David Goodman's comment that 'doctors do not generally settle where healthcare needs are greater' is one reason the inverse care law still exists.
It is my belief that the majority doctors do not seek to serve society, but the individual patient [mostly] and themselves. Hence, specialities that are financially lucrative or render a good lifestyle, and hospitals and health centres in 'leafy surburbs' will always attract the best, leaving 'cinderella' fields [such as elderly care and palliative care] and inner-city deprived posts struggling to recruit. I know this from bitter personal experience from the backlash I elicited from doctors when I suggested in a BMJ opinion earlier this year that 'As doctors we need to serve the community, not it exist to serve us'. [1] The majority of doctors disagreed.
I do not think this means that doctors are bad people - it just simply reflects human nature. There are many examples around the world where, left to the whim of individuals to decide what they want to, adverse consequences result. The ‘brain drain’ from developing countries is one example. In India, many doctors, mostly from higher castes, train abroad for a number of years before going back to set themselves up in lucrative private practice serving their own elite castes, whilst government hospitals and local clinics remain in a state of disarray. This is not the fault of those individual doctors – who simply see an opportunity for a better life – but the system [e.g. poor government hospitals] that encourages it.
The increase in renumeration and reduction in working hours in primary care in England has led to this field becoming highly competitive now, a drastic change to only 10 years ago. I thus agree with David Goodman that the answer is more than simply increasing numbers, but perhaps incentivising doctors to enter fields or areas with the greatest need is the real solution.
1. Zaman MJS, BMJ 2007;334:44 (6 January)
Competing interests:
None declared
Competing interests:
No competing interests
12 August 2007
M Justin S Zaman
Research Fellow, Epidemiology and Specialist Registrar, Cardiology
Rapid Response:
Not more doctors
David Goodman's comment that 'doctors do not generally settle where healthcare needs are greater' is one reason the inverse care law still exists.
It is my belief that the majority doctors do not seek to serve society, but the individual patient [mostly] and themselves. Hence, specialities that are financially lucrative or render a good lifestyle, and hospitals and health centres in 'leafy surburbs' will always attract the best, leaving 'cinderella' fields [such as elderly care and palliative care] and inner-city deprived posts struggling to recruit. I know this from bitter personal experience from the backlash I elicited from doctors when I suggested in a BMJ opinion earlier this year that 'As doctors we need to serve the community, not it exist to serve us'. [1] The majority of doctors disagreed.
I do not think this means that doctors are bad people - it just simply reflects human nature. There are many examples around the world where, left to the whim of individuals to decide what they want to, adverse consequences result. The ‘brain drain’ from developing countries is one example. In India, many doctors, mostly from higher castes, train abroad for a number of years before going back to set themselves up in lucrative private practice serving their own elite castes, whilst government hospitals and local clinics remain in a state of disarray. This is not the fault of those individual doctors – who simply see an opportunity for a better life – but the system [e.g. poor government hospitals] that encourages it.
The increase in renumeration and reduction in working hours in primary care in England has led to this field becoming highly competitive now, a drastic change to only 10 years ago. I thus agree with David Goodman that the answer is more than simply increasing numbers, but perhaps incentivising doctors to enter fields or areas with the greatest need is the real solution.
1. Zaman MJS, BMJ 2007;334:44 (6 January)
Competing interests:
None declared
Competing interests: No competing interests