A modest proposal.

About two months ago I was talking to an elder in my church. He is a General Practitioner (Family Practitioner in the UK) and runs a large practice in the poor part of Dunedin. He is worried about the structure of his practice. All his partners are women doctors and work part time. He is the only full timer, and he is approaching retirement. He is the only person who provides continuity for much of the practice.

Our GP is an academic woman doctor who we book two weeks in advance as she only works two sessions (there are ten sessions in a five day week) in her practice. She has a PhD. She is an extremely good doctor. But, for many good reasons she does not want to ever work full-time again.

This demographic transition is known. However, it cannot be corrected. There is a limit to the sizes of medical schools, and it is the number of clinical placements where students can get good experience. I am very aware that in NZ that has been maximised, to the point that the current proposal for a third medical school will seriously impede the one I graduated from.

The first sensible proposal would be to forgive student loans if graduates are prepared to work for the same number of years in the NZ health system, where they are put. If they want to move to Australia (where the pay and hours are better) they would have to pay off the loans first.

But that would be acceptable to the authorities, and it will not solve the problem outlined over ten years ago.

Feminisation of the medical workforce has been a major change over the past 20 years. The sex ratio in Australian medical schools is now 50:50, or with a slight excess of women. The flow-on effects of this change are particularly obvious in specialties like general practice, in which more than 50% of current trainees are female. Female doctors have a working life that approximates 60% that of male doctors. Significant amounts of time are consumed by family demands, and a desire to work sensible (and regular) hours on their return to the workforce. Safe working-hours policies are now established in most junior medical officer awards, and these have had a significant impact on workforce requirements in public hospitals. Further, male doctors are no longer willing to work the hours that were the norm 20 years ago, and are still worked by their senior colleagues. Together, these changes have spawned a current unmet need for medical services.

There is another way. Since, over a career, medical women work about 60% of the time that medical men do, the proportion of women in medical school should be decreased. I suggest to a third of any school's intake. By doing this, you will leverage the differentiation in behaviour between men and women to ensure that there are enough doctors.

This will mean that the intake marks will be somewhat higher for women than men for medical schools that have intakes in the first year after high school. Again, this is fair, as young women still have a differential advantage from having their transition through puberty and the associated neurocognitive changes two years earlier. From a social justice perspective, it also corrects for the feminist bias in primary and secondary education.

If there is a third medical school, in the Waikato, let it be for graduates, for parents, and let women be encouraged to have their children earlier, and go through medical school part time. This will take not the current five years, but ten: at that point the graduates will be far more mature, and be ready to serve their communities full time through their ten year bond.

There are many who would oppose this. I suggest that these people are acting against those who are poor, are not supporting good access to all for health care, and are letting their sexism and racism hurt health care provision.

Indeed, this quite modest proposal should be adopted by most medical schools in countries where sense remains, that is anywhere but Canada.