5%, and 49.9%. Three years after qualification, an unreserved first choice was expressed, in successive cohorts, by 27.9%, 26.1%, and 35.1%. Doctors from newly established English medical schools showed the highest levels of choice for general practice.
The percentage of doctors, in their first post-qualification year, whose first choice of eventual career was general practice has not changed much in recent years. By year 3 after qualification, this preference has increased in recent years. At years 1 and 3, the overall first choice for general practice is considerably lower than the required 50%, but varies substantially by medical school. In depth studies of why this is so are needed.
career choice; general practice; junior doctors; medical education; workforce planning
To report doctors' rejection of specialties as long-term careers and reasons for rejection.
Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification.
Main outcome measures
Current specialty choice; any choice that had been seriously considered but not pursued (termed ‘rejected’ choices) with reasons for rejection.
2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of ‘job content’ was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns.
There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes.
To investigate factors which influenced UK-trained doctors to emigrate to New Zealand and factors which might encourage them to return.
Cross-sectional postal and Internet questionnaire survey.
Participants in New Zealand; investigators in UK.
UK-trained doctors from 10 graduation-year cohorts who were registered with the New Zealand Medical Council in 2009.
Main outcome measures
Reasons for emigration; job satisfaction; satisfaction with leisure time; intentions to stay in New Zealand; changes to the UK NHS which might increase the likelihood of return.
Of 38,821 UK-trained doctors in the cohorts, 535 (1.4%) were registered to practise in New Zealand. We traced 419, of whom 282 (67%) replied to our questionnaire. Only 30% had originally intended to emigrate permanently, but 89% now intended to stay. Sixty-nine percent had moved to take up a medical job. Seventy percent gave additional reasons for relocating to New Zealand including better lifestyle, to be with family, travel/working holiday, or disillusionment with the NHS. Respondents' mean job satisfaction score was 8.1 (95% CI 7.9–8.2) on a scale from 1 (lowest satisfaction) to 10 (highest), compared with 7.1 (7.1–7.2) for contemporaries in the UK NHS. Scored similarly, mean satisfaction with the time available for leisure was 7.8 (7.6–8.0) for the doctors in New Zealand, compared with 5.7 (5.6–5.7) for the NHS doctors. Although few respondents wanted to return to the UK, some stated that the likelihood of doctors' returning would be increased by changes to NHS working conditions and by administrative changes to ease the process.
Emigrant doctors in New Zealand had higher job satisfaction than their UK-based contemporaries, and few wanted to return. The predominant reason for staying in New Zealand was a preference for the lifestyle there.
The transition from medical student to junior doctor in postgraduate training is a critical stage in career progression. We report junior doctors' views about the extent to which their medical school prepared them for their work in clinical practice.
Postal questionnaires were used to survey the medical graduates of 1999, 2000, 2002 and 2005, from all UK medical schools, one year after graduation, and graduates of 2000, 2002 and 2005 three years after graduation. Summary statistics, chi-squared tests, and binary logistic regression were used to analyse the results. The main outcome measure was the level of agreement that medical school had prepared the responder well for work.
Response rate was 63.7% (11610/18216) in year one and 60.2% (8427/13997) in year three. One year after graduation, 36.3% (95% CI: 34.6, 38.0) of 1999/2000 graduates, 50.3% (48.5, 52.2) of 2002 graduates, and 58.2% (56.5, 59.9) of 2005 graduates agreed their medical school had prepared them well. Conversely, in year three agreement fell from 48.9% (47.1, 50.7) to 38.0% (36.0, 40.0) to 28.0% (26.2, 29.7). Combining cohorts at year one, percentages who agreed that they had been well prepared ranged from 82% (95% CI: 79-87) at the medical school with the highest level of agreement to 30% (25-35) at the lowest. At year three the range was 70% to 27%. Ethnicity and sex were partial predictors of doctors' level of agreement; following adjustment for them, substantial differences between schools remained. In years one and three, 30% and 34% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 3% in each year regarded it as serious).
The vast knowledge base of clinical practice makes full preparation impossible. Our statement about feeling prepared is simple yet discriminating and identified some substantial differences between medical schools. Medical schools need feedback from graduates about elements of training that could be improved.
Changes to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery.
Postal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification years between 1974 and 2005. They were sent in the first year after qualification, at year three and five years after qualification, and at longer time intervals thereafter.
Responses were received from 27 749 of 38 280 doctors (73%) at year one, 23 468 of 33151 (71%) at year three, and 17 689 of 24 870 (71%) at year five. Early career preferences showed that surgery has become more popular over the past two decades. Looking forward from early career choice, 60% of respondents (64% of men, 48% of women) with a first preference for a surgical specialty at year one eventually worked in surgery (p < 0.001 for the male-female comparison). Looking backward from eventual career destinations, 90% of responders working in surgery had originally specified a first choice for a surgical specialty at year one. 'Match' rates between eventual destinations and early choices were much higher for surgery than for other specialties. Considering factors that influenced early specialty choice 'a great deal', comparing aspiring surgeons and aspiring general practitioners (GPs), a significantly higher percentage who chose surgery than general practice specified enthusiasm for the specialty (73% vs. 53%), a particular teacher or department (34% vs. 12%), inclinations before medical school (20% vs. 11%), and future financial prospects (24% vs. 13%); and a lower percentage specified that hours and working conditions had influenced their choice (21% vs. 71%). Women choosing surgery were influenced less than men by their inclinations before medical school or by their future financial prospects.
Surgery is a popular specialty choice in the UK. The great majority of doctors who progressed in a surgical career made an early and definitive decision to do so.
To report the career destinations, views and future plans of a cohort of senior doctors who qualified in the 1980s.
Postal questionnaire survey of all doctors who qualified from all UK medical schools in 1988.
The response rate was 69%. We estimated that 81% of the total cohort was working in the NHS, 16 years after qualification; and that at least 94% of graduates who, when students, were from UK homes, were working in medicine. Of NHS doctors, 30% worked part-time. NHS doctors rated their job satisfaction highly (median score 19.9, scale 5–25) but were less satisfied with the amount of leisure time available to them (median score 5.4, scale 1–10). NHS doctors were very positive about their careers, but were less positive about working hours and some other aspects of the NHS. Women were more positive than men about working conditions; general practitioners were more positive than hospital doctors. Twenty-five percent reported unmet needs for further training or career-related advice, particularly about career development. Twenty-nine percent intended to reduce their hours in future, while 6%, mainly part-time women, planned to increase their hours. Overall, 10% of NHS doctors planned to do more service work in future and 24% planned to do less; among part-time women, 18% planned to do more and only 14% less.
These NHS doctors, now in their 40s, had a high level of satisfaction with their jobs and their careers but were less satisfied with some other aspects of their working environment. A substantial percentage had expectations about future career development and change.
Objective To report the percentage of graduates from British medical schools who eventually practise medicine in the British NHS.
Design Cohort studies using postal questionnaires, employment data, and capture-recapture analysis.
Setting Great Britain.
Subjects 32 430 graduates from all British medical schools in nine graduation cohorts from 1974 to 2002, subdivided into home based medical students (those whose homes were in Great Britain when they entered medical school) and those from overseas (whose homes were outside Great Britain when they entered medical school).
Main outcome measures Working in the NHS at seven census points from two to 27 years after qualification.
Results Of home based doctors, 88% of men (6807 of 7754) and 88% of women (7909 of 8985) worked as doctors in the NHS two years after qualification. The corresponding values were 87% of men (7483 of 8646) and 86% of women (7364 of 8594) at five years; 86% (6803 of 7872) and 86% (5407 of 6321) at 10 years; 85% (5404 of 6331) and 84% (3206 of 3820) at 15 years; and 82% (2534 of 3089) and 81% (1132 of 1395) at 20 years. Attrition from the NHS had not increased in recent cohorts compared with older ones at similar times after graduation. Of overseas students, 76% (776 of 1020) were in the NHS at two years, 72% (700 of 972) at five years, 63% (448 of 717) at ten years, and 52% (128 of 248) at 20 years.
Conclusions The majority of British medical graduates from British medical schools practise in the NHS in both the short and long term. Differences between men and women in this respect are negligible. A majority of doctors from overseas homes remain in Britain for their years as junior doctors, but eventually about half leave the NHS.
Objective To study the career progression of NHS doctors, comparing men and women.
Design Postal questionnaire surveys.
Participants and setting Graduates of 1977, 1988, and 1993 from all UK medical schools.
Results The response rate was 68% (7012/10 344). Within general practice, 97% (1208/1243) of men, 99% (264/267) of women who had always worked full time throughout their career, and 87% (1083/1248) of all women were principals. Median times from qualification to principal status were 5.8 (95% confidence interval 5.6 to 6.0) years for men, 5.6 (5.4 to 5.8) years for women who had worked full time during training, and 6.8 (6.5 to 7.0) years for all women. Of the 1977 and 1988 graduates in hospital practice, 96% (1293/1347) of men were consultants, compared with 92% (276/299) of women who had always worked full time throughout their career and 67% (277/416) of women who had not. Median time to first consultant post was 11.7 (11.5 to 11.9) years for men, 11.3 (11.0 to 11.6) years for women who worked full time during training, and 12.3 (12.0 to 12.6) years for all women. Women who had not always worked full time throughout their career were over-represented in general practice and under-represented in most hospital specialties, substantially so in the surgical specialties and anaesthetics. Women who had always worked full time were under-represented not only in the surgical specialties but also in general practice.
Conclusions Women not progressing as far and as fast as men was, generally, a reflection of not having always worked full time rather than their sex. The findings suggest that women do not generally encounter direct discrimination; however, the possibility that indirect discrimination, such as lack of opportunities for part time work, has influenced choice of specialty cannot be ruled out.
To report on the future career plans of senior doctors working in the NHS.
All doctors who qualified in 1977 from all UK medical schools.
Main outcome measures
Future plans and whether participants had any unmet needs for advice on how to put their future plans into effect.
25% definitely intended to continue with their current employment on the same basis until they retired; 75% hoped for change. A reduction in working hours was the most commonly desired change; but a substantial percentage also wanted changes in job content. 50% of respondents intended definitely (17%) or probably (33%) to work in the NHS to their normal retirement age; and 37% definitely (20%) or probably (17%) intended to retire early. 48% had made plans, in addition to the standard pension, to facilitate early retirement. The main factors given for considering early retirement were family reasons and wanting more time for leisure, a desire to maintain good health, excessive pressure of work, and disillusionment with NHS changes. A reduction in workload would be the greatest inducement to stay. 31% of respondents reported that they had unmet needs for advice about their future plans. Of these, about half were needs for advice about planning for retirement.
Many senior NHS doctors would like to reduce their working hours. Less than a quarter definitely intend to work in the NHS to normal retirement age. Even for senior doctors, advice on career development is needed.
To study the career destinations, job satisfaction and views of UK-trained senior doctors.
All doctors who qualified from all UK medical schools in 1977; and Department of Health employment data.
Main outcome measures
Career destinations of medical qualifiers from 1977.
72% responded to the questionnaire. Using all available evidence, including that on non-responders, 76% of the cohort, comprising 77% of the men and 74% of the women, were working in the NHS 27 years after qualification. Approximately 18% were in medical jobs either overseas or outside the NHS. Of respondents in the NHS, 89% of men and 51% of women had full-time contracts. NHS doctors rated their job satisfaction highly, with a median score of 19.5 on a scale from 5 (very low satisfaction) to 25 (very high satisfaction). Satisfaction with time off for leisure was much lower, with a median score of 4.6 on a scale from 1 (low) to 10 (high). Of those in the NHS, 67% agreed that they worked longer hours than they thought they should; and 40% agreed that their working conditions were satisfactory.
27 years after qualification, the percentage of women who were working in the NHS was similar to that of men. Although these senior doctors had high levels of satisfaction with the content of their jobs, they were not so satisfied with their working hours and working conditions. Our results can be used as benchmarks, against which the career pathways and satisfaction levels of more recently qualified doctors can be compared.
The paper aims to report trends in career choices for ophthalmology among UK medical graduates.
Postal questionnaire surveys were undertaken of qualifiers from all UK medical schools in nine qualification years since 1974. Data were analysed by univariate cross-tabulation. The significance of comparisons between groups of doctors were calculated by the use of chi-squared tests and adjusted residuals.
Ophthalmology was the first choice of long term career for 2.3% of men and 1.5% of women one year after qualification; 2.0% of men and 1.4% of women three years after; and 1.8% of men and 1.2% of women at five years. Comparing early choices with eventual destinations, 64% who chose ophthalmology in year one, 84% in year three, and 92% in year five eventually practised in the specialty. The concordance between year one choice and eventual destination was higher for ophthalmology than for most other specialties. 'Enthusiasm for and commitment to the specialty' was the most important single factor in influencing career choice. The prospect of good working hours and conditions was also an important influence: it influenced career choice a great deal for a higher percentage of those who chose ophthalmology (66% in the third year) than those who made other surgical choices (23%).
Those choosing ophthalmology show a high level of commitment to it. Their commitment is strengthened by the prospect of attractive hours and working conditions. Many doctors who become ophthalmologists have already made their choice by the end of their first post-qualification year.
A survey of newly qualified doctors in the UK in 2000/2001 found that 42% of them felt unprepared for their first year of employment in clinical posts. We report on how UK qualifiers' preparedness has changed since then, and on the impact of course changes upon preparedness.
Postal questionnaires were sent to all doctors who qualified from UK medical schools, in their first year of clinical work, in 2003 (n = 4257) and 2005 (n = 4784); and findings were compared with those in 2000/2001 (n = 5330). The response rates were 67% in 2000/2001, 65% in 2003, and 43% in 2005. The outcome measure was the percentage of doctors agreeing with the statement "My experience at medical school has prepared me well for the jobs I have undertaken so far".
In the 2000/2001 survey 36.3% strongly agreed or agreed with the statement, as did 50.3% in the 2003 survey and 58.5% in 2005 (chi-squared test for linear trend: χ2 = 259.5; df = 1; p < 0.001). Substantial variation in preparedness between doctors from different medical schools, reported in the first survey, was still present in 2003 and 2005. Between 1998 and 2006 all UK medical schools updated their courses. Within each cohort a significantly higher percentage of the respondents from schools with updated courses felt well prepared.
UK medical schools are now training doctors who feel better prepared for work than in the past. Some of the improvement may be attributable to curricular change.
Objectives To study the reasons given by junior doctors trained in the United Kingdom for considering leaving UK medicine.
Design Analysis of replies to postal questionnaire surveys.
Setting United Kingdom.
Participants 1326 doctors who qualified in 1999.
Main outcome measure Reasons for considering leaving.
Results Of 1047 doctors who indicated that they would stay in medicine but not necessarily in the United Kingdom, 65% (682) gave reasons for leaving that concerned lifestyle, such as a preference for living outside the United Kingdom; 41% (433) gave reasons concerning working conditions in UK medicine; and 18% (184) gave positive work related reasons, such as wanting to work in developing countries. Of 279 doctors considering leaving medicine, 75% (210) cited working conditions, 23% (63) cited lifestyle reasons, and 9% (24) cited positive interests in a different career. Of the 169 doctors who said that they would probably or definitely leave the United Kingdom but remain in medicine, 78% (132) specified lifestyle reasons. Of the 42 who said that they would probably or definitely leave medicine, 67% (28) cited working conditions.
Conclusions The wish to work abroad, but to stay in medicine, was more common than the wish to leave medicine. The preference for a different lifestyle, particularly to live outside the United Kingdom, is not readily amenable to policy changes to the medical working environment. The smaller numbers of doctors who gave work experience as a reason for considering leaving medicine might be influenced to stay by improvements in working lives.
Objectives To report on the country of training and ethnicity of consultants in different specialties in the NHS, on trends in intake to UK medical schools by ethnicity, and on the specialty choices made by UK medical graduates in different ethnic groups.
Design Analysis of official databases of consultants and of students accepted to study medicine; survey data about career choices made by newly qualified doctors.
Setting and subjects England and Wales (consultants), United Kingdom (students and newly qualified doctors).
Results Of consultants appointed before 1992, 15% had trained abroad; of those appointed in 1992-2001, 24% had trained abroad. The percentage of consultants who had trained abroad and were non-white was significantly high, compared with their overall percentage among consultants, in geriatric medicine, genitourinary medicine, paediatrics, old age psychiatry, and learning disability. UK trained non-white doctors had specialty destinations similar to those of UK trained white doctors. The percentage of UK medical graduates who are non-white has increased substantially from about 2% in 1974 and will approach 30% by 2005. White men now comprise little more than a quarter of all UK medical students. White and non-white UK graduates make similar choices of specialty.
Conclusions Specialist medical practice in the NHS has been heavily dependent on doctors who have trained abroad, particularly in specialties where posts have been hard to fill. By contrast, UK trained doctors from ethnic minorities are not over-represented in the less popular specialties. Ethnic minorities are well represented in UK medical school intakes; and white men, but not white women, are now substantially under-represented.
Objective To determine whether women, ethnic minorities, and particular specialties are discriminated against in the receipt of NHS distinction awards.
Design Analysis of database of consultants eligible for distinction awards.
Setting England and Wales, 2002.
Main outcome measures Holding of B, A, and Aplus distinction awards, analysed for all awards, irrespective of when made, and for awards made in the last five years studied.
Results Women and doctors from ethnic minorities were substantially under-represented among award holders when no account was taken of potential confounding factors. Differences diminished after multivariate analysis, but some remained significant. For example, the adjusted odds ratio of women holding awards compared with men was 0.69 (95% confidence interval 0.59 to 0.82) for any award and 1.37 (0.86 to 2.20) for Aplus awards; the odds ratio for any award for non-white doctors trained abroad compared with white doctors trained in the United Kingdom was 0.45 (0.37 to 0.56). In the last five years studied the adjusted ratio of women to men was 0.94 (0.79 to 1.10) for B awards and 1.54 (0.85 to 2.83) for Aplus awards. The adjusted ratio for non-white British trained consultants was 0.86 (0.62 to 1.17) for B awards and 1.20 (0.37 to 3.87) for Aplus awards; for non-white consultants trained abroad it was 0.68 (0.54 to 0.85) for B awards and 0.69 (0.15 to 3.10) for Aplus awards; and for white consultants trained abroad it was 0.70 (0.54 to 0.91) for B awards and 0.90 (0.38 to 2.15) for Aplus awards.
Conclusion Historical under-representation in award holding by women and doctors from ethnic minorities was partly explained by time spent as a consultant. Recent awards showed no under-representation of women and no appreciable under-representation of ethnic minorities overall. However, doctors who trained abroad—both white and non-white—remained under-represented for B awards.
BACKGROUND: In recent years there have been difficulties with recruitment in the United Kingdom (UK) to principalships in general practice. AIM: To compare recruitment trends in cohorts defined by year of qualification and to report attitudes of young doctors about the attractiveness of a career in general practice. DESIGN OF STUDY: Cohort studies. SETTING: UK medical qualifiers in the years 1974, 1977, 1983, 1988, 1993, and 1996. METHOD: Postal questionnaire surveys conductedfrom 1975 to 1999. RESULTS: Five years after qualification, 23.8% of 1993 qualifiers were in UK general practice, compared with 25.9% and 32.8% of 1988 and 1983 qualifiers respectively. Six per cent of responders in the 1993 cohort were general practitioner (GP) principals, compared with 10% of the 1988 cohort and 20% of the 1983 cohort. Ten years after qualification, 37.7% of 1988 qualifiers and 42.7% of 1983 qualifiers were in UK general practice. Older GPs had lower job satisfaction than their contemporaries in hospital practice, while younger GPs were more satisfied than younger hospital doctors with the time available for leisure. Although young doctors are less inclined to enter general practice nowadays, over haf of the 1996 qualifiers, when surveyed in 1999, actually regarded general practice as a more attractive career than hospital practice. CONCLUSION: Patterns of entry into and commitment to UK general practice are changing. Fewer young doctors are choosing and entering general practice and early commitment to full-time principalships is falling. The 1996 cohort, however, took an encouragingly positive view of the attractiveness of careers in general practice.