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Rapid Responses: Rapid Responses published:
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More than words?
- jan a. coebergh (26 November 2004)
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Grass is indeed greener !
- Antony R Charles (28 November 2004)
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Adverse Effects Of Reduction in Junior Doctors Working Hours
- Muhammad Hanif Shiwani (8 December 2004)
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?Looking for happiness and better life
- Sanjay Dalmia (17 December 2004)
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jan a. coebergh, PRHO medicine Royal Victoria Infirmary Newcastle ne2
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Dear BMJ, It would be most interesting to see how UK graduates attitudes to practising medicine have changed since this study was conducted in 1999. Some anecdotal evidence: I graduated in 2004 from Newcastle Medical School and most of my friends have been encouraged to go into General Practice for lifestyle reasons, which maybe be partially due to the new GP contract which gives the opportunity to limit out-of-hours commitments. This study also does not show what the total proportion of non-UK European Union and fee-paying students from outside the European Union is. Some are expected by their government to return to their country of origin. The question "Apart from temporary visits abroad, do you intend to practise medicine in the United Kingdom for the foreseeable future?" might not capture those who would consider working in another country for a few years, which at this young age is hardly temporary. The survey was conducted at the end of the PRHO year, which is a particular period of dissillusionement and soul- searching. Perhaps a cohort study would better answer whether junior doctors actually do what they say? Dr Jan Coebergh
Competing interests: None declared |
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Antony R Charles, Asst. Professor, Pediatric Surgery St. Johns Medical College Hospital, Bangalore, India 560034
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Sir, Moss, Lambert, Goldacre et al have indeed muddied the waters here ! Healthcare in the developing world has seen an increasing migration to the west, mainly the UK and the US (1,2). Of the main reasons expounded in these studies and from countless interractions with colleagues who have left India for the UK and the US, it is the lack of proper 'working conditions' and a sense of 'better lifestyle' that drives doctors overseas. It is indeed a peculiar situation that this study has found that junior doctors in the UK consider leaving their country for an overseas country on the same grounds ! Is it a reaffirmation of the adage about 'grass being greener' as opposed to the nostalgic 'green green grass of home'? Is it not a question we doctors from the developing world need to ask ourselves again as must doctors in the developed world or has the world shrunk so much that 'where' one is doesnt matter anymore. Indeed, poaching as applied to wildlife of the flora/fauna variety raises enough hackles and is on its way out. On the other hand, poaching of health care professionals with 'victims' more than willing to acqueisce is rampant and has raised only a few eyebrows. But this study will hopefully stir up a inter-national, intra-national and an intra-personal debate. Questions, questions.... Antony Robert Charles References 1. Managing brain drain and brain waste of health workers in Nigeria. Article: Stilwell et al. 2004;82:595-600 http://www.who.int/bulletin/bulletin_board/82/stilwell1/en/print.html 2. How to Bridge the gap in human resources for health. Charles Hongoro, Barbara McPake. Lancet 2004; 364: 1451-56 Competing interests: None declared |
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Muhammad Hanif Shiwani, Consultant General Surgeon and Honorary Senior Clinical Lecturer Barnsley District General Hospital
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Editor, Philip J M et al paper [1] in their paper reported that the UK medical graduates are not happy with the working conditions in UK medicine, the reasons being excessive working hours and poor working lives. This study represents junior doctors who are UK graduates only and does not provide any views of the foreign medical graduates. Overseas doctors make up to 33% of UK SHO posts and 14 % of PRHO posts [2]. The reduction in the junior doctors working hours not only has raised concerns for the quality of the training they receive but also has created an increase growth of non-standard grade posts which particularly effects immigrant doctors. In UK, foreign medical graduates trained outside the EEA make up to 65% of the staff grades compared with 17% of consultants. [3]. The number of overseas doctors qualifying as GPs increased by 50 percent in last four years-with overseas applicants up-to three-fold . Many of these doctors are those who have changed their career due to failure to achieve desired posts or undue stress in their specialities. This creates a poor working life environment for immigrant doctors in UK. United Kingdom is a substantial net importer of doctors and NHS hospitals have become increasingly dependent on doctors qualified overseas. While department of health and the NHS are attempting to tackle adverse working conditions in order to increase the number of doctors working in the NHS in England and “improving working lives" aims to ensure that everything is done to encourage doctors, once recruited, to remain in the NHS, they must consider that improvement in the working life of foreign medical graduates is also vital. References: 1-Moss P J, Lambert T W, Goldacre M J, Pen, Lee P. Reasons for considering leaving UK medicine: questionnaire study of junior doctor’s comments BMJ 2004;329:1263-1265. 2- General Medical Council. UK Department of Health. Census 2002.GMC News 2003; 21:1. 3- Roger Dobson. Poor countries need to tackle the health brain drain. BMJ 2004; 329:419. Competing interests: None declared |
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Sanjay Dalmia, Surgical Registrar Royal Shrewsbury Hospital
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It is interesting to read your article about number of doctors intending to leave medicine or UK in future. I think medicine used to be a pleasure in the past and now has become an exercise of lifelong competition, maintaining standards,passing exams,revalidations etc. Though these procedures are good for raising standards but all these assessments are subjective and therefore inherently liable to false positives and negatives.I agree it is difficult to formulate a nonsubjective way of assessment and appraisals.Having come form India a few years back I can understand how doctors are willing to travel for professional,lifestyle and economical reasons. Number of doctors moving within UK from one hospital to another have substantially increased in recent years. In most of these cases they are moving from one area to another at same pay and same work. They are obviously looking for happiness.I go back to your online survey in 2001 where it showed that anything from 40- 70% doctors were in "unhappy" category anywhere in the world.It is clearly going to continue that people will move from country A to B, hospital X to Y,speciality Y to Z and even a career change from B to C and so on.The urge to do something more and better will continue to affect our profession and I dont know whether thats what makes it interesting, problematic or just challanging-depends on your own outlook. Competing interests: None declared |
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