Career Focus


BMJ 1998; 317 doi: (Published 10 October 1998) Cite this as: BMJ 1998;317:S3-7164

Workforce planning is at best an imprecise art, in which small shifts from the assumptions punched into statistical models cause large deviations from predicted values over the medium to long term. When gaps occur, current British policy is to plug them with graduates from overseas.

The situation is particularly acute in obstetrics and gynaecology, where excessive recruitment to the registrar and senior registrar grades in the pre-Calman era has left 95 specialist registrars languishing at the top of the grade, holding their certificate of completion of specialist training, but unable to get a consultant post.

Dr John Biggs, Cambridge University's postgraduate medical dean, said that the knock on effects in the senior house officer grades are very clear. Until the jam at the top grade is cleared, training numbers cannot be released to allow senior house officers to enter the specialist registrar grade. Less than one third of current senior house officers in the specialty are UK graduates.

GMC data support this view: new UK graduate registrations are constant, but EU and overseas registrations are rising sharply.

A working party will examine the problems of O&G, but the example illustrates the general dilemma of the workforce planner: how to train just enough specialists, yet enable flexibility, for the NHS, and for doctors.

Critics of British reliance on overseas help call it “reverse foreign aid.” Its defenders argue that the doctors return home with valuable experience.

Two questions: if the training overseas doctors receive is so valuable, should we be giving it away so freely? And if the “payment” (in NHS work) does favour the UK, how does it square with Calman's aim of improving and shortening specialty training posts?

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