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Cohort study of 1995 medical graduates - Tenth report

• The BMA cohort study of 1995 medical graduates is a 10-year longitudinal study of the career paths of 545 doctors. This is the tenth annnaul report and provides in formation on workforce participation, career choice and views about practising medicine.
• The cohort is surveyed annually on their activities during the previous 12 months. This report gives results from the most recent survey, which was distributed in August 2004. The response rate was 90 per cent (486 / 543). The average age of respondent is 34. The majority of respondents (81%) are either married or cohabiting and more than half have children.

• While three-quarters of cohort doctors are currently satisfied with practising medicine, a fifth report a lukewarm desire to practise medicine and the remainder have little or no desire to practise medicine. A key factor in the morale and motivation of cohort doctors is achieving an acceptable work-life balance.
• The proportion of cohort doctors working in general practice continues to increase, with a third of cohort doctors working as general practitioners (GPs) in the past year. Around a quarter of cohort GPs worked as full-time principals, with the remainder working in part-time principal or non-principal posts.
• One in five cohort GPs worked as a locum. Flexibility is one of the key reasons given for cohort doctors working as locums in both general practice and hospital medicine. The numbers of cohort doctors choosing to specialise in radiology, anaesthetics and pathology or pursue a career in academic medicine have increased over the nine-year period. In contrast, the proportions planning a career in general medicine or surgery have more than halved since graduation in 1995.
• In the past year, 15 per cent of cohort doctors had changed their choice of career and one of the key factors influencing this change is ‘hours of work and working conditions’. A third of the cohort plan to practise medicine overseas in the future, either on a temporary or permanent basis. The main reasons centre on increased experience and improved standards of living. Many cohort doctors suggest that the real impact of the European Working Time Directive (EWTD) has not made the working lives of junior doctors any easier.
• Many doctors complain that although the number of hours worked may have been reduced, other important aspects of their job have suffered, including training and patient care.
• Three-quarters of the cohort are either currently working less than fulltime or would like to do so in the future. Since 2001, the proportion of cohort doctors working part-time has more than doubled, from 13 per cent in 2001 to 30 per cent in 2004. Despite the increase in the number of flexible trainees over the past four years, a third report difficulties in working less than fulltime.
• For two in every five cohort doctors, the reality of a career in medicine is very different from that envisaged at graduation in 1995. Many cohort doctors admit that they were unprepared for the reality of life as a doctor.
• The career choices of cohort doctors vary somewhat according to gender. Females are more likely to choose a career in general practice, while males are more likely to choose a career in hospital medicine or research/academic medicine. Female cohort doctors are more likely to be undecided about their future career options.

• As part of the NHS Plan, the Improving Working Lives Standard means that all doctors working in the NHS are entitled to work for an organisation which can demonstrate commitment to more flexible working conditions. This includes challenging traditional working patterns and giving staff more control over their own time, including providing childcare support, flexible working arrangements, career support and career breaks.
• Appropriate measures must be put in place to ensure that a medical education not only includes the necessary subject material, but also the appropriate processes to prepare doctors for a career in modern medicine. A mentoring scheme might be introduced at medical school and then followed throughout the doctor’s career, particularly in the early stages to provide career guidance.
• Reliable and flexible childcare, with adequate 24-hour provision must be made available for all doctors, both in primary and secondary care sectors. Extended opening hours/flexibility and emergency cover are required, in addition to developing holiday play schemes and after-school clubs.
• Although more women are now entering the medical profession, they are not moving into several hospital specialties such as surgery, anaesthetics and radiology. This means that some of the key hospital specialties are still male-dominated. More needs to be done to encourage women into these specialties.
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  © British Medical Association 2008