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Views And Reviews Acute Perspective

David Oliver: Making less popular medical jobs more attractive

BMJ 2018; 362 doi: (Published 10 July 2018) Cite this as: BMJ 2018;362:k2936

Re: David Oliver: Making less popular medical jobs more attractive

Agree with Dr Oliver’s thoughts. May I add my ha’penny worth, please?

Long long ago, in the late fifties, there were bottle-necks in some specialities. Examples: paediatrics, OB-Gyn, thoracic surgery. “Time-expired senior registrars” galore. Some went abroad as consultants. Some entered general practice - I knew some, worked with some, or my family were patients with one. They were happy but felt “ deprived”.
Some SRs took up one session of consultancy when it fell vacant in easy travelling distance and kept some sessions at the old teaching hospital until Sir...... retired.
I knew some, worked with them.

One senior registrar in paediatrics returned from abroad, could not get a consultancy, switched to geriatrics as a consultant. What a great geriatrician he was. He worked in a hospital in my local authority when I was in public health.

There was in hospital service, for the juniors, “ a peripheral allowance”. A tidy sum, I think about 10% of the salary. Strange as it may seem, it was even available to post-holders in some specialities (hard to fill) in metropolitan areas.

Then, there was the ability of the Senior Administrative Officers of the Reg Hosp Boards to entice senior registrars from teaching hospitals to fill consultant posts in market towns otherwise unattractive. Financial incentive. I knew some (worked with them when I was in public health).

Those were the days when huntin’, fishin’, shootin’ did attract doctors, in general practice, in hospitals and in public health. There were good schools too within easy travelling distance and the doctors’ wives could run the children to school. Nowadays? ...........I have no solutions.

In those days, perhaps long before the rapid responder, Honorary Lollipop Lady‘s time, general practitioners could be attracted to designated areas where they got extra money. Not far from Peterborough, in the swamps of East Anglia, where the roads were few, in the hard winters the villagers actually ice-skated, there was a village called MANEA. Here the Executive Council could not attract a GP. But, a junior hospital doctor from a county hospital nearby did take up the practice. His wife was from those parts. He served the community till he retired. By now I guess the village is a town with metalled roads criss-crossing the Fens. Traffic busy, year round.

One more point. Then I shut up.

In those times, there was no “burn out”. I should know because I was a junior in acute specialities in the early 1960s. And there were no extra duty payments of any kind. Reasons were three, I believe. We juniors were happy (if anyone wasn’t, he moved to another hospital), despite heavy work-load because we were valued. Secondly, there were plenty of non-acute hospitals where you could spend six months or more, reading for your exams, or whatever took your fancy. Thirdly, although very few house-men were married, there was plenty of social life.

1. Bring back low intensity hospitals working in tandem with major acute hospitals.
2. Abolish the clutter of diplomas (money -making racket).
3. Let there be only three exams - the FRCS, MRCP, MRCOG.
4. Give doctors, junior and senior, more time to relax.
5. By all means recruit more doctors from abroad. BUT, each one of them should, first, mandatorily spend six months as an honorary clinical clerk in a geriatric or psychogeriatric unit where his ability to understand the needs and the solutions of the English patient can be fostered.

An old man rambling .......

The end

Competing interests: Senility, seeking better health service.

18 July 2018
JK Anand
Retired doctor
Free spirit
Peterborough (market town, once, in Northamptonshire, now a poyglot conurbation in the County of Cambridgeshire)