DEPENDENCE ON OVERSEAS DOCTORS

41 Fuller and McCartney also comment on our application of statistical method. The background to our analyses was not only the original contribution by Miller and Miller:6but also our own demonstration of a highly significant difference in serum-H.D.L. between healthy persons and patients who had had myocardial infarction (r< 0-001).’ This strong evidence a

a lower serum-H.D.L. level in C.H.D. patients than in healthy people led to our alternative hypothesis that patients with angiographically demonstrable coronary atherosclerosis have lower serum-H.D.L. levels than do patients without demonstrable lesions. With such alternative hypotheses one uses one-sided tests, so this criticism by Fuller and McCartney is in

for

be many who feel, as I do, that the institutionalising of the T.R.A.B. and the language courses and so on that will inevitably spring up round it, will serve to perpetuate the absurdity by postponing the day still further when a radical reappraisal of the whole structure, as well as individual’s positions and activities within it, becomes inevitable. Dunn’s Hill

House,

Willesborough, Ashford,

error.

T. R. CULLINAN

Kent

PART-TIME SENIOR-REGISTRAR POSTS

Institute of Medical University of Oslo, Oslo 3, Norway

Genetics,

First Department of Medicine, University Central Hospital, Helsinki, Finland

K. BERG A.-L. BØRRESEN

Central Hospital, Boden, Sweden

M. H. FRICK G. DAHLÉN

Institute of Statistics, University of Copenhagen, Copenhagen, Denmark

J. STENE

THE POLITICS OF W.H.O.

SIR,-It was encouraging to read your editoriaheabout the resolution of the Executive Board of W.H.O., urging non-govemmental organisations affiliated to it to expel the Republic of China (Taiwan) from their membership. At the general assembly of the World Federation of Societies of Anesthesiologists in Mexico City in April, it was resolved that: (1) The Society of Anaesthesiologists of the Republic of China shall not be expelled, as it has in no way violated the Constitution. (2) The W.F.S.A. shall welcome an application for membership from the appropriate society of the People’s Republic of China. (3) Every effort shall be made to resolve as quickly as possible the problem raised by the communication from W.H.O. (4) A reply shall be sent to the Director-General of W.H.O., expressing the confident trust that no action may be taken which might damage the excellent relations which have been established with the W.F.S.A., thereby endangering the health and lives of men, women, and children in the developing countries. I hope that all non-governmental organisations will reply in similar terms. Politics have no place in medicine. 10/40 Wimpole Street, London W1M 7AF

D. D. C. HOWAT, Chairman, Executive Committee, W.E.S.A.

DEPENDENCE ON OVERSEAS DOCTORS

SIR,-Before the Temporary Registration Assessment Board

(T.R.A.B.) and the bureaucracy it spawns become an accepted, and therefore indispensable, part of British medicine there are one or two statements that need making loudly and clearly. Chief among these is that it is ultimately absurd that any supposedly experienced and wealthy society could have made the provision of health care so technically and organisationally complex that it has to rely on the importation of poorer countries’ scarce resources to support it. No other profession in our own or any other lifetime has so completely failed to distinguish between demands and needs that it can no longer hope to provide for the servicing of either. There must 16. Miller, G. J., Miller, N. E. ibid. 1975, i, 16. 17. Berg, K., Berresen, A.-L., Dahlén, G. ibid. 1976, i, 499. 18. Lancet, 1976, i,1282.

SIR,-Dr Sterling has highlighted

one of the problems of doctors who contracts and recomrequire part-time employing mends that regional health authorities should create more part-time consultant posts. However, if two such employees were to take up the equivalent of one full-time post a further problem will ensue. Presumably two people instead of one will be absent from work for their annual leave of six weeks, plus any study leave that is granted. Since part-time posts are most easily arranged within service specialties the implication in terms of providing regular continuity of service may be serious. There are three other aspects relating to the employment of women doctors under the terms of the HM(69)6 scheme. The first is the prolonged time which it can take to obtain authorisation for the establishment of such a post. I have been told that some ten separate bodies have to be consulted, and it is therefore hardly surprising that it took about eight months to negotiate my most recent post under this scheme. This was despite the fact that a woman doctor was already in such a post but about to leave, there were no new person-power implications, and the training programme had been accepted and was in being. The second is the requirement for the holder of one of these part-time posts to complete the time of training equivalent to someone in a whole-time post. Most schemes of higher professional training (H.P.T.) at senior-registrar level require the incumbent to complete three years of this type of training. While "soft options" must obviously be avoided and although appropriateness of previous experience is taken into account by con-

sultant

advisory appointment committees,

a woman

part-time

doctor may have to be prepared to be a part-time senior registrar for perhaps six years. This may be a disincentive to many potential applicants to the scheme, especially if it is coupled with the possibility of the husband taking up a post elsewhere sometime during this period. In these latter circumstances the whole administrative pursuit will have to be repeated, and not only will the doctor’s continuity of training be interrupted but also the new authority concerned may be less than enthusiastic about instituting such a post. The third aspect which can create a problem is the situation where a married woman senior registrar may have completed about two years or so in a full-time appointment. She may then either be required to move with her husband or she may desire, for the sake of her children, to reduce her commitment to a part-time one. In either event a part-time post may have to be negotiated. Of course, with sufficient of the appropriate training behind her she may be eligible for consultant appointment (as does happen with only two years full-time H.P.T. in some specialties). What is she to do if there is no locally convenient consultant appointment available to her? Give up or continue forever on a part-time training basis? If, as Dr Gnineberg has suggested,2 the proportion of female medical students does increase from the traditional 20% to about 50% then it will be important to ensure that it is possible for women doctors to achieve their career potential. This being so it is absolutely essential that serious thought be given to 1.

2.

Sterling, N. Lancet, 1976, i, 1285. Grüneberg, A. B.M.A. News Review, 1976, ii,

30.