- Scarlett McNally, professor
- scarlettmcnally{at}cantab.net
Follow Scarlett on Twitter @scarlettmcnally
After decades as a full time surgeon, during which I didn’t go to a dentist for a seven year stretch and forgot to MOT my car twice, I finally went part time in 2015. My mother’s dementia meant that I needed to manage solicitors, builders, carers, and other tasks as her court appointed deputy, so I dropped my working hours to a nominal 36 hours a week. Nowadays I couldn’t manage my health and other commitments without being part time, nor would I manage the intensity of the work expected. Yet the NHS’s organisation of its workforce and culture needs to change, as it encourages other NHS staff and the mainstream press to be scathing about part timers.1
The current system still seems set up around a bygone era when most doctors were men, with a partner managing home life. Now over half of graduating doctors are women. But society hasn’t adapted, and women still end up shouldering a disproportionate number of caring and home duties.
Most foundation doctors want to train and work 80% of full time hours.2 This isn’t a slippery slope, as certain sections of the media have warned. Foundation doctors want one day a week for life administration, parenting, other activities, and wellbeing. The NHS should accommodate and celebrate this or risk losing more of its workforce. In some specialties 15% of doctors in postgraduate training resign because the workload is impossibly intense.3 In medicine the phrase “less than full time” disguises the current reality that doctors working “part time” may still do many more hours than other professions’ full time hours.
I’m a far better doctor as a part timer, and I’m ruthlessly efficient. I still see the same number of complex patients, by giving information to patients so that pathways of care are clear and by empowering the multidisciplinary team to make decisions without me. I couldn’t manage more shifts at their current intensity. To manage part time working I also spend a few hours of my free time each week preparing every operating list and clinic. But this underlines the fact that the system needs to improve.
Flexibility helps retention
A General Medical Council report in 2019 showed that doctors need autonomy, belonging, and competence for their work-life balance.4 This sounds good, but it’s just lip service unless we acknowledge that the workload expected of doctors at all grades is highly demanding and often impossible. Sleep deprivation, including from overwork and lengthy commuting, is linked to an increased risk of developing illnesses including dementia5 and relationship difficulties.6 It’s also a risk factor linked to suicide,7 which is already as much as four times greater in women doctors than in the general population.8 Fatigue, similarly, can have detrimental effects on safety, health, and performance.9
We need to change the culture, workload, and practicalities around work. Firstly, we need to acknowledge that flexible working helps retention, and we should signpost good practice around part time work, such as the Academy of Medical Royal Colleges’ guide to what it now terms “flexible working.”10
Secondly, we must reduce the relentless workload for all doctors by increasing the number of administrative staff, doctors’ assistants, and IT systems that allow doctors to focus on doctoring—and to get their breaks and leave work on time.
Thirdly, we need additional postgraduate training slots for doctors. Rota gaps are caused because the historical headcounts of training posts haven’t kept up with the numbers of staff who are out on programme placements, working flexibly, or on parental leave.11 Chronic understaffing and the associated pressures can make other staff resentful of those working fewer hours. Training slots could be increased rapidly.
Finally, the system needs to value doctors so that organisations keep them doing the job they trained for rather than being dependent on locums. I hear my consultant colleagues fighting to restore benefits for future generations to allow them to continue to deliver excellent care and remain in the NHS. Let’s value all staff members for the time they’re with us, including part timers.
Footnotes
-
Competing interests: Scarlett McNally is a part time consultant orthopaedic surgeon and president of the Medical Women’s Federation.
-
Provenance and peer review: Commissioned, not externally peer reviewed.