Promotion to hospital consultant: regression analysis using NHS administrative data

Objectives: To examine factors influencing promotion to hospital consultant Design: Multivariate logistic regression analysis of NHS administrative data between 1991 and 2000. Setting: Hospitals in NHS Scotland. Population: All registrars, senior registrars, and specialist registrars in Scotland. Main outcome measure: The proportion of doctors promoted to NHS consultant. Results: Compared with doctors who graduated in Scotland, graduates from the rest of the United Kingdom and from overseas were less likely to be promoted to consultant (odds ratio 0.65, 95% confidence interval 0.52 to 0.82; and 0.37, 0.28 to 0.50, respectively). Promotion and holding an honorary contract before promotion were positively associated (1.37, 1.03 to 1.83); and the number of years since graduation (5.98 per year, 4.94 to 7.23). Women were less likely to be promoted (0.73, 0.60 to 0.90), as were doctors who worked part time (0.27, 0.17 to 0.42). Probabilities of promotion did not have a clear time trend between 1993 and 2000, and NHS boards in non-metropolitan areas of Scotland were more likely to offer promotions than NHS boards in metropolitan areas, presumably reflecting a higher gap between demand and supply in these boards. Conclusion: As the proportion of women in hospital medicine increases, government targets for the recruitment of consultants are unlikely to be met unless the promotion process is examined. It is unclear whether more recent reforms of the medical career structure will deal with these issues.