Adam Smith Institute

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Another one of those failures of state planning

This is something that is neutral:

Women will soon form the majority of doctors, after the female workforce doubled in 20 years.

A report by the General Medical Council (GMC), which regulates doctors, found the profession was reaching “parity” between male and female.

As women have been the majority of trainee doctors for many years now therefore the profession - as the age cohorts move through the workplace - will beome majority female. As we say, this in itself is something neutral. Now that we’ve decided to be neutral about sex (or gender, to preference) in employment the outcome is neither here nor there. It just is.

Of course this is also, at heart, something glorious. By being that neutral about employment we’ve fostered the economic liberation of women. Which is indeed a glory of this modern world.

But there’s also another lesson here, the gross incompetence of state planning. Doctors’ training has been a nationalised monopoly pretty much since the start of the NHS that seven to eight decades ago. It’s not exactly the work of genius to be able to note that more female doctors means that we require more doctors.

There are, after all, those maternity leaves to cover. There’s the likelihood that some of those highly trained professionals will go on half- or part-time working while the children are young. We might mutter that there’s no logical reason why it would be women alone that do this but then a peek outside the window will show us that it does indeed tend to be mothers, not fathers, that do so.

In order to gain the same amount of doctoring going on as the profession feminises we need to have a higher headcount of doctors. Where, before, training 100 doctors (at that £250k cost per head or whatever) might gain us 90 Full Time Equivalent doctors (some will always slope off to write books, go into politics, waste their lives in other ways, that sort of thing) we might, in a feminised profession, train 100 and gain 85. Entirely made up numbers there just to show the logic.

An all seeing state, that state that takes unto itself the task of planning everything, should be able to see this. We’ve been pointing to it for a couple of decades now ourselves and if we can see it then the people who do this planning for a living obviously must have been able to do so. We mean, obviously, right?

While the total number of qualified GPs working in NHS general practice in England rose from 34,474 to 36,492, after taking working hours into account, the full time equivalent (FTE number of qualified GPs fell from 27,948 to 27,321. Factoring in population growth, the average number of GPs fell from 0.53 to 0.45 for every 1000 patients, representing a fall of 15%. Nursing numbers remained stable.

Ah. No. They didn’t.

Which is all we need to know about state planning, isn’t it? Not competent to deal with something both as plain as the nose on a face and also moving at the speed of percentage points a decade.

We’ve had state planning of land use for the same period of time and have a shortage of land that can be used. State planning of doctoring and a shortage of doctors. The Soviets - recall, Tsarist Russia exported grain, post-Soviet Russia and Ukraine export grain, Soviet Russia imported grain - had state planning of food and had a shortage of food. Venezuela had state planning of toilet paper and guess what?

There are indeed those arguments that can be had about the ethical, moral, logical attributes and desirability of state planning. But let’s not lose sight of the fact that it does not, in fact, work. Simply because the state is not good at planning.

To test this contention on the efficiency, effectiveness, of state planning try making a GP appointment. Well?

Tim Worstall