Peter Littlejohns, Carol Dumelow and Sian Griffiths
The NHS Executive expects purchasers and providers to base their agreed patterns of care on evidence of clinical effectiveness. If this approach is to be successful it is…
Abstract
The NHS Executive expects purchasers and providers to base their agreed patterns of care on evidence of clinical effectiveness. If this approach is to be successful it is necessary to reconcile conflicting published information about effectiveness and local professional opinion. In this study we have identified the type of interactions that occur when purchasers and providers were brought together to discuss how this policy could be implemented locally. Three geographically‐based multidisciplinary workshops were structured around three case studies: coronary artery disease, diabetes, and the management of clinical depression in general practice. The proceedings were transcribed and analysed using content analysis methods. Structured observation techniques were used to examine the interaction between providers and purchasers in the three groups that discussed coronary artery disease. While the overall pattern of interactions between purchasers and providers was similar among the workshops, there were significant differences within them. In two of the workshops providers dominated the discussions on clinical effectiveness, which may affect the purchaser's ability to implement a policy of clinical effectiveness. If a local policy of clinical effectiveness is to be successful there is a need to strengthen purchasers' ability to match the provider's knowledge and enthusiasm.
Carol Dumelow and Sian Griffiths
A survey of 890 appointment committee members undertaken in SouthThames (West) Regional Health Authority showed that women doctors areless likely to apply for posts in hospital…
Abstract
A survey of 890 appointment committee members undertaken in South Thames (West) Regional Health Authority showed that women doctors are less likely to apply for posts in hospital medicine, although if they do apply they stand a better chance of getting appointed. Male respondents perceived role conflict in combining professional and family demands, child‐care arrangements and career breaks to be the main barriers facing female hospital doctors. In contrast female doctors considered organizational culture, career structure and working practices to be the main barriers. Candidates, particularly female candidates, are still being asked questions about their plans to have a family and ability to combine family and professional demands. There is a need to ensure the culture, attitudes and organizational practices within the medical profession are changed if there is to be equity of opportunity and effective use of resources in the future.
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Discusses Goal 3 of Opportunity 2000 and questions its feasibilitywithin the framework of contemporary society and its healthorganizations. The possibility of increasing the…
Abstract
Discusses Goal 3 of Opportunity 2000 and questions its feasibility within the framework of contemporary society and its health organizations. The possibility of increasing the number of women consultants from 15.5 per cent in 1991 to 20 per cent in 2000 requires substantial changes in selection and training and the commitment of employers to provide a much more flexible working environment. Describes a workshop held by the Regional Health Authority to explore possibilities in the region for achieving Goal 3. Specific issues raised were the differential rates in specific specialties. Surgery is a particular case in point. It may well be that this particular region does not achieve Goal 3, but the question is also raised of its feasibility and/or desirability. The goal may need to be redefined, if it is to be achieved sensibly.
The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the…
Abstract
Purpose
The paper aims to explore the increasing feminisation of the medical profession and career progression of women in the medical profession. Furthermore, the paper explores the implications of gender segregation in the medical profession for health service provision.
Design/methodology/approach
The paper presents an overview of studies in this area and draws upon primary, empirical research with medical practitioners and medical students. However, unlike most other studies the sample includes male and female participants. The research involved élite interviews and self‐completion questionnaires in order to provide perspectives of both male and female medical practitioners and medical students.
Findings
The findings are consistent with those of other studies; that gender discrimination and segregation is still prevalent in the medical profession. But there are significant differences in perceptions between the genders. Moreover, it is concluded that the gendered career structure and organisational culture of the health sector and medical profession create a role conflict between personal and professional lives. The current difficulties in reconciling this role conflict create barriers to the career progression of women in the medical profession.
Research limitations/implications
Further research in this area could include a longitudinal study of medical students and the impact of changes in the design of medical training and career structures to assess whether these changes enable female career progression in the medical profession. Further analysis is needed of gendered practices and career development in specific specialist areas, and the role of the medical profession, NHS and Royal Colleges should play in addressing gender and career progression in medicine.
Practical implications
Gender segregation (vertical and horizontal) in the medical profession will have implications for the attraction, retention and increased shortages of practitioners in hospital and surgical specialities with the resultant economic and health provision inefficiencies.
Originality/value
The paper provides a review of literature in this area, thereby providing a longitudinal perspective of gender and the medical profession. Moreover, the research sample includes both male and female medical practitioners and medical students, which provides perspectives from both genders and from those who have experience within the medical profession and from those beginning their career in the medical profession. The research will be of value to the medical profession, the NHS and Royal Colleges of Medicine.