- Email: [email protected]
AN EXPENSIVE CONGRESS
852 PREREGISTRATION HOUSE-OFFICERS
SiR,-Many of your readers will be aware of the problem which last August, and this February, with the arrangements for filling preregistration house-officer (PRHO) posts. On Nov 26 you published a letter from my predecessor, Sir Henry Yellowlees, expressing the Department’s concern at the position which had arisen in August and outlining the steps which were being taken to try to prevent it happening again. In the event, a small number of graduates of UK medical schools either failed to obtain preregistration posts for Feb 1, 1984, or were not prepared to take posts which were available. Some new arrangements are being introduced to reduce the likelihood of the problem recurring this arose
summer.
The Department has asked all English health authorities to do their best to fill their August PRHO posts by the end of April and to tell the Safety Net, run by the Council for Postgraduate Medical Education, about filled and unfilled posts, as at April 27. All English medical schools have been asked to notify the Safety Net of their unplaced final-year students as at the same date. There will then be a period of concentrated and coordinated matching during May to facilitate the filling of remaining posts with UK students. The same arrangements will apply in Wales. Although we have introduced these arrangements at short notice it is vital that all involved cooperate fully, as only by doing so will health authorities feel confident that there will be time to fill those posts not needed by UK graduates and will students feel confident that they can be sure of a post to go to. There are several things students can do to ease the situation for themselves or their colleagues:
(1) Make realistic decisions about the likelihood of obtaining a place locally. Not all students can obtain posts in the area where they studied, and some of those who did not obtain a post in February were those who were not able or not prepared to apply for jobs which were available elsewhere. This is largely a London and Home Counties problem. (2) Act responsibly once a job has been obtained. Some students have held job offers while continuing to apply for other jobs and have only released the first job at a late stage, making it difficult for authorities to refill the post at short notice and depriving their colleagues of an opportunity. (3) Keep in touch with their medical schools and keep them informed of the position. Students still looking for jobs should make this known to their schools-and once they have received a job offer they must report the fact immediately so that their names can be removed from the list of unplaced candidates.
We are pursuing several other steps to see what further changes might be required in the longer term but we hope that the action we are taking will prevent a recurrence of the difficulties encountered in February and in August last year. These seem to have arisen mainly through a lack of confidence in the system both on the part of some health authorities who have not been confident that UK graduates will be available for their posts and on the part of students who have been fearful that they will be unable to obtain posts. We hope that earlier action to match people and posts will do much to restore confidence. Responsibility for ensuring that graduates from UK medical schools are able to look forward with confidence to the certainty of having a PRHO post to go to on qualification is shared between a variety of interests-including medical schools, health authorities, consultants with PRHOs, and the students themselves. The function of DHSS is to do everything possible to give guidance and to coordinate arrangements, and this we are doing. I hope this letter makes this clear. Department of Health and Social Security,
E. D. ACHESON,
London SE1 6BY
Chief medical officer
night (or, in a lower grade hotel,$35, or, in a youth For five nights, the grand total would be$1175. A banquet on the last night costs$50, and, allowing for two meals a day and other expenses, one would be lucky to get away with any change out of$1500. A variety of post-congress tours is offered. Two tours in the Soviet Union will last from June 8 to 15 (almost twice as long as the congress itself), and the single-room hotel costs for them will be$550-575. With personal expenses, not much change from$750. The tours are purely personal, and do not constitute a visit by IPPNW; no element of antinuclear protest will be involved. In the Third World 10 million children die each year of starvation. Their deaths and the other miseries of that world might well be the trigger to a nuclear war. Should doctors purporting to be against nuclear war spend$50 a head on a banquet? Why not a registration fee of$50 to cover the inevitable overheads? And why not make it a condition of attendance that all delegates should stay at youth hostels? Those three items could save$300-500 a head. And could not the would-be USSR trippers show the sincerity of their views by donating the$750 to the relief of Third World hunger instead? The money thus made available would be a drop in the ocean of Third World need but the world’s media would flock to see distinguished physicians and surgeons emerging each morning from their youth hostels, making a final congress meal out of a sandwich and a glass of beer, and returning straight home instead of savouring the "amazing good taste" of Kiev cathedral, the "stunning art collections" of the Leningrad Hermitage, and the "handmade wooden souvenirs" one can buy in Moscow. Cannot IPPNW see that by spending money on this scale at or in association with an antinuclear congress-they are not offering a cure for the disease from which western man suffers. Instead, they are themselves the disease.
be some$75
a
hostel,$12).
Craigliath, Oughterard, Co Galway, Ireland
JOHN S. BRADSHAW
HEART TRANSPLANTS AND PRIORITIES Evans
10, p 567) criticises cardiac misallocation of National Health Service resources, which would be better spent on the "routine cardiac surgical service". While his criticism has merit, it nonetheless points out a serious problem in determining when a surgical procedure has therapeutic value rather than mere potential. In the UK and in the US, renal transplantation has long been considered efficacious. Yet clinicians and policymakers seem bewildered by the status of heart transplantation. The accompanying figure compares cadaveric kidney graft and heart transplant patient survival rates in the US for patients on conventional immunosuppressive therapy. (Except for the rare occasion upon which cardiac retransplantation is done, it is more appropriate to compare cadaveric kidney graft with heart transplant patient survival rather than kidney transplant patient with heart SlR,—Dr
transplantation
as
(March
a
AN EXPENSIVE CONGRESS
SIR,-International Physicians for the Prevention of Nuclear War (IPPNW) holds its fourth annual congress in Finland on June 3-8, and someone, knowing my antinuclear views, gave me a copy of the programme and a registration form. I shall not be going. A return flight from Ireland to Helsinki would cost$550. The congress registration fee is$150 for an official delegate and$250 for an observer, as I would be. Accommodation in a Finnish hotel would
Cadaver
kidney
and heart
transplant survival compared.
SiR,-Many of your readers will be aware of the problem which last August, and this February, with the arrangements for filling preregistration house-officer (PRHO) posts. On Nov 26 you published a letter from my predecessor, Sir Henry Yellowlees, expressing the Department’s concern at the position which had arisen in August and outlining the steps which were being taken to try to prevent it happening again. In the event, a small number of graduates of UK medical schools either failed to obtain preregistration posts for Feb 1, 1984, or were not prepared to take posts which were available. Some new arrangements are being introduced to reduce the likelihood of the problem recurring this arose
summer.
The Department has asked all English health authorities to do their best to fill their August PRHO posts by the end of April and to tell the Safety Net, run by the Council for Postgraduate Medical Education, about filled and unfilled posts, as at April 27. All English medical schools have been asked to notify the Safety Net of their unplaced final-year students as at the same date. There will then be a period of concentrated and coordinated matching during May to facilitate the filling of remaining posts with UK students. The same arrangements will apply in Wales. Although we have introduced these arrangements at short notice it is vital that all involved cooperate fully, as only by doing so will health authorities feel confident that there will be time to fill those posts not needed by UK graduates and will students feel confident that they can be sure of a post to go to. There are several things students can do to ease the situation for themselves or their colleagues:
(1) Make realistic decisions about the likelihood of obtaining a place locally. Not all students can obtain posts in the area where they studied, and some of those who did not obtain a post in February were those who were not able or not prepared to apply for jobs which were available elsewhere. This is largely a London and Home Counties problem. (2) Act responsibly once a job has been obtained. Some students have held job offers while continuing to apply for other jobs and have only released the first job at a late stage, making it difficult for authorities to refill the post at short notice and depriving their colleagues of an opportunity. (3) Keep in touch with their medical schools and keep them informed of the position. Students still looking for jobs should make this known to their schools-and once they have received a job offer they must report the fact immediately so that their names can be removed from the list of unplaced candidates.
We are pursuing several other steps to see what further changes might be required in the longer term but we hope that the action we are taking will prevent a recurrence of the difficulties encountered in February and in August last year. These seem to have arisen mainly through a lack of confidence in the system both on the part of some health authorities who have not been confident that UK graduates will be available for their posts and on the part of students who have been fearful that they will be unable to obtain posts. We hope that earlier action to match people and posts will do much to restore confidence. Responsibility for ensuring that graduates from UK medical schools are able to look forward with confidence to the certainty of having a PRHO post to go to on qualification is shared between a variety of interests-including medical schools, health authorities, consultants with PRHOs, and the students themselves. The function of DHSS is to do everything possible to give guidance and to coordinate arrangements, and this we are doing. I hope this letter makes this clear. Department of Health and Social Security,
E. D. ACHESON,
London SE1 6BY
Chief medical officer
night (or, in a lower grade hotel,$35, or, in a youth For five nights, the grand total would be$1175. A banquet on the last night costs$50, and, allowing for two meals a day and other expenses, one would be lucky to get away with any change out of$1500. A variety of post-congress tours is offered. Two tours in the Soviet Union will last from June 8 to 15 (almost twice as long as the congress itself), and the single-room hotel costs for them will be$550-575. With personal expenses, not much change from$750. The tours are purely personal, and do not constitute a visit by IPPNW; no element of antinuclear protest will be involved. In the Third World 10 million children die each year of starvation. Their deaths and the other miseries of that world might well be the trigger to a nuclear war. Should doctors purporting to be against nuclear war spend$50 a head on a banquet? Why not a registration fee of$50 to cover the inevitable overheads? And why not make it a condition of attendance that all delegates should stay at youth hostels? Those three items could save$300-500 a head. And could not the would-be USSR trippers show the sincerity of their views by donating the$750 to the relief of Third World hunger instead? The money thus made available would be a drop in the ocean of Third World need but the world’s media would flock to see distinguished physicians and surgeons emerging each morning from their youth hostels, making a final congress meal out of a sandwich and a glass of beer, and returning straight home instead of savouring the "amazing good taste" of Kiev cathedral, the "stunning art collections" of the Leningrad Hermitage, and the "handmade wooden souvenirs" one can buy in Moscow. Cannot IPPNW see that by spending money on this scale at or in association with an antinuclear congress-they are not offering a cure for the disease from which western man suffers. Instead, they are themselves the disease.
be some$75
a
hostel,$12).
Craigliath, Oughterard, Co Galway, Ireland
JOHN S. BRADSHAW
HEART TRANSPLANTS AND PRIORITIES Evans
10, p 567) criticises cardiac misallocation of National Health Service resources, which would be better spent on the "routine cardiac surgical service". While his criticism has merit, it nonetheless points out a serious problem in determining when a surgical procedure has therapeutic value rather than mere potential. In the UK and in the US, renal transplantation has long been considered efficacious. Yet clinicians and policymakers seem bewildered by the status of heart transplantation. The accompanying figure compares cadaveric kidney graft and heart transplant patient survival rates in the US for patients on conventional immunosuppressive therapy. (Except for the rare occasion upon which cardiac retransplantation is done, it is more appropriate to compare cadaveric kidney graft with heart transplant patient survival rather than kidney transplant patient with heart SlR,—Dr
transplantation
as
(March
a
AN EXPENSIVE CONGRESS
SIR,-International Physicians for the Prevention of Nuclear War (IPPNW) holds its fourth annual congress in Finland on June 3-8, and someone, knowing my antinuclear views, gave me a copy of the programme and a registration form. I shall not be going. A return flight from Ireland to Helsinki would cost$550. The congress registration fee is$150 for an official delegate and$250 for an observer, as I would be. Accommodation in a Finnish hotel would
Cadaver
kidney
and heart
transplant survival compared.