Academic medicine: who is it for?

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7487.363-b (Published 10 February 2005) Cite this as: BMJ 2005;330:363

Academic physicians are affected by specific failures of postgraduate training

  1. Hamish S Fraser, academic physician (hamish_fraser{at}hms.harvard.edu)
  1. Brigham and Womens Hospital, 75 Francis Street, Boston, MA 02115, USA

    EDITOR—Dobson in his news article on continental doctors taking up top posts in UK heart medicine and surgery describes an important but not surprising situation.1 2 The refusal of the postgraduate training system to train more than a few cardiologists in the 90s has had serious repercussions for the provision of cardiac care in the United Kingdom. Nine years ago when I moved to the United States, one of seven or eight major teaching hospitals in Boston had more consultant cardiologists than in the whole of Scotland. It could be argued that the greatest need just now is to get clinical cardiologists and surgeons into post as soon as possible. This will obviously reduce the flow into the academia, compounded by the incentive of gold.

    In addition the UK specialist training system remains rigid and perverse. New specialties such as my own, medical informatics, struggle to take hold in hospitals as it is very hard to take the risk of stepping off the career ladder to complete novel research training (which ideally needs to be done when young).

    In the United States and some European countries, medical training is modular, and a three or four year residency leads to a registerable qualification to practise. Academic physicians can “bolt on” fellowships in research or clinical work relatively interchangeably. Often research training is also done as an undergraduate in the United States.

    In the United Kingdom, seven or eight years of clinical work and membership of the Royal College of Physicians or fellowship of the Royal College of Surgeons count for virtually nothing. Exciting research requires risk taking and a new vision, but the nine to 10 year monolithic training system sets up such individuals to fail. It is no coincidence that with short modular training in general practice the United Kingdom leads the world in primary care informatics, but its hospitals require massive and risky investment to catch up.


    • Competing interests None declared.


    1. 1.
    2. 2.
    View Abstract

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
    Sign up for a free trial