Rapid Responses to:

LETTERS: Malcolm Molyneux UK doctors are already put off by changes in training BMJ 2007; 334: 709-b-710-b [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Old UK training system prevented physicians working abroad

Hamish SF Fraser   (5 April 2007)

The wider fall-out of MMC: fewer volunteers?

Andrew C K Lee   (10 April 2007)

Look closer to home

HG DESILVA   (14 April 2007)

Old UK training system prevented physicians working abroad 5 April 2007
Hamish SF Fraser, Assistant professor of Medicine Harvard Medical School Send response to journal: Re: Old UK training system prevented physicians working abroad	I support Malcolm Molyneux's concern about the UK training system putting up barriers to trainee physicains working abroad. I now work in several developing countries, but I would have loved to have done this as an SHO or Registrar 15 years ago. I was told in no uncertain terms that such time out would count against me in future job applications. Its vital that we preserve the great progress that has been made over the last decade in allowing trainees to return to their career positions. Director of Informatics and Telemedicine, Partners In Health Competing interests: None declared
The wider fall-out of MMC: fewer volunteers? 10 April 2007
Andrew C K Lee, formerly Medical Programme Manager with MEDAIR South Asia Send response to journal: Re: The wider fall-out of MMC: fewer volunteers?	Modernising Medical Careers (MMC), as highlighted by Professor Molyneux(1) , will undoubtedly affect those junior doctors seeking to undertake research work in developing countries. However, as also intimated in the same article as well as the article the week before(2) , MMC will also serve to discourage UK doctors who had planned to volunteer themselves to a variety of positions in low and middle income countries worldwide. My concern would be the potentially adverse effect on the recruitment of UK doctors by relief and development agencies, mission hospitals and organisations, and the voluntary sector. UK volunteer doctors have for decades served with emergency relief teams in war zones and in post- disaster situations, in isolated understaffed hospitals, and as medical missionaries worldwide. Most of these organisations experience perpetual expatriate medical staff shortages, often exacerbated by the high turnover of staff. Many are also dependent on volunteer doctors to keep programmes and hospitals in the field running. In addition to the turbulence generated by working in a different country and culture under often trying circumstances, volunteers often experience difficulties on return to the United Kingdom. There are the stresses of trying to re-acclimatize to UK culture again, re-adjusting to UK hospital practices and there are also difficulties of re-entry to the NHS system where returnees often have to make do with locum work, non- training posts, or have to wait and try for several months to obtain a suitable training post. This presents a triple whammy of financial hardship, job insecurity and career uncertainty. All these obstacles were already present before MMC, and it is likely that the situation will only worsen at present. Indeed, some of our potential volunteers as well as current staff have already voiced their concerns that they may put themselves at considerable disadvantage career- wise when taking time out to work overseas. If these and future doctors are discouraged from work overseas, the NHS will lose the richness of experience, versatility and global understanding that returning volunteers bring. Providing a recognised outlet for doctors to serve elsewhere may help ease the current congestion of applicants for jobs. There is now an opportunity for a revised MMC to facilitate those UK doctors intending to work overseas as well as returnees, and to acknowledge the useful contribution that these doctors give overseas. At the end of the day, it is not how much sympathy and compassion we voice for the ill, poor and marginalized in disadvantaged communities worldwide that matters. We need to match our words with deeds. References 1.Molyneux M, Marsh K, White N, et.al.UK doctors are already put off by changes in training. BMJ 2007; 334: 709-710. (7 April) 2. Whitty CJM, Doull L, Nadjm B. Global health partnerships. BMJ 2007;334:595-6. (24 March.) Competing interests: None declared
Look closer to home 14 April 2007
HG DESILVA, GP London Send response to journal: Re: Look closer to home	With MMC potentially reducing the pool of clinicians undertaking research overseas, maybe now is the time to encourage a broader age-range of applicants. Earlier this year I clearly remember a research post at the Wellcome site in Kilifi advertising for a canditate 'ideally under 30', whilst the Wellcome Reaserch Training Fellowsips are aimed at canditates 'not normally be more than ten years from the date of their first medical, dental or veterinary qualification' http://www.wellcome.ac.uk/node2131.html What is the rational basis for these age cut-offs? It would seem that science is more ageist than pop-music! Competing interests: Recently completed DTM&H (London) and planning to work overseas again