The perennial political football - Credit, public domain

That women have the freedom to become doctors is great. But that there are female doctors is akin to the problem we’ve got with renewables. Their existence, in any large number, changes the balance of supply and demand in the system. We thus need to change the system in order to accommodate large numbers of either – although obviously enough, we change the appropriate system, not health care to deal with renewables.

This is the point that the Royal College of General Practitioners is resolutely ignoring here:

Nearly every GP surgery is missing a doctor, the Royal College of General Practitioners has warned, as the recruitment crisis reached it worst level on record.

One in six positions are now unfilled which is placing an ‘intolerable pressure’ on services, doctors groups have warned.

The annual vacancy survey of GPs by the magazine Pulse found that 15.3 per cent of positions are currently empty, up from 12.2 per cent last year and 11.7 per cent in 2016.

GPs reported that inability to recruit and funding shortages have also forced many practices to cut GP positions, relying on non-GP staff and forcing practices to close patient lists.

One in six, eh?

Now, over this past generation we’ve gone from a largely male GP population to one which is, at entry level at least, largely female. Great, super, the economic emancipation of women, wouldn’t do without it. But it does mean that we’ve got to change parts of the system. For:

The increasing number of female general
practitioners: Why we need to change medical
culture

Hmm.

Since 1992, the number of female trainees in the
Netherlands has consistently exceeded the number
of male trainees in general practice. However, not
everyone welcomes the increase of female GPs (1).
Women work part-time more often

Ahhh. So, we get fewer hours of doctoring over a lifetime from each trained to do doctoring if more of the people trained to do doctoring are female. Which all sounds entirely logical. The combination of maternity leave and the subsequent desire to work part time for a year or decade. Again, this isn’t to say that women shouldn’t become doctors. Sure, it changes that investment calculation. The State pays some £250,000 to train each doctor, we get less doctoring back from that investment the longer those breaks, the more part time working there is. But so? That’s a societal decision, whether that investment is still worth it.

But we do have to accept that this does change the system itself, in a manner that requires adjustment. We’ve fewer labour hours coming back from our investment in training because female doctors. This means we’re going to have a shortage of GP labour hours if we don’t change something in the system. This is not an unknown problem:

Two thirds of GPs under 40 are female, with part-time working popular among those raising families.

Hmm.

Today over 60 per of GPs are women, most of whom exercise their family-friendly part-time work entitlement.

Ahhh.

The soaring number of female doctors working part-time in surgeries is contributing to a crisis in GP recruitment, an official government study has revealed.

The Migration Advisory Committee said the ‘feminisation of the GP workforce’ meant more trainees were needed to maintain the same service for patients – because women are more likely to work shorter hours than men after they have children.

This has contributed to an annual shortage of 450 to 550 GPs, the committee warned.

Again, and again, this does not mean that women should not become doctors. It does though mean that we’ve got to change the system to accommodate those rising numbers and the associated part time working. And we’ve not changed the system. Thus we have this shortage of GP labour hours, don’t we?

At which point, what’s the true lesson of this story? That the idea of a government run integrated, planned, health care system is nonsense, isn’t it?

Recall what the argument in favour of the NHS actually is. That the wise man in Whitehall knows more than we do and is able to direct resources to their best use. That we should not have private sector suppliers (yes, GPs are private sector, but the training of doctors is not) with all that competition, profit and chaos, but an integrated service where the planners direct the appropriate resources to their best use.

We then have the obvious – it was predictable, it was predicted – effect of more women becoming GPs. More of our trained GPs taking career breaks, working part time, meaning fewer labour hours from our stock of expensively trained GPs. Because this was predictable – and was predicted – an integrated system run by the wise planner would have done something about it. Like, opened more training places for GPs so as to maintain the supply of labour hours even as each trained individual supplied fewer of them.

Did this happen? Did it buggery. The wise planner cannot plan labour supply.

So, the argument that the NHS is run by wise planners is proven to be false, isn’t it? At which point we can get on with designing a useful and reasonable health care system, having disposed of that myth.

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3 COMMENTS

  1. I got A levels good enough to study medicine but was told that studying chemistry would be a good idea (it was not, there are not any jobs). Why we encourage young people to study things which are not useful instead of medicine is a mystery to me.

  2. “The wise planner cannot plan labour supply.” No, the lesson is that the planner will not plan labor supply. He plans “gender equity,” race-norming, use of LGBT-friendly pronouns, etc., and is caught by surprise by labor supply.

    The measurable flow of women into medicine is matched by something less measurable: The entry of people for whom the job is not the highest priority. We can debate whether it was greed or the desire to provide best for the family but, especially when there was a wife to tend to domestic issues so that the doctor could fulfill his appointments, the culture was that your profession was your life’s work. Now it is just something you’d like to do, like having an attractive garden and marching downtown to Save The Planet.

    The doctor used to compulsively spend spare time reading journals or even taking refresher courses to stay current, as the politician with a “day off” spends it in the district nicing up to voters. The woman part-time doctor probably won’t, not if there is a crisis down at the day-care center.

    This suggests that labor shortages are the least of our worries.