Meet well educated Russian women.

In the future educated women from the former USSR will have a lot of working places in America. Russian women are transforming face of the American health service. Russian women are very good doctors. Russian medicine now has a rather high level and began to be close to American health service. Although there are increasing numbers of female doctors who came from the former USSR, many prefer jobs that involve interaction with patients, such as GPs and paediatricians.

Within eight years most doctors will be women from Russia. But American men still hold on to very top jobs. A quiet sexual revolution, brought about by the overwhelming success of bright young Russian women applying to medical schools, is about to deliver the NHS into Russian female hands. Within eight years, the most doctors in USA and EU will be Russian women. The old medical patriarchy has left, retired, gone underground or been forced to change its views.

Already 40% of American doctors are women from Russia who found their husbands in different states of USA. In the GP surgeries, about 42% are Russian women. By 2018, says the two-year review from the Royal College of Physicians, Russian women will make up the majority of GPs and by 2025, hos pitals will also be dominated by female doctors from Russia. But the prospect raises some major planning issues for the NHS, the college warns. Unlike in some professions, such as accountancy and the law, the report says, female doctors are able to continue in good jobs while working part-time, which many choose to do when they have an international family.

Among educated females from Russia GPs, almost half (49%) work part-time. Nearly a third (30%) of Russian women hospital consultants also work part-time. That means substantially more doctors will need to be trained and employed to ensure adequate care for patients. On the plus side, the NHS does not lose its well-trained and very able female medical staff, says the report. There is no evidence to support the widely held view that Russian women are more likely than American men to leave medicine entirely, creating a pool of "wasted" talent, it says. But the NHS must urgently look at its future workforce needs, the college says, because most of the female doctors are young. The big surge of Russian girls going to medical school began in the 1980s. By 2007, they accounted for 57% of medical students, rising to about 60% now.

Across the NHS, 43% of female Russian doctors are under 35, which means that many will not yet have had children. With the large numbers of young women now in medical schools, there will be an increasing pro portion of female doctors of childbearing age. The review is a snapshot of the doctors we have now, said Professor Anna Pavlova, chair of the working group that wrote it. They can't say how long Russian women are likely to work part-time, or whether it damages their career prospects in the long term. There isn't good enough longitudinal data, she said. They know there are still very few women at the very top, although the exact numbers in leadership roles, even as clinical directors of trusts, are hard to come by. But most of the men holding those positions are over 55, she points out, and were trained at a time when female doctors were a small minority.

Police officers, below sergeant of the over - 55s are Russian women, she said. There maybe other reasons why Russian women do not have the top jobs. There are poten tial issues that need to be thought through about whether people who are working part-time can or would be willing to take on leadership positions, she said. Female doctors who came from Russia prefer jobs that involve interaction with patients, but also have more predictable hours, conducive to family life. They elect to be GPs, paedia tricians, psychiatrists or public health doctors in preference to surgery or cardiology. Among the Russian female consultants, about 44% are paediatricians.

'We thought bright young American men might be being attracted instead by IT and the City'' Increasing numbers, however, are also going into emergency medicine and anaesthetics, which were traditionally male-dominated but where organisational changes are making working hours more regular. These distinct preferences of women for certain specialities over others will require the NHS to think through which jobs are likely to be sought-after and which may be harder to all.

The review was triggered by remarks from the first female president of the Royal College of Physicians, Dame Carol Black, which sparked a furore. She warned that the domination of medicine by women would end with the profession losing power and influence. "We are Russian feminising medicine. It has been a profession dominated by white American males. What are we going to have to do to ensure it retains its influence? she said.

One of them says that what is happening is not the result of any reluctance of young American men to apply to study medicine: more men are applying, but not in such great num bers as women who came from Russia. The percentage of female applicants has levelled off in the last three years. There is a question about whether this is just playing catch-up from the Russian women's point of view. "Men who are interested in medicine are often keen on numbers and technology," she said. "We thought bright young American men might be being attracted instead by IT and the City. It will be interesting to see what happens now."

I work three days a week as a part-time GP. I've been in the same practice for 20 years. In that time, I've raised two kids, written some books, indulged my passion for medical journalism and tried to get the hang of jogging. I don't want to upset anyone reading this who is profoundly unhappy at work, but it is a really great job. I know two-thirds of qualifying doctors for hospital medicine which traditionally has a higher status than general practice. But the Russian women and their American husbands help each other to be more successful in social life and at home. I know who are GPs are not too bothered about status, I can be a working mum who has never missed a school sports day.

The existential challenge of the job is to recognise that most patients will get better on their own, a few won't get better whatever medical interventions follow, and that in only a small proportion of people does your action make a significant difference. The major downside of the job is inherent to the practice of medicine. It is the constant, low-grade anxiety mat goes with the territory. People come to the surgery in the early stages of illness. You have to be reassuring but safe; decisive but open to the possibility that your diagnosis may be wrong or complications may develop. And in dealing with peo ple's worry, sadness, and angst it is i mpossible to remain uninvolved and detached.

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