Probe into why doctors drop out

March 24, 1995

The British Medical Association is drawing up plans to follow the careers of 500 medical students to discover why up to a quarter drop out of the profession three years after qualifying.

One possible explanation is the dramatic increase in the number of female medical students, who make up at least half the intake to medical schools, many of whom later leave to have children.

Since medical schools became co-educational after the Second World War, there have been rumblings about the effect of domestic commitments on women's professional contribution. This was the ostensible reason for the notorious quotas in most medical schools, which lasted until the mid-1970s, says Mary Ann Elston, senior lecturer in social policy and social science at London's Royal Holloway College.

These quotas sprang from a 1944 decision that public funding for medical schools should be dependent on their admitting a "reasonable" proportion of women. Dr Elston says that because of the pressure of female applicants, quotas served not to foster opportunities, but to keep out all but the best-qualified.

But intakes varied dramatically across the country. In the mid-1960s, some English provincial and Scottish schools admitted more than 30 per cent, while some London schools admitted less than 15 per cent, she says.

Following the Sex Discrimination Act, there has been a steady rise in female applicants, while the number of male applicants has not risen since the mid-1970s.

The rigours of a medical career, particularly at its outset, are well known. Working "part-time" often involves what passes for a normal working week in other professions, says Dr Elston.

But the high drop-out rate cannot yet be blamed on women: at present the BMA does not know the proportions of men and women leaving the profession. The recent Policy Studies Institute report by Isobel Allen on doctors and their careers found that the majority of women doctors continued to work when they had small children.

Jenny Firth-Cozens, a principal researcher in Leeds University's department of psychology, has followed a cohort of medical students since 1985, and found that the highest stress factor for women was conflict between career and family.

But, she says "it's the same for the men. Both men and women felt equal conflict". Previous research, including her own, posed questions on childcare only to women, she says. When both sexes were included the answers were surprisingly similar.

"I think there's a general move, not restricted to medicine, that men think they're having a raw deal in having to be the only ones pursuing the career. There's a move away from wanting to be the breadwinner because it's now a great responsibility."

Dr Firth-Cozens's work on stress and depression shows the medical profession suffers significantly more. But while male and female students had the same levels of depression, women doctors became more depressed than men after graduation. "Women are more self critical than men, and blame themselves or their children and families rather than blaming the career structure, which I think is seriously at fault."

Men's depression may be less severe, but their tolerance of traditional professional pressures such as long hours and on-call commitments appears to be falling. The Policy Studies Institute report says today's young doctors are less willing to accept the custom and practice of a medical careers system which they consider outmoded and punitive in the demands made on them.

Following a recent BMA News Review report on pressures felt by women GPs, a male GP warned: "General practice takes over your life. While I accept that most male GPs have supportive wives at home, they too have to sacrifice their family life. If women GPs are to be taken seriously in their desire to be equal they must accept all the pitfalls."

But the BMA's survey of medical students may find that the desire for equal opportunities is the desire that neither women nor men should have to sacrifice their family life for their career.

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