Life in the slow lane: ‘Women’s work’

Dr Seema Pattni reflects on Pulse’s sexism investigation, looking at the division of work between male and female GPs and the consequences it can create

‘I am a slow GP.’

This is a statement I have heard with growing frequency in recent times. It is a statement usually made with berating tones, and one I hear overwhelmingly (but not exclusively) from female doctors. 

But what has this evaluation been based on? Perpetual late running clinics? Being the last to leave work? Or perhaps, it is performance feedback and dashboards, increasingly focussed on the speed of consulting, which have fed into this critical narrative of being ‘slow.’

This label seems especially unfair to those who manage a disproportionate case load of ‘slower work.’ By ‘slower work’ I am referring to appointments that require more sensitivity, and trauma-informed approaches, with in-depth consulting and chaperones. Typical cases under this umbrella include gynaecology, women’s health, family planning and mental health cases. And, more often than not these cases are automatically assigned to female GPs. 

According to Pulse’s sexism investigation, nine in 10 female GPs say that certain types of work are disproportionately diverted their way because of their gender. Wider studies substantiate and strongly support these findings. I can certainly relate to this from my own experience, that of my colleagues and the female GPs that I speak to in my role as a career coach. 

Diverting ‘women’s work’

The diversion of ‘slow work’ to female GPs is frequently done without asking patients about their preference. Obviously, it is important that patient preference to see a female GP is respected. However, on asking, I have repeatedly found that some patients prioritise timing and immediacy of an appointment rather than clinician gender. Studies extensively show that patient preference is largely based on the expertise of the doctor.

Interestingly, a systematic review in 2021 reported that half of obstetrics and gynaecology patients had no preference for a same-gender doctor; but for those who did, it was only a strong preference in 20%-25% of patients. Another study showed that 59% of female patients having a breast examination had no gender preference when choosing their doctor. Differences were observed depending on patient ethnicity and cultural background. The main reason cited for preferring a female doctor was due to communication style. 

So, aside from patient preference, I am curious as to why this diversion of work towards female GPs takes place. Is it founded on an assumption that female doctors are better at it? Or maybe, there is an assumption that female doctors enjoy this type of work? Perhaps, it is assumed to be ‘women’s work’? These assumptions are often incorrect. 

One-way traffic

However, I have observed no mirroring of this work diversion – I don’t see men’s health cases being redirected towards male GPs. This is intriguing considering what some of the research shows. A primary care study showed that preference for a same-gender doctor was more pronounced in male patients. Further surveys revealed that 42-52% of male patients indicated same-gender doctor preference for urological issues, particularly for genital examinations.

The pile-up

Regardless of the reasons behind the allocation of ‘women’s work’, there is a pile-up of negative consequences experienced by those assigned the work: appointment overrun; clinic overrun; the feeling of being ‘dumped on’. This leads to stress, frustration and ultimately a sense of reduced autonomy and job dissatisfaction. 

Feelings of not being in control, not being heard and lack of autonomy extends beyond work allocation. It is something that I hear from many female doctors, especially those with protected characteristics, when they reflect on practice meetings, clinical discussions, MDTs, contract issues, salary and non-clinical work (audits, teaching and QOF). 

The result of working longer and uncompensated hours is gruelling for us all. For female doctors it exacerbates the gender pay gap, which is higher in general practice, than other medical specialties. 

All these factors contribute to burnout, which several studies confirm is notably higher in female doctors.

Roadworks ahead?

Given the complexities behind being a ‘slow GP’, perhaps the label needs to be reframed. There is no easy solution, without limitations or complications, but there needs to be an urgent call to action to genuinely even things out. 

Opening the conversation can be challenging but it is important, especially in the context of retention problems and issues around deskilling. Reviewing and auditing work allocation within practices is one step towards addressing imbalances. Even if certain types of work were allocated purely on patient preference alone, depending on the ratio of male to female GPs, this could still lead to heavier distribution of more complex work in one direction. 

Acknowledging all types of work which take longer, or which are more complex, and reflecting this in appointment times might be difficult but it is possible, and certainly sensible. Correctly compensating the burden of work in salary, is this really such a radical notion? 

There is a strong evidence-base to support a call for action. A comprehensive review of 71 studies, across 26 countries spanning 43 years, demonstrated that female doctors have higher workloads and that they face a deep professional conflict: as compassionate, empathetic practitioners in an environment that values speed. 

Such is life in the slow lane.

Dr Seema Pattni is a London-based GP and careers coach for female doctors. Click here to find out more.