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More money for training?

BMJ 1997; 315 doi: (Published 26 July 1997) Cite this as: BMJ 1997;315:259
  1. Christopher Bulstrode,
  2. John Lourie
  1. clinical reader in orthopaedic surgery, Oxford
  2. consultant orthopaedic surgeon, Milton Keynes

    Sociologically, hospital doctors are members of craft guilds. Consultants (the masters of these guilds) control their craft through the royal colleges. The junior doctors are their apprentices. Unfortunately the master/apprentice model has always been open to abuse. It is in the master's interest to extend the length of the apprenticeship. This enhances the status of the guild, holds down the number of masters, and maintains a comfortably closed shop. In Britain between the 13th and 15th centuries the length of an apprenticeship rose from seven to 16 years, and finally had to be cut back by royal statute.

    Length of apprenticeship still continues as a problem in hospital medicine in the late 20th century. Consultants have been taking 10 or more years in specialty training to achieve accreditation. This is far longer than necessary, if training is the only factor involved. The problem now (as it was no doubt in the 14th century) is that the large numbers of apprentices have become the backbone of the service. The reduction in junior doctors' hours, combined with the reduction in length of training, is bringing about a staffing crisis in …

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