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BMA cohort study of 1995 medical graduates : Eighth report

May 2003

Key findings

• Seven years after graduation from medical school a greater proportion of cohort doctors are becoming dissatisfied with practising medicine. Only two-thirds of the cohort indicate a strong or very strong desire to practise medicine and male doctors are more likely to feel positively about practising medicine than females.
• A shift in preferred career options of cohort doctors since graduation is apparent. Nineteen per cent of doctors said that their choice of career had changed due to experiences in the last year. Such experiences include hours of work, working conditions and domestic circumstances.
• Competition for national training numbers (NTN) continues to be a central concern for junior doctors, with 15 per cent of doctors reporting problems obtaining a NTN in order to complete their training. Many doctors are undertaking postgraduate degrees and research fellowships in order to improve their chances of securing a NTN.
• Part-time and flexible working is important to many cohort doctors, with a fifth currently working less than full-time, but a further 50 per cent wanting to do so in the future. Whilst those doctors who currently work less than full-time are predominantly female, 40 per cent of male doctors would like to do so at some time in the future.
• Whilst 30% of the cohort spent some or all of the year working as general practitioners, less than a third of GP doctors working as full-time principles and a further third were working as locums. The most common reason given for working as a locum was ‘flexibility’

Background
The BMA cohort study is a 10-year longitudinal study of 545 doctors who graduated from UK medical schools in 1995. The study aims to provide information on the careers of doctors, and particularly to:

• identify doctors who leave medicine as a career, or who choose to work in another country, to assess the magnitude of this loss and the factors which influence it
• identify patterns of workforce participation and specialty choice of doctors who remain in the UK, and the factors which influence them
• investigate career progression, especially those factors which influence variation between doctors.

The study began in May 1995 when an invitation to participate was mailed to all final year medical students in the United Kingdom. Of the total responses received (1,400/3,500), a random stratified sample of 600 was drawn to ensure that the sample was representative of the population in terms of sex, ethnicity and medical school. The initial questionnaire was mailed in August 1995, around the time of graduation. The mailing received a response rate of 80 per cent, giving a final cohort size of 545.

The collection of data is conducted primarily through a postal questionnaire sent to the 545 participants every August. This process is designed to be both continuous and longitudinal. Information is collected on the preceding 12-month period and linked from year to year which allows for the career paths of the respondents to be tracked over time.

The most recent questionnaire was mailed in August 2002 and received a response from 90 per cent of the cohort. The average age of respondent is 32 and respondents are evenly divided by gender (49% males/51% females). Whilst the majority of respondents are of white ethnic origin, 7 per cent are of Indian ethnic origin and 2 per cent of Pakistani ethnic origin.

Workforce participation
The doctors in the study were asked how they had spent the preceding 12 months. The majority of the cohort (92%) spent at least some of the last 12 months working as doctors in the UK. Other activities included working overseas (8%), travelling (2%), and temporary breaks from the workforce for reasons such as childcare or to pursue other interests.

Seven years after graduating from medical school, six per cent of the cohort (24) have left the UK medical workforce. These doctors have either left medicine as a career altogether or are working overseas and do not intend to return to the UK. The most common reasons for leaving medicine as a career were dissatisfaction with medicine and the attractions of other careers. The main reason for emigration was to accompany spouse or to seek better working conditions.

Junior doctors’ hours of work
Since 1994 the New Deal has restricted junior doctors’ actual hours of work to 56 per week. The survey found that more than half (54 per cent) of senior house officers typically worked more than the 56-hour limit and almost a quarter worked in excess of 70 hours per week. Nevertheless, the mean number of working hours for SHOs has declined from 64 hours two years after graduation to 58 hours currently.

Whilst most junior doctors working in hospital specialties, reported that their working hours had been monitored by their trusts, only three quarters of SHOs and 64 per cent of SpRs regarded this a true reflection of their working hours.

Junior doctors’ pay
A new system for junior doctors’ pay was introduced at the end of 2000. Posts are put into bands according a number of criteria which include the intensity of work, the unsocial nature of working arrangements and the degree of compliance with the New Deal controls on hours of work and rest periods. The new contract penalises the employer financially if a post breaks New Deal limits. It was hoped that this system would help to reduce the hours of work for junior doctors and improve working conditions.

Respondents were asked to indicate their pay band and whether they had encountered difficulties in being allocated to the correct one. Almost half of all SHOs were in band 3, indicating that their post was not compliant with the New Deal. Furthermore, 28 per cent of SHOs had faced difficulties in being allocated to the correct pay band. Forty-three per cent of SpRs were in band 3 and only 13 per cent had experienced problems in being allocated to the correct pay band.

Career choice and aspirations
A shift in preferred career options of cohort doctors since graduation is apparent. More doctors are now planning to enter general practice and specialties such as radiology, anaesthetics and pathology. In contrast, a declining number of doctors are planning to specialise in general medicine and surgery. Nineteen per cent of doctors said that their choice of career had changed due to experiences in the last year. Such experiences include hours of work, working conditions and domestic circumstances.

Amongst GP doctors in the cohort, more than 40 per cent of GP registrars do not plan to enter general practice immediately upon certification. Instead, most planned to work as locums, to study further or to travel. The majority (77%) of GP registrars would be prepared to provide general medical services on a salaried service basis. Whilst only 31 per cent of GP doctors in the cohort were working as full-time principles, a further third were working as locums. The most common reason given for working as a locum was ‘flexibility’.

In the past year, 49 doctors worked as research fellows and 46 were doing a postgraduate degree. The main reason for undertaking such research positions was to improve the chance of getting an SpR post/national training number.

At some point in the past year, 14 per cent of the cohort worked in other medical employment, including locum in one of the hospital grades, non-consultant career grade or non-standard grade or other forms of medical employment.

Satisfaction with practising medicine
Respondents were asked to give their views on practising medicine and the survey shows that seven years after graduation from medical school a greater proportion of cohort doctors are becoming dissatisfied with practising medicine. Only two-thirds of the cohort indicate a strong or very strong desire to practise medicine and male doctors are more likely to feel positively about practising medicine than females.

Several key factors influence this response including:

• the general state of the NHS and increased governmental pressure to achieve targets and meet guidelines
• a desire for greater work-life balance, including more flexible working arrangements
• low morale and lack of cohesion amongst the profession generally
• increasing workload
• increasing competition for national training numbers

Key recommendations

• Improved monitoring of junior doctors’ hours and a confidential system through which junior doctors can report their working conditions in the knowledge that they will receive the support they need to improve their working conditions.
• Ensuring that doctors are instrumental in developing standards and targets for which they are asked to account and providing adequate training and support to undertake the management role which increasingly is being demanded of doctors. This preparation needs to be at junior doctor level as they progress to consultant or general practitioner principal, in order to better equip them for taking leadership and management roles.
• Improving opportunities for flexible working and creating an environment in which doctors are able to restart career paths, retrain and diversify without attracting criticism is vital to ensuring high morale and motivation amongst junior doctors.

The full report, BMA cohort study of 1995 graduates - eighth report is available free from:

Health Policy and Economic Research Unit
British Medical Association
BMA House
Tavistock Square
London WC1H 9JP
Tel: 0207 383 6604

Email: info.hperu@bma.org.uk