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

Yes it matters

Nobody is guaranteed a job, however there is no justification for over- training on this scale.

The NHS is in the uniquely advantaged situation of being a monopoly employer of junior doctors. This comes with certain responsibilities and the current situation - that thousands of hard working, young professionals have invested substantial sums and years of their lives only to then be told they are part of a grand and somewhat absurd experiment in marketisation - represents an abuse of that position.

Has Professor Maynards glib managerialism advanced to such a stage that there is no moral dimension to any policy development? What sort of society are we trying to create?

All this is justified on the grounds that more competition is good. As Graham Winyard rightly points out doctors will be exiting at too junior a level for competition to lever standards in a meaningful way, even if postgraduate selection procedures were sufficiently rigorous (which they manifestly are not). It is likely to make the medical degree less popular, simply lowering standards and competitiveness at the entry level and represents a huge waste of already strained teaching resources.

It would be much better if there was acknowledgement that those deciding medical school numbers simply got their sums wrong, rather than engaging in a disingenious debate about the putative benefits of what is obviously a large scale error in workforce planning. That would, however, require a level of transparency and accountability (the kind Maynard rightly demands of doctor productivity) that is unlikely to materialise.

Competing interests: None declared

Competing interests: No competing interests

03 May 2008
Chris M Laing
Consultant Nephrologist
Royal Free Hospital, London