Moving on: Recommendations from a conversation with young doctors

Moving on: Recommendations from a conversation with young family doctors from around the world

As a growing specialty, the contribution of family medicine to global health systems is part of “the critical role of primary health care around the world …. to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health”.¹ The World Organization of Family Doctors² is a worldwide network of professional bodies representing family doctors; its ways of working include hosting conferences, convening special interest groups, and having formal regional and national networks and representation. One key component is its ‘Young Doctors Movements’ (YDMs), with input from seven different world regions. This energetic group provides an important voice of support and development to those setting out into the challenging and exciting world of family medicine!
We hope that readers will engage with the debate in their own settings and help us find solutions to some of the issues raised.


At the most recent WONCA global conference in Sydney in October 2023, the WONCA Women’s Working Party on Women and Family Medicine (WWPWFM) met with more than forty representatives of the YDMs from all world regions, to discuss common themes and possible ways to work together. This report summarises the key themes from group discussions; links them to the broader literature; and makes some recommendations for ways forward. We hope that readers will engage with the debate in their own settings and help us find solutions to some of the issues raised. These responses will help to encourage our younger colleagues and ensure their career-long productivity for our speciality.

Key themes

Broadly, these divided into challenges of the profession, and personal challenges. Within the first, participants raised issues about the status of the speciality of family medicine, expressing concerns about the skills of family doctors not being valued, and other specialities ‘looking down on’ family medicine. They also voiced worry about the speciality not having the same level of academic opportunity – for example, to do research — and a lack of visible role models and mentors. Another professional theme was the demanding nature of the speciality – the complexity of some patients; the need to interface with others in the community to deliver excellent care; and the frequent tensions between the system and its bureaucracy and costs, set against the priorities of patient-centred delivery.

Broadly, these divided into challenges of the profession, and personal challenges.

The second ‘personal’ theme involved discussions about balancing work and life; how to make effective career choices; and concerns about lack of flexible work options to allow other roles – such as caring for children, but also for other professional roles such as becoming a family medicine educator. This component raised the very relevant theme of gender, since more than 50% of family doctors in most countries are now female.³,⁴ Specifically, women more often than men need to combine being family carers with their work life;⁵ they recognize the potential disadvantage to their careers posed by this extended role commitment. The participants also noted that female family doctors, perhaps due to perceived cultural differences, are more often sought out by the emotionally needy; and may therefore face an additional level of complexity and psychological demand within their working days.

Many of these factors have been noted elsewhere in the literature and mirror the findings of a study previously carried out by members of the WWPWFM, wherein: “Participants described a complex interface between competing demands, expectations of their gender, and internalised expectations of themselves. Systemic barriers, such as lack of flexible working, excessive workload, and the cumulative impacts of unrealistic expectations impaired the ability to fully contribute in the workplace.”⁶ It may be seen as sad, though unsurprising, that these issues have not resolved over the subsequent period since 1990: but some recommendations from the Sydney discussion group suggest key ways forward.

What may help?

The 2020 study also identified the importance of people having choice over their work; and access to supportive relationships and guidance, both to absorb negative experiences and to build professional confidence over time. The study found that “External support, such as strong personal networks, and an adaptive work setting and organisation or system, maximised interviewees’ professional contributions.”⁶ The Sydney discussion strongly supported the need to access supportive networks, and individual mentors, and also encouraged women to enter roles where they could act as role models. Safe spaces for reflection, such as this meeting, were also seen as important. The other recommendations encouraged people to actively seek out different roles and options, in order both to understand the full range of opportunities over a working career, and also to find their own preferences and ‘niche’.

The Sydney participants therefore offered some recommendations for the medical care systems and the career support structures for family doctors, particularly in the early stages: (1) clearer options for alternatives to fulltime employment, available to all, both to fulfil other professional and also carer roles; and (2) structured career support and further development opportunities within practice settings, and through other networks and individual mentorship. These modifications again are mirrored in the literature,⁷ but cannot be achieved unilaterally. WONCA itself has repeatedly highlighted the need for “dedicated leadership, institutional commitment, strategic policy development, and appropriate resources” at the systems level, to support family medicine to maximise its potential.⁸ We also need to be skilful in addressing these dilemmas, which can be described as ‘wicked’ problems that cannot be solved easily⁹– leveraging for change by exploring dilemmas with others, building relationships, and finding common values. For WONCA itself, based on the views from the discussions in Sydney, we would strongly recommend that all WONCA organisations.

• continue to engage with YDM and WWPWFM agendas
• continue to call on others at national levels to recognize these issues
• address gender bias in family medicine career opportunities
• ensure that all family doctors have access to mentors, career support and guidance, and advice on working options and contracts (this is particularly important in the earlier career stages when people are still trying to find their 'niche') – and
• make sure these discussions are solution-focused and lead to positive actions.

Hopefully, by the next WONCA global conference (in 2025 in Portugal), we shall be able to share examples of good practice and see progress!

Authors
Amanda Barnard,
Lucy Candib,
Amanda Howe (corresponding author),
Hina Jawaid,
Elizabeth Reji, 
on behalf of the WONCA Working Party for Women and Family Medicine (WWPWFM).

References

1. Astana Declaration 2018. https://www.who.int/publications/i/item/WHO-HIS-SDS-2018.61 (accessed 15/1/24)
2. https://www.globalfamilydoctor.com/AboutWonca/brief.aspx (accessed 15/1/24)
3. https://geographical.co.uk/culture/countries-with-the-most-female-doctors#:~:text=Most%20of%20the%20global%20healthcare,the%20majority%20of%20medical%20doctors. (accessed 15/1/24)
4. https://www.oecd.org/gender/data/the-proportion-of-female-doctors-has-increased-in-all-oecd-countries-over-the-past-two-decades.htm (accessed 15/1/24)
5. Department Health and Social Care. Mend the gap: independent review into gender pay gaps in medicine in England. DHSC 2020.
6. Shiner A, Watson J, Doohan N, Howe A. Learning or leaving? An international qualitative study of factors affecting the resilience of female family doctors. BJGP Open 2020; 4 (1): bjgpopen20X101017
7. Jefferson L, Holmes M. The GP workforce crisis: what can we do now? British Journal of General Practice 2022; 72 (718): 206- 207.   DOI: https://doi.org/10.3399/bjgp22X719225.
8. Kidd M ed. The Contribution of Family Medicine to Improving Health Systems: A guidebook from the World Organization of Family Doctors, 2nd. Edition 2013. Radcliffe Health; England.
9. Mennin, S. Ten Global Challenges in Medical Education: Wicked Issues and Options for Action. Med.Sci.Educ. 31 (Suppl 1), 17–20 (2021). https://doi.org/10.1007/s40670-021-01404-w