Brain gum, CME, and keeping up to dateBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7204.0 (Published 24 July 1999) Cite this as: BMJ 1999;319:0
The BMJ and "black boxing"
The BMJ, as we reported last week (17 July p 194), was criticised at the BMA’s recent annual meeting for failing to implement the motion passed at the 1998 meeting to "black box" non-standard hospital appointments. Hospital Doctor, a newspaper supported by advertising, has argued in a portentous editorial that the BMJ is putting money ahead of principle and that "BMA leaders must bow to democracy The issue is—unsurprisingly—much more complicated.
Hospital Doctor has taken up this cause with such enthusiasm because it hopes to take some of the BMJ’s share of the market for classified advertising (with no intention, needless to say, of turning down or controlling any advertisements). Sadly it did not declare its conflict of interest, in a way that is becoming routine in respectable publications.
The problem we are all trying to address is that of jobs that exploit doctors because they are not approved for training, are non-standard, and may not comply with national terms and conditions of service. The BMA has been campaigning to get rid of these jobs for some five years but with little success. Sadly, it may suit some financially stretched trusts to create such posts and some doctors, for various reasons, to take them.
It was frustration that led to the 1998 motion for the BMJ to "black box" advertisements for such posts. Those proposing the motion recognised that the move could not solve the problem, but they hoped it would contribute to a solution.
"Black boxing" is a process whereby those employers who might be in dispute with the BMA can be listed in an "Important notices" section at the front of the classified advertising supplement of the BMJ. It is widely misunderstood as a process whereby individual advertisements are printed within a black border. The council of the BMA (not the editor) decides who will be black boxed. The editor does not have any autonomy to refuse to carry out the wishes of the council, and I’m happy with that position. The BMA invented the black box many years ago to avoid having to censor advertisements because it recognised the great value to BMA members of having all job advertisements gathered in one place. It was also no doubt influenced by a desire to continue to receive the income from the advertisements.
As soon as the 1998 motion was passed we (BMJ staff) set about considering how to implement the motion. Consulting with the representatives of both junior and senior doctors, we recognised that listing all offending trusts in the black box would not work for three main reasons. Firstly, we would probably at some stage have to list every trust in the country in the black box because most have advertised such posts. Secondly, such lists would not help those applying for jobs know which were not approved (because any one trust may be advertising both approved and non-approved posts). Thirdly, we might easily black box a trust for advertising a post that did conform to standard conditions even though it didn’t say that it did: we might then be legally liable.
In other words, it was practical problems that led us to rethinkthe way we implemented the policy. With the approval of the representatives of junior and senior doctors we thus proposed a policy of highlighting in bold posts that are approved for training or comply with national terms of conditions and service. In addition, we have drawn attention to the issue in an editorial, drafted notes to readers to supplement the highlighting, mailed trusts and advertising agencies, and promoted good recruitment practice to employers. This strategy is working well with training posts but has had only limited impact on the non-standard career grade posts.
As the proposers of the 1998 motion recognised, the problem of non-standard posts cannot be solved through the BMJ. And it certainly won’t be solved by black boxing every trust that lists such a job. The BMA, supported by the BMJ, needs to continue with negotiations and the other components of our existing strategy to counter this deep seated problem.
The worst outcome of all would be to allow Hospital Doctor to take over the advertising. Those looking for jobs would have to start to look in more than one place. Doctors would have no control whatsoever over the advertising policies of Hospital Doctor. And the income from advertising would end up in the pockets of the shareholders of Reed-Elsevier, which owns Hospital Doctor, rather than in supporting the BMJ, which is owned by doctors and published by doctors for doctors.
19 July 1999
- Anonymous. BMA leaders must bow to democracy. Hospital Doctor 1999; 15 Jul: 12.
- Smith R. Countering poor training within the NHS. BMJ 1999;318:552.
- Editorial Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.205
- Clinical Review Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.236
- Letter Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.256
- Letter Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.256a
- Letter Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.256b
- Letter Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.258
- Letter Published: 24 July 1999; BMJ 319 doi:10.1136/bmj.319.7204.258a
- MEDICOPOLITICAL DIGEST Published: 17 July 1999; BMJ 319 doi:10.1136/bmj.319.7203.193
- Fillers Published: 17 July 1999; BMJ 319 doi:10.1136/bmj.319.7203.193a
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