A doctor needs a wife

Women are at least as capable as men at doctoring, but continue to have more demands on their time

How do we encourage more people to become doctors, specifically GPs?

This was the question posed at a recent GP workshop. We were asked what we would say to a group of medical students or NCHDS were we to try to extol the virtues of our chosen profession.

In any mixed group of medical specialists, I feel it is my duty to remind the room that GPs are, in fact, the Best Doctors. We look after more than 90 per cent of the patients in Ireland on any given day (I remember our local emergency department boasting about seeing 200 patients in 24 hours, while our six-doctor practice was seeing the same number between 8:30am and 6pm). We know our patients, we advocate for them, we sign the endless bloody forms even though they drive us nuts. We shield them, as much as we can, from the tyranny of over-investigation and under-listening that inevitably occurs in a hospital setting. We can hold clinical uncertainty like an overflowing jug of water – not always successfully, but we give it our best shot.

At the meeting, I reproduced an old adage I have been trotting out since 2016 – that job satisfaction is related to the three fundamental principles of Autonomy, Mastery, and Purpose.

I had learned about this from the business guru Daniel Pink, but it was more thoughtfully delivered to me by admirable chaps such as Graham Watt and Michael West (West had the sense to change it to Autonomy, Belonging, and Contribution² – you can’t beat a good ABC). This landed well with my workshop colleagues. We all relish the notion that as GPs, we are the captains of our own ship, we are good at our jobs, and our work benefits others.

However, my workshop-mates were a little unsure if all GPs were as enthusiastic about autonomy as they were. There was reference to the number of GPs who choose to work in salaried roles, either in corporate primary care settings or (even worse it seems) as HSE employees in public health or community medicine. There was a suggestion that young GPs are not interested in managing businesses, or opening new premises, or setting up partnerships. These doctors were called out for preferring to leave their place of employment once they had finished seeing patients, and were not willing to continue their working day into the evening, writing reports, and dealing with HR issues.

At no point during the conversation did anyone mention gender, or women, or the feminisation of general practice. Everyone is FAR too woke to end up in that mire. But it didn’t really need to be said. The significant majority of newly qualified GPs are women. This is the group that seems to want different things from their predecessors. Wouldn’t it be reasonable to have an open, honest conversation about whether one factor influences the other?

Hypothetically, why would women want to approach their working life differently from men? Women frequently assert that they are as capable of doing the job as their male counterparts, so how can they then go expecting special treatment?

Women are as capable as men at doctoring. In fact, repeated studies indicate that the patients of female doctors have better outcomes on a range of measures.³ 

Why won’t they perform the other important elements of the job with equal gusto?

The main reason is that women remain statistically more likely to have other demands on their time. In Ireland, on average, women spend 21 hours per week more than men on unpaid work.⁴ This refers to time spent caring for relatives (children, parents, or others) and domestic labour such as cleaning, laundry, meal preparation, and the like.

Twenty-one hours is quite a lot. That’s three working days for many people (two for the overworked martyrs that are doctors). You can see that it might be tricky to spend an additional couple of hours per day filling in medico-legal reports when you are attempting to fit 10 days’ work into seven.

The equitable solution is for all doctors, of any gender, to have an unpaid support person to complete these menial, but necessary background tasks, thereby freeing up the Important Professional to work harder at their Important Job. Someone who will instinctively know when the school bake sale will be happening, and when to clean the coffee machine, and where the doctor has left their stethoscope (in the car, as always).

If every doctor had a wife, then every doctor would be free to revel in their own Autonomy, Mastery, and Purpose.

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC6468027/ (‘Every doctor needs a wife: An old adage worth reexamining’)

2. https://bjgp.org/content/72/718/206

3. https://www.forbes.com/sites/roberthart/2024/04/22/patients-fare-better-with-women-doctors-study-finds/

4. https://www.ihrec.ie/downloads/Caring-and-Unpaid-Work-in-Ireland.pdf