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EDITOR'S CHOICE: Fiona Godlee Training our doctors BMJ 2007; 335: 0 [Full text]

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Training opportunities for overseas doctors

Abdul Mohammed   (24 September 2007)

Dis-empowering Doctors

Bilal A T Bhatti   (25 September 2007)

Training and careers of French doctors

herve Maisonneuve, Yves Matillon   (5 October 2007)

Training opportunities for overseas doctors 24 September 2007
Abdul Mohammed, Clinical fellow in Medicine Bridlington & District Hospital, Bridlington YO16 4QP Send response to journal: Re: Training opportunities for overseas doctors	I do not agree with Prof Winyard's explanation. If the government knew that there would be many UK graduates by now, why wasn't the influx of overseas doctors stopped long time ago. NHS has used the services of overseas doctors when needed and now all these doctors are struggling to find a job. No body realises how much we have contributed to the NHS services so far. General Medical Council has been conducting PLAB exam for overseas doctors for years but infact should have stopped this long time ago as it was obvious that there would be job crisis. Competing interests: None declared
Dis-empowering Doctors 25 September 2007
Bilal A T Bhatti, 5th Year Medical Student Derriford Hospital, Plymouth, PL6 8DH Send response to journal: Re: Dis-empowering Doctors	Dear Sir, I read your article with great interest. With the current reforms brought about by MMC and the European Time Directive (ETD), it seems as though Medicine the UK has changed for the worse. Looking at the profession broadly, can we really say that being a doctor now means the same as it did even 5 years ago? Personally, I think that doctors in the UK have lost their voice and with this, they are losing the respect that they have had for centuries. Take the example of the new Specialist Reistrars, or "Trainees". After spending 5 years and graduating from Medical School it is pitiful that we are demoting our Senior staff (with at least 5 years experience) to the position of trainees! Given the choice, would you have a trainee or a Registrar perform your anterior resection? Hearing the dissaproval from Senior and Junior staff regarding MMC, I am perplexed as to why these concerns were not raised earlier in a united voice? Being the optomist I am, I think that it is still not too late for doctors throughout the country to make their voices heard. However, in order to do this, we must make a stand as one body. It is true what they say, "united we stand; divided we fall" and we are falling. Regards, Competing interests: None declared
Training and careers of French doctors 5 October 2007
herve Maisonneuve, GAME president and CME manager Pfizer, 75014 Paris, Yves Matillon Send response to journal: Re: Training and careers of French doctors	Editor, Your editorial quoting articles in the BMJ issue of 22 September 2007 exposed uncertainties and raised questions regarding the training and the careers of UK doctors.1 This situation is not unique to the UK. Other European countries, and particularly France, are struggling with a shortage of junior doctors (more acute in certain specialties) and an uneven distribution of doctors across the country leading to potential issues regarding the immigration of doctors to fill the gaps.2 In the UK, there are published data cited by Ed Borman3 indicating that 36% of doctors registered to practise in the NHS qualified abroad. There are also unpublished data showing that almost half of the MTAS (Medical Training Applications Service) applicants were trained overseas (table 2 on page 594).4 The French system does not currently have sufficient data to drive decisions, and when available, as in the UK, data must be interpreted with caution. In a move to have more data available on the demography of French health care professionals, the ‘Observatoire National de la Démographie des Professions de Santé’, (www.sante.gouv.fr/ondps/) was set up 5 years ago. It’s too early to draw conclusions on its utility. The UK is not the only country that urgently needs coherence of policies on immigration and medical training to avoid further difficulties in the future. In France, we have 4 issues: Medical student quotas based purely on short term economic constraints, unequal distribution of doctors throughout the country, lack of selection process for doctors qualified outside France, inadequate evaluation of all doctors throughout their career. The number of students in medical schools and the number of graduate doctors seem to be set on short term economic constraints. Medical schools admitted 8000 students in 1975, 6000 in 1980, 4000 in 1990, 3500 in 2000 and it was urgently decided to train 7100 students in 2007. Once, they pass this selection, medical students are reasonably assured to graduate 10 years later. Thus we are still following short term reasoning, without considering other factors such as the feminisation of the workforce, the decrease in working hours, the increasing gap between graduating and beginning professional activity, early retirement, the quest for a better quality of life, the place of other health care professionals (specifically nurses), and the migration of doctors around the world. The distribution of doctors across France is also a subject of debate as there are discrepancies between regions, with more doctors per capita in the South than in the North. Many villages in the countryside have no doctors, and too many specialists are competing in large cities.. Managing the balance between incentives and disincentives for doctors (and other health care professionals) to set up practice in order to ensure access to care is a subject of continued political debate. At the end of September 2007, the new government proposed to regulate the distribution of regional doctors by requiring authorisation to open a new surgery In October 2007, medical students and residents are going on ‘strike’ (a French way to signify opposition to government) to fight this proposal.. The current shortage of French doctors was described 15 years ago by the Conseil National de l’Ordre des Médecins (French medical association), and other academic bodies. French community doctors do not work in hospitals, and vacant positions are filled by poorly-paid foreign doctors. In 2007, there are thousands of doctors who qualified abroad and are employed in hospitals without having passed any serious selection process. Having learned medicine in a different cultural context and knowing the basics of the French language are not sufficient when we recognize the importance of communication skills, professionalism and cooperation between professions. Basically, we need to assess competencies of all doctors throughout their career, irrespective of the country where they qualified. The public in all countries seek to receive the best care from health care professionals. As in many countries, in France, this reflection on competency assessment started in 2002,5 after the Bristol affair. The French colleges of medical specialties should propose an evaluation process for assessing doctors during their career. Foreign and French doctors should be subject to the same process if they wish to work in France. The next step will be the implementation of the process, and decision-makers should be sufficiently informed to make the right decisions. Communication between decision-makers and the profession is key at country and at the European level. Five groups have their specific responsibilities: trainee doctors, professional organizations (colleges), employers, government and patients. We should all share information (although insufficient, there is discussion at the European community level), produce accurate data and promote research to better regulate the medical professions. We should allocate funds to organise conferences and observe the immigration of doctors. This should avoid making short-term opinion-based decisions, and allow for long-term decisions to be taken based on research data. Hervé Maisonneuve, MD President of Global Alliance for Medical Education, www.game-cme.org and Continuing Medical Education Director, Pfizer, Paris, France. Yves Matillon, MD Professor of Clinical Epidemiology, Claude Bernard University, Lyon and Head of the health professions competencies evaluation task force, Health ministry, Paris, France. No conflict of interest. We thank Chloe Brown for editing this paper References 1 Godlee F. Training our doctors. BMJ 2007;335: doi:10.1136/bmj.39343.610613.47 2 Le Breton-Lerouvillois G, Kahn-Bensaude I. L’atlas de la démographie médicale en France (généralités). Situation au 1er janvier 2007. Conseil national de l’ordre des médecins, Paris. Juin 2007, étude n°40. www.conseil-national.medecin.fr 3 Borman Ed. Should postgraduate training places be reserved for UK graduates? No. BMJ 2007;335:591. 4 Winyard G. Medical immigration: the elephant in the room. BMJ 2007;335:593-595. Competing interests: None declared