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Rapid Responses: Rapid Responses published:
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The Last Inequality
- William G Notcutt (6 June 2004)
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Service specialities suffer?
- Paul E Sigston, Charles Wetton (24 June 2004)
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Other goals in life!
- Alastair Lack (30 June 2004)
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William G Notcutt, Consultant Anaesthetist James Paget Hospital, Great Yarmouth
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Now that we have set to rest the issues of sex and ethncity as discriminators against achieving higher awards it is time to address the huge inequalities between specialties. My own, anaesthesia, is no less clincally demanding than any others. However, surgeons and physicians still hold the limelight in the opinions of the profession and the public as to who the really hard working, skilfull and clever doctors are. This of course is not evidence-based. I suspect that another reason is related to research publications. Anaesthesia, Intensive Care and Pain Management are not easy areas to undertake classical clinical trials. It was evident whilst sitting on a regional Awards Committee for 3 years that the number of papers published was still a very strong determinant of success in awards. Furthermore those doctors who achieved national and international reputations and who were able to sit on important committees seemed to come from departments that would be well-staffed with juniors, research assistants etc. Commonly, having read many applications, I was left wondering who was really doing the everyday work; who was working through the night with the emergencies; who really was doing all the hard slog producing the research papers? There did not seem to be enough hours in the day for everything. I perceived that many unsuccessful applicants were clearly very hard working clinicians who were worthy of recognition but who had only limited time to persue some the activities that lead to success in the awards race. I hope that the system can be improved further and eliminate the current clear inequalities. However, I believe that the methodology for assessing for higher awards needs much more scrutiny. There may be benefit in studying the emerging methodologies being used at local levels, previously for Discretionary Points and now for Clinical Excellence Awards. Competing interests: I am an Anaesthetist. I hold a "B" award. I was a member of a regional awards comittee until 2 years ago. |
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Paul E Sigston, Consultant in Anaesthetics Kent and Sussex Hospital, TN4 8AT, Charles Wetton
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Editor, Lambert et al comprehensively describe the distribution of distinction awards amongst consultants and our attention was particularly drawn to their observation of differences in B awards between specialities1. Under the auspices of the Advisory Committee on Clinical Excellence Awards (ACCEA), clinical excellence awards have replaced distinction awards and local discretionary points, with a principle of “equality of opportunity”2. We have analysed the distribution of discretionary points for the last year within our large trust and compared the odds ratio of receiving a discretionary point. Our data correlates closely with the data on distinction awards in their paper. For example, the odds ratio compared to general medicine for receiving a discretionary point is 0.24 for anaesthetics (0.32 in Lambert’s paper), 0.31 for radiology (0.4) and 0.83 for pathology (0.71). It appears that for both local and national wards, there is a consistent lack of representation of some specialities, especially the service specialities. It may be that some specialities are more “worthy of reward than others”, or it may be that the assessment system that is in place inherently discriminates against some specialities1. We believe that the ACCEA should examine the data and question whether the clinical excellence awards scheme follows their guidance in allowing a fair distribution of awards between specialities. Dr Paul Sigston Consultant Anaesthetist Dr Charles Wetton Consultant Radiologist 1. Lambert TW, Goldacre MJ, Vallance E, Mallick N. Characteristics of consultants who hold distinction awards in England and Wales: database analysis with particular reference to sex and ethnicity. BMJ 2004; 328:1347-9 (5 June.) 2. Department of Health The new NHS consultant reward scheme: Clinical Excellence Awards. London: Department of Health, August 2003. Competing interests: Both authors have received discretionary points and belong to specialities that receive few awards |
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Alastair Lack, Retired Home SP54LX
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This paper is fundamentally flawed by not having checked that the 'lifestyle goals' of the various consultant groups, white and non-white, are the same. To achieve a distinction award often involves considerable sacrifice of family life in the pursuit of distinction in one's career. It is a very moot point amongst many consultants that I have spoken to as to whether the reward is worth this sacrifice - certainly many women do not think so. So all this paper may be showing is that award holders value distinction more highly than non-award holders value family. It would be no surprise to me if it was shown at some future date that ethnic minorities and women value families more highly! Competing interests: I held an 'A'award |
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