Bob Bury

“Medicine less of a self-selected elitist profession”

Today, I want to talk about fiscal drag. No, don’t stop reading. There was an article in The Times a couple of weeks ago about the higher tax-rate threshold, and how the failure to raise it was resulting in people not previously considered to be well-off moving into the 40% tax band. And that’s called fiscal drag, apparently.

Anyway, the article included the result of a survey (and don’t you wish we could stop people doing ‘surveys’?) which revealed that the great British public thought it was quite wrong that blameless individuals such as policemen, teachers and senior nurses should be financially penalised in this way. But what about doctors?, I hear you ask. Well, no surprises there. Sixty four per cent of those surveyed thought the rich bastards deserved it.

Now although I’ve made a resolution not to get angry about stuff like this, on account of the fact that it probably reduces my already rapidly diminishing life expectancy, this particular article had me seeing red for at least two reasons. First, the survey itself completely misses the point, probably deliberately in a quest for publicity, about tax thresholds.

Thresholds are just that: a level of income which triggers a particular rate of tax. As such, they are based on income and on presumed ability to pay at that rate. We can argue that taxes are too high, and that a continued failure to revise thresholds upwards skews the tax burden, but the way in which the money is earned is irrelevant. If it’s deemed to be wrong for a senior nurse earning £X per annum to have 40% of it confiscated, it’s equally wrong for a junior doctor (or plumber or accountant) earning the same amount to be similarly taxed.

So the survey was based on a faulty premise, but the results relating to medics are likely to be a reflection of the public’s perception that we are a bunch of middle-class toffs, most likely from medical families, who can well afford to pay any amount of tax. And of course, it used to be like that.

When I started medical school in 1967, the first two friends I made turned out to be grammar school boys, like me. It soon became apparent that we were very much in the minority, with almost all our fellow students coming through the public school system, and many of them with medical parents who had also trained at The Middlesex (younger readers won’t have heard of the Middlesex Hospital: it has since been razed to the ground, along with its 1960s vintage medical school, and subsumed into UCL).

And this paragraph was to have started with ‘but it’s all different now, isn’t it?’. Actually, I will still start it like that anyway, because instictively, I believe it to be true.

Medicine is less of a self-selected elitist profession now than it was almost 50 years ago, certainly if my experience of teaching medical students in Leeds towards the end of my career was representative. There isn’t the same gulf in social status between doctors and the majority of their patients, which has to be a good thing for both parties. It’s just a pity that public perception seems to be lagging so far behind the reality.

But then I did something I don’t often do when penning one of these rants, namely a bit of research. I found this from last year, a GMC report showing that a third of medical students are still drawn from private schools, and a quarter from selective state schools. Only 11.5% grew up in households receiving income support. These figures led the authors to conclude that ‘people from lower socioeconomic backgrounds are under-represented in medicine’.

So perhaps I’m wrong, and the public are right, we are still a bunch of toffs?

But hang on a minute. When I started at The Middlesex (which was far from being the most elite training centre in London – yes, Barts, I’m talking about you), I struggled to find anyone else who wasn’t a doctor’s son with a private education. Now we see that of today’s intake ‘only’ 11.5% come from households receiving benefit, and that 8.3% – almost one in ten! – received free school meals. This represents a huge change, and it could only be seen as a poor state of affairs by authors who are too young to remember how things used to be, and who probably subscribe to the philosophy which demands that the membership of every profession should mirror exactly that of society at large, and who view anything short of that as elitism.

And now we’re in danger of getting on to selective education (it’s always the same with hobby horses, you wait for ages, then three come along all at once). Because I’m not saying everything in the medical school selection process is perfect, and we probably could do more to ensure equality of opportunity, but imposing selection quotas based on social class is not the answer. I’ll let Gareth Payne speak for me: in a comment on the online version of the GMC report, he said –

‘I think the only way forward is to have grammar schools so that bright children from disadvantaged backgrounds can be pushed and encouraged to achieve their potential’.

His declared interest was that he came from a council estate in a South Wales ex-mining village. I came from a similar estate in the midlands, and I was lucky. First, I had parents who encouraged me, and secondly, Tony Crosland had yet to succeed in his avowed aim of destroying ‘every f*****g grammar school in England’ in pursuit of the socialist goal of mediocrity for all, so I had access to a great education. If I lived on that same estate today, I seriously doubt that I would have become a doctor, or even gone to university.

But it’s the parental encouragement that matters the most, so is it any surprise that two thirds of medical students surveyed by the GMC had parents who were university educated? The answer to any perceived bias is not to regret that fact, but to ensure that we up our educational standards and instill the work ethic that was second nature to my parents’ generation. It’s no good bemoaning the fact that doctors tend to be drawn from that part of the population which comes from a ‘good home’. We need to ensure that those who are not so lucky are given the means to realise their potential, and you don’t do that by insisting that they share their classrooms with contemporaries who view education as an irrelevance. They will, in their turn, provide that ‘good home’ for their own children.

Instead, we allow the development of an underclass whose low expectations are matched by outcomes.

And now I’m sounding like a Daily Mail reader. Time for a lie down. And my tablets. Mustn’t forget my tablets.

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3 Responses to ““Medicine less of a self-selected elitist profession””

  1. Mark II says:

    The gulf between private and state schools – the haves and the have nots – is a challenge which spreads well beyond medicine. Politics, the civil service, the City, etc.
    However, I’m repeatedly surprised at how few current doctors care that their children are unlikely to interact with any ‘poor kids’ (some might say ‘real kids’) before voting age and adulthood, regardless of the profession they choose.
    Familial ambition is more important than school structure. My son is doing fine at the local comp – it’s as streamed as a grammar (but importantly not on wealth) and has a healthy regard for a wider education than just targeted exam results.
    Have a read of ‘Freakanomics’ for the data relationships in educational progression; it’s about the number of books in your house, and what that says about your family.
    Widening access to university will slowly lead to a more culturally mixed medical profession, especially through the programmes for late comers to the profession; but don’t expect a significant change until families in social housing are inspired to load their shelves with books.

  2. Bob Bury says:

    it’s as streamed as a grammar (but importantly not on wealth)

    But nor were grammars, Mark, at least not the one I went to (I accept that these days the middle classes are more likely to be able to move to houses in the catchment areas of the few remaining grammars, but that wasn’t an issue when there was one in every town).

    Your books on shelves argument is spot on, and that’s what I was getting at in my third from last para. when I talked about ‘good homes’.

  3. MLW says:

    There are a number of indicators suggesting that social mobility is far more restricted now than when you were at school, Bob. So if recruitment to medical courses has become more egalitarian, then cue applause. I wonder if that’s because medicine is one of the few courses that almost guarantees an income sufficient to manage the resultant debt (assuming well-to-do Mum & Dad don’t foot the bill)? I really doubt I would have risked relying on the earning power from my physics degree recouping £30k before I needed a mortgage etc.

    One aspect of recruitment into medical school seems still to be an emphasis on hospital-related experience prior to application. I wonder how much that disadvantages kids without pushy middle-class parents who network with senior hospital staff to get work-experience opportunities for their offspring to embellish their CVs?

    BTW – during the term I was accommodated in the Middlesex Hospital Medical School residence, I was able to cycle back pissed from any part of London, due to the adjacent BT tower being an unmissable landmark. Happy days!

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