ANALYSIS :The days of the 80-hour a week GP are coming to an end and continuity of care is increasingly being challenged, writes Dr Muiris Houston, Medical Correspondent.
IN GENERAL, doctors over 45 are predominantly male and work full-time, while a majority of those under 45 are women who work part-time.
But the rapidly changing face of medicine is driven by a growth of female entrants to medical schools.
With women filling 70 per cent of GP training places in the State, it is not just the gender of your doctor that is going to change: the very structure of your local family practice is about to be challenged by a number of societal, policy and demographic factors.
Family-friendly working arrangements are one of the top priorities for a new generation of medical graduates.
Gone are the days when 80-hour working weeks were accepted as part of the job; flexibility, mobility and a life outside of medicine are the key aspirations of today's newly qualified doctors.
Even though these aspirations are vocalised by both sexes, as in other professions, the burden of childcare falls more on women doctors.
This is clearly reflected in the findings of the TCD study, which shows that 57 per cent of female GPs who have taken maternity leave work three days or less in practice, compared with 13 per cent of women family doctors who have not had children.
GP principals and partners in practice are primary-care doctors who are clinically independent and who have a say in the overall running and development of the practice they work in.
Unlike assistants and locums, these GPs are involved in managing their practices and making strategic decisions regarding patient care and the development of what is essentially a small business.
But with the imminent retirement of a large number of predominantly male, full-time GPs in the next five years, it looks as if they will be replaced with a largely female cohort of doctors whose priority will be part-time work.
Indeed some young GPs may wish to avoid the responsibility of practice management, opting instead for sessional payments for purely clinical work.
So why not increase the number of places in GP training schemes to reflect the feminisation of medicine and the part-time working wishes of the majority?
This is certainly an option, albeit one with significant additional training costs attached, but it assumes some significant changes in the provision of primary care in the community.
Family practice is built around local accessibility and continuity of care.
Part-time working threatens this model: with increasing levels of chronic illness, patients are going to need more, not less, ongoing care from the same doctor.
With the gradual disappearance of full-time male GPs and an increase in part-time female family doctors, continuity of care becomes a significant challenge.
A number of studies have shown that women doctors contribute less than men to the important developmental aspects of general practice, such as training, teaching and research.
Whether this is by choice or lack of opportunity, the effect is the same: women doctors may not be sufficiently involved to guide the future development of care in the community.
This lack of involvement could be crucial given the significant changes to primary care proposed by health administrators.
In Britain, a polyclinic model of general practice, at least partly funded by the private sector, has been proposed.
Essentially super-sized group practices, polyclinics are seen by many family doctors as the death knell for traditional general practice.
It is a seductive model, but not without dangers for patients.
The private sector will always be profit- rather than patient-driven; continuity of care as we know it will disappear; and doctors risk losing their clinical independence.
Fearing a domino effect, senior doctors are now voicing what would once have been unthinkable: is there a need for a different approach to medical recruitment in the interests of both equity and the future delivery of services?