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EDITORIALS: David C Goodman Expanding the medical workforce BMJ 2007; 335: 218-219 [Full text]

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Another sort of target

Michael Schachter   (6 August 2007)

Not more doctors

M Justin S Zaman   (12 August 2007)

Another sort of target 6 August 2007
Michael Schachter, Senior lecturer in clinical pharmacology St Mary's Hospital London W2 1NY Send response to journal: Re: Another sort of target	Evidence for the US and elsewhere suggests that merely increasing the number of doctors, including specialists, does not produce better outcomes. Equally it is unsatisfactory that in fields like neurology and rheumatology we have had in this country ratios of one specialist per 100,000 people, leading to very long waiting times for non-urgent consultations and incidentally promoting private practice as a means of queue jumping. This situation has improved in recent years but the implication is that there is some optimal range of numbers we should be aiming for in terms of the medical workforce as a whole and its specialties. But does anyone know what that is?If this is not seriously considered now we will inevitably end up, as they do in Italy and Germany, with unemployed doctors, who are understandably disgruntled and who cost a great deal of public money to train. Competing interests: None declared
Not more doctors 12 August 2007
M Justin S Zaman, Research Fellow, Epidemiology and Specialist Registrar, Cardiology University College London Send response to journal: Re: Not more doctors	David Goodman's comment that 'doctors do not generally settle where healthcare needs are greater' is one reason the inverse care law still exists. It is my belief that the majority doctors do not seek to serve society, but the individual patient [mostly] and themselves. Hence, specialities that are financially lucrative or render a good lifestyle, and hospitals and health centres in 'leafy surburbs' will always attract the best, leaving 'cinderella' fields [such as elderly care and palliative care] and inner-city deprived posts struggling to recruit. I know this from bitter personal experience from the backlash I elicited from doctors when I suggested in a BMJ opinion earlier this year that 'As doctors we need to serve the community, not it exist to serve us'. [1] The majority of doctors disagreed. I do not think this means that doctors are bad people - it just simply reflects human nature. There are many examples around the world where, left to the whim of individuals to decide what they want to, adverse consequences result. The ‘brain drain’ from developing countries is one example. In India, many doctors, mostly from higher castes, train abroad for a number of years before going back to set themselves up in lucrative private practice serving their own elite castes, whilst government hospitals and local clinics remain in a state of disarray. This is not the fault of those individual doctors – who simply see an opportunity for a better life – but the system [e.g. poor government hospitals] that encourages it. The increase in renumeration and reduction in working hours in primary care in England has led to this field becoming highly competitive now, a drastic change to only 10 years ago. I thus agree with David Goodman that the answer is more than simply increasing numbers, but perhaps incentivising doctors to enter fields or areas with the greatest need is the real solution. 1. Zaman MJS, BMJ 2007;334:44 (6 January) Competing interests: None declared