Intended for healthcare professionals

Head To Head

Does it matter that medical graduates don’t get jobs as doctors? Yes

BMJ 2008; 336 doi: (Published 01 May 2008) Cite this as: BMJ 2008;336:990

Missing the big picture?

Both Graham Winyard and Alan Maynard misunderstand a basic issue the NHS - it is understaffed. Surprisingly neither author mentions the Wanless report - this report was the basis behind the increase in medical school graduates. Even worse, they both fail to acknowledge that this increase did not translate into more hours at the front line of the NHS.

The European Working Time Directive has limited the actual hours spent by doctors on the coal face, cancelling out the modest increase in numbers.

Today, the UK continues to have one of the lowest proportions of doctor per head of population, and per bed, within developed countries. There are 4-fold differences between the major city teaching hospitals and their less glamorous counterparts. The solutions proposed by both authors will fail to address these basic issues. Firstly, there is a shortage of nurses as well as doctors so no level of substitution on a questionable evidence base will be effective. Secondly recent moves via the World Trade Organisation to allow free movement of skilled labour from India and China means that restricting 'competition' will become increasingly difficult. Perhaps this means that Alan Maynard will have his way. However it can be mitigated in part by the Audit Commission having a basic standard for the level of staffing, since the trusts have no direct incentives to maintain appropriate provision. This would benefit our patients as well as reduce the level of uneccessary medical unemployment.

Hardly controversial?

Competing interests: None declared

Competing interests: No competing interests

06 May 2008
Sudeep Chand
SpR in Public Health
UCL Centre for International Health and Development, WC1N 1EH