Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Are governments listening to this question?
- Om Prakash (2 May 2008)
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Yes it matters
- Chris M Laing (3 May 2008)
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Jobs for medical graduates
- John G Salmon (6 May 2008)
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Missing the big picture?
- Sudeep Chand (6 May 2008)
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Future of medical employment not so rosy
- Krishna Gupta (7 May 2008)
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Jobs for medical graduates
- Graham Neale (9 May 2008)
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Author's reply
- Graham P Winyard (16 June 2008)
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Om Prakash, Assistant Professor of Psychiatry Geriatric Clinic & Services, Department of Psychiatry, NIMHANS, Bangalore, INDIA
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It is difficult to understand why medical graduates are denied jobs when governments throughout the world spend a lot on their education. On the one hand, the United Nations declared 'health for all' for all societies but on the other hand, governments are not providing enough opportunities to medical graduates to serve the society. It is mockery of the system of medical education that the doctors are being denied jobs after wasting more than 5 years. The situation is much worse in developing and undeveloped countries due to which the doctors have to plan their careers in Western countries. Because of this, the societies of poor countries suffer. I would suggest the governments of developing/undeveloped counties must take this question seriously and the doctors from these countries must serve their countries rather going to green pastures. Competing interests: None declared |
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Chris M Laing, Consultant Nephrologist Royal Free Hospital, London
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Nobody is guaranteed a job, however there is no justification for over- training on this scale. The NHS is in the uniquely advantaged situation of being a monopoly employer of junior doctors. This comes with certain responsibilities and the current situation - that thousands of hard working, young professionals have invested substantial sums and years of their lives only to then be told they are part of a grand and somewhat absurd experiment in marketisation - represents an abuse of that position. Has Professor Maynards glib managerialism advanced to such a stage that there is no moral dimension to any policy development? What sort of society are we trying to create? All this is justified on the grounds that more competition is good. As Graham Winyard rightly points out doctors will be exiting at too junior a level for competition to lever standards in a meaningful way, even if postgraduate selection procedures were sufficiently rigorous (which they manifestly are not). It is likely to make the medical degree less popular, simply lowering standards and competitiveness at the entry level and represents a huge waste of already strained teaching resources. It would be much better if there was acknowledgement that those deciding medical school numbers simply got their sums wrong, rather than engaging in a disingenious debate about the putative benefits of what is obviously a large scale error in workforce planning. That would, however, require a level of transparency and accountability (the kind Maynard rightly demands of doctor productivity) that is unlikely to materialise. Competing interests: None declared |
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John G Salmon, Partner in general practice Southmead Surgery, Farnham Common, Bucks SL2 3ER
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The question you have to ask is who would study for a medical degree if they knew they were not going to be able to work as a doctor afterwards. Not many I suspect as it is a long hard degree course and is not much good for any other occupation. This fact, once generally known, is going to lead to a drop in the quality of applicants. This is self defeating if the assumption is made that the competition as it is now, is good for medicine. Competing interests: None declared |
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Sudeep Chand, SpR in Public Health UCL Centre for International Health and Development, WC1N 1EH
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Both Graham Winyard and Alan Maynard misunderstand a basic issue the NHS - it is understaffed. Surprisingly neither author mentions the Wanless report - this report was the basis behind the increase in medical school graduates. Even worse, they both fail to acknowledge that this increase did not translate into more hours at the front line of the NHS. The European Working Time Directive has limited the actual hours spent by doctors on the coal face, cancelling out the modest increase in numbers. Today, the UK continues to have one of the lowest proportions of doctor per head of population, and per bed, within developed countries. There are 4-fold differences between the major city teaching hospitals and their less glamorous counterparts. The solutions proposed by both authors will fail to address these basic issues. Firstly, there is a shortage of nurses as well as doctors so no level of substitution on a questionable evidence base will be effective. Secondly recent moves via the World Trade Organisation to allow free movement of skilled labour from India and China means that restricting 'competition' will become increasingly difficult. Perhaps this means that Alan Maynard will have his way. However it can be mitigated in part by the Audit Commission having a basic standard for the level of staffing, since the trusts have no direct incentives to maintain appropriate provision. This would benefit our patients as well as reduce the level of uneccessary medical unemployment. Hardly controversial? Competing interests: None declared |
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Krishna Gupta, Middle grade, General Surgery, Blackpool Victoria Hospital, Blackpool, FY3 8NR
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Going through both the articles it emerges that the future of employment for medical graduates may not be as rosy. But overseas doctors are not entirely to blame for the situation for local graduates. Traditionally majority of overseas doctors have been working here as non- consultants grade. The government acknowledges them as important part of medical work force but very little avenue for their advancement have been created.Certainly, many of them are better skilled than new consultants. Due to HSMP overseas doctors competing for training posts, the public has the opportunity of getting better quality doctors as consultants due to the element of competition. Now if some of the local graduates have to accept non- consultant jobs, they should not feel too bad.In medicine, like in any profession, you have to change your priorities according to situation.But to me, the bigger threat to medical employment is back door entry by non-medical personnel, who could not get a medical seat, to grab many jobs traditionally done by doctors. Competing interests: None declared |
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Graham Neale, Visiting professor Clinical Safety Research Unit, Dept of Surgery, Imperial College, St Mary's Hospital London W2 1NY
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Most British A-level students who opt for a career in medicine express altruistic sentiments that they rarely get an opportunity to satisfy. However, they are well aware that they are likely to end up in well-paid interesting jobs backed up by generous index-linked pensions. Thus, it is not surprising that English-speaking doctors from developing countries are attracted to the UK and the USA. Most claim to be seeking higher clinical training but many are looking to settle into comfortable permanent careers in the health service of their chosen country. This drain on the medical (and nursing) workforce of developing countries is inconsistent with efforts to improve global healthcare (1,2,3). The present problems of providing jobs for junior doctors could be ameliorated by organising training programmes that included a spell of work in a developing country. As Patel Vikram wrote "The opportunity to work in different societies is a rich experience with benefits that go beyond financial gain"(1). Of course there would be considerable logistic difficulties and the GMC would have to demonstrate flexibility (3). However, it would be a splendid challenge for the International Department of the Royal College of Physicians. 1. Vikram P. Recruiting doctors from poor countries: the great drain robbery. BMJ 2003; 327: 926-8. 2. Dere L Buch E. The future of healthcare in Africa. BMJ 2005; 331: 1-2. 3. Whitty CJM Doull L. Global health partnerships. BMJ 2007; 334: 595-6. Competing interests: None declared |
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Graham P Winyard, Retired Winchester SO239TE
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The House of Commons Health Committee provided the best postscript to this debate in its report on Modernising Medical Careers, published on 8th May (1). It identified the need to restrict access for non-EEA doctors to UK training posts as a necessity in the light of the recent expansion of UK medical schools, and urged the Department of Health and the Home Office to "work together to resolve this embarrassing problem as a matter of urgency". The crucial importance of this issue seems at last to have been recognised, having been ducked by Tooke and most other commentators. Whether a satisfactory solution can be devised remains to be seen: the House of Lords forthright rejection of Department of Health guidance leaves a large cohort of non-EEA doctors eligible to apply for training posts for some years to come.
To respond directly to a couple of Alan Maynard's points, no-one, not even the doctors directly affected, has ever sought job guarantees. He may be right that market forces and changes in skill mix will reduce demand for doctors in the future. All one can say is that there are few signs of this happening in spite of a decade of ideologically driven "local workforce planning" devoted to that end. But if we have trained local doctors it just seems plain common sense to use them to meet staffing needs, rather than import others. Competing interests: None declared |
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