Doctors' Careers: Aims and Experiences of Medical Graduates

358 Pages·1991·2.66 MB·English

by  James Parkhouse

Doctors’ careers
The training, employment and career movement of doctors is of
fundamental concern to all those working in and administrating the
National Health Service and private medicine within Britain and
around the world.
Doctors’ Careers makes available to a wide readership, in one
volume, the results of a comprehensive survey of medical choices and
career progress of doctors qualifying from British medical schools
during a decade, from 1974 to 1983. No other survey of this kind has
been carried out over a prolonged period of time. This is a unique record
of the aspirations, feelings and experiences of a very large group of
doctors, during a time of considerable changes in emigration, training
for general practice and the position of women doctors. The book deals
with these issues, and also the reasons for choosing and changing careers
within medicine, postgraduate qualifications, internal migration of
doctors within the UK, aspects of some important individual
specialties—medicine, surgery, psychiatry and anaesthetics—and the
personal opinions of doctors about their training and the career
problems of British medicine. The data have important implications for
medical staff planning, and this is taken up in an analysis of the
employment status of doctors five years after leaving medical school.
Doctors’ Careers will interest doctors, educationalists, health
service planners and social scientists in the United Kingdom, and in
many other countries where similar problems and experiences are
encountered.
James Parkhouse has a broad background for this study, having
trained and practised as an anaesthetist, in England, the USA and
Canada; been responsible for postgraduate teaching and organising of
training, as Professor of Anaesthetics in Winnipeg and Manchester;
been directly concerned with medical education in general as
Postgraduate Dean in Sheffield, and later in Newcastle; and having
been involved in many committees and discussions on medical staff
planning. He has lately been Director of the Medical Careers Research
Group in Oxford.

Doctors’ careers
Aims and experiences
of medical graduates
James Parkhouse
London and New York
First published in 1991
by Routledge
11 New Fetter Lane, London EC4P 4EE

This edition published in the Taylor & Francis e-Library, 2003.

Simultaneously published in the USA and Canada
by Routledge
a division of Routledge, Chapman and Hall Inc.
29 West 35th Street, New York, NY 10001

© 1991 James Parkhouse

Wordprocessed by Amy Boyle Word Processing Services
All rights reserved. No part of this book may be reprinted or
reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter
invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in
writing from the publishers.

British Library Cataloguing in Publication Data
Parkhouse, James
Doctors’ careers.
1. Great Britain. Doctors
I. Title
610.69520941

Library of Congress Cataloging in Publication Data
Parkhouse, James
Doctors’ careers: aims and experiences of medical
graduates/James Parkhouse.
p. cm.
Includes bibliographical references.
1. Physicians—Great Britain. 2. Medical colleges—Great Britain-Alumni.
3. Medicine—Vocational guidance—Great Britain.
I. Title.
[DNLM: 1. Career Choice. 2. Career Mobility. 3. Education, Medical.
4. Specialties, Medical. W 21 P246d]
R690.P29 1991
610.69’52’0941–dc20
DNLM/DLC
for Library of Congress 90–8366
CIP

ISBN 0-203-11512-0 Master e-book ISBN

ISBN 0-203-16322-2 (Adobe eReader Format)
ISBN 0-415-04649-1 (Print Edition)
Contents
List of figures and tables vi
Introduction and acknowledgements xv
1 The background 1
2 The study 8
3 Career choice 31
4 Career progress: intercalated degrees 70
5 Career progress: postgraduate examinations 80
6 Career progress: internal migration—
who goes where? 104
7 Career progress: international movement 119
8 Career progress: employment status
of doctors 143
9 Women doctors 166
10 Individual specialties: medicine 195
11 Individual specialties: surgery 213
12 Individual specialties: psychiatry 233
13 Individual specialties: anaesthetics 250
14 Individual specialties: general practice 273
15 Comments and opinions 283
Conclusion 313
Appendix 315
Bibliography 317
Index 324
v
Figures and tables
FIGURES
2.1 Response rates (1974 respondents) 28
2.2 Response rates (1977 respondents) 28
12.1 Career paths of 1974 qualifiers becoming
senior registrars and/or consultants
in psychiatry 243
12.2 Career paths of 1977 qualifiers becoming
senior registrars and/or consultants
in psychiatry 244
13.1 Career paths of 1974 qualifiers becoming
senior registrars and/or consultants in
anaesthetics 264
13.2 Career paths of 1977 qualifiers becoming
senior registrars and/or consultants in
anaesthetics 265
14.1 Career paths of 1974 qualifiers choosing
general practice as a career 274
14.2 Qualifiers from Scottish medical schools
in 1977 who became general practitioners
by 1984 278
TABLES
2.1 Numbers of questionnaires sent and
(uncorrected percentage response rates) 10
2.2 Non-London medical schools (1977
qualifiers) 14
2.3 London medical schools and totals
(1977 qualifiers) 16
2.4 Non-London medical schools
(1983 qualifiers) 18
vi
Figures and tables
2.5 London medical schools and totals
(1983 qualifiers) 20
3.1 First career choices: percentages of
respondents in the pre-registration year 32
3.2 Second career choices: percentages of
respondents in the pre-registration year 34
3.3 Third career choices: percentages of
respondents in the pre-registration year 36
3.4 Firmness of first choice of career in the
pre-registration year: percentages of
respondents and specialties with highest
and lowest proportions of definite choices 38
3.5 Intentions expressed at pre-registration
stage regarding practising in the UK:
percentages of respondents and specialties
with highest and lowest proportions of
‘definitely yes’ replies 40
3.6 First choices of career at the pre-
registration stage for main specialty
groups: percentages of respondents from
all years surveyed 42
3.7 First choices of career at the pre-
registration stage for medical
specialties: percentages of respondents
from all years surveyed 44
3.8 First choices of career at the pre-
registration stage for surgical
specialties: percentages of respondents
from all years surveyed 48
3.9 Changes of mainstream choice among
doctors responding to every two-year
survey (1974 qualifiers: 1,006 doctors) 52
3.10 Changes of specialty choice among doctors
responding to every two-year survey
(1974 qualifiers: 1,006 doctors) 53
3.11 Changes of mainstream choice among
doctors responding to every two-year
survey (1977 qualifiers: 1,859 doctors) 54
3.12 Changes of specialty choice among doctors
responding to every two-year survey
(1977 qualifiers: 1,859 doctors) 55
3.13 First choice of career (corrected for
ties): changes of mainstream between 1975
and 1981 (1974 qualifiers) 56
vii
Doctors’ careers
3.14 First choice of career (corrected for
ties): changes of mainstream between 1978
and 1984 (1977 qualifiers) 58
3.15 Importance of various factors in years
shown (1974 qualifiers) 60
3.16 Importance of various factors in years
shown (1977 qualifiers) 61
3.17 Male 1974 qualifiers in 1981 (1,396
doctors with valid career choices) 62
3.18 Female 1974 qualifiers in 1981 (540
doctors with valid career choices) 62
3.19 Male 1977 qualifiers in 1984 (1,657
doctors with valid career choices) 64
3.20 Female 1977 qualifiers in 1984 (856
doctors with valid career choices) 64
3.21 Importance of various factors at the
pre-registration stage (1980 and
1983 qualifiers) 67
4.1 Numbers of qualifiers showing Oxbridge
graduates and those with optional
intercalated degrees 71
4.2 Percentages of qualifiers (excluding
Oxbridge graduates) with optional
intercalated degrees, by location of medical school 71
4.3 First choices of career at pre-
registration stage (corrected for
ties) as percentages of all first
choices of career 72
4.4 Posts held by 1,680 1974 qualifiers
in 1987 and by 2,336 1977 qualifiers
in 1986 (percentage distribution
between specialties for each column
shown) 74
4.5 Posts held by 1,680 1974 qualifiers
in 1987 and by 2,336 1977 qualifiers
in 1986 (percentage distribution between
types of post for each row shown) 74
4.6 Numbers of postgraduate qualifications
per 100 respondents (1974 and 1977
qualifiers combined) 76
5.1 UK qualifications (percentages of
respondents to one or more questionnaires) 81
5.2 Other qualifications (percentages of
respondents to one or more questionnaires) 82
viii
Figures and tables
5.3 Main qualifications by sex (percentages
of respondents to one or more
questionnaires) 83
5.4 Main qualifications in hospital
specialties—medical school differences
(1974 and 1977 qualifiers combined:
percentages of respondents to one or more
questionnaires) 84
5.5 Time of passing main specialty examinations
(numbers of qualifiers: 1974 and 1977
combined) 85
5.6 MRCP: numbers of respondents working in
various specialties (1974 qualifiers in
1987 and 1977 qualifiers in 1986) 86
5.7 FRCS: numbers of respondents working in
various specialties (1974 qualifiers in
1987 and 1977 qualifiers in 1986) 90
5.8 MRCOG: numbers of respondents working in
various specialties (1974 qualifiers in
1987 and 1977 qualifiers in 1986) 92
5.9 FFARCS: numbers of respondents working in
various specialties (1974 qualifiers in
1987 and 1977 qualifiers in 1986) 94
5.10 MRC Psych: numbers of respondents working
in various specialties (1974 qualifiers
in 1987 and 1977 qualifiers in 1986) 96
5.11 FRCR: numbers of respondents working in
various specialties (1974 qualifiers in
1987 and 1977 qualifiers in 1986) 97
5.12 MRC Path: numbers of respondents working
in various specialties (1974 qualifiers
in 1987 and 1977 qualifiers in 1986) 98
6.1 Total number of moves, including abroad
(1974 respondents in 1985) 105
6.2 Number of moves over distances indicated
(1974 qualifiers in 1985: percentages) 106
6.3 Number of moves by latest career choice
(1974 qualifiers in 1985) 107
6.4 Number of moves by medical school group
(1974 qualifiers in 1985) 108
6.5 Respondents known to have held senior
registrar appointments (1974 and 1977
qualifiers) 110
6.6 Respondents known to have held consultant
appointments (1974 and 1977 qualifiers) 112
ix