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FRIENDLY FOREIGN DOCTORS
697
until
THE LANCET LONDON:SATURDAY, MAY 31, 1941
FRIENDLY FOREIGN DOCTORS THE debate in Parliament on May 13may do
something to clear the air in regard to the difficulties which have arisen in making full and rapid use of the medical men and women from enemy and occupied countries who have sought refuge with us. It was clear that some of the speakers had an imperfect understanding of all the ramifications of this problem. Even the reply by Miss HORSBURGH, parliamentary secretary to the Ministry of Health, left some of them unexplained. Laymen might be excused for suspecting that professional obstruction was causing the delay, since it is true that the British Medical Association resisted, in the pre-war years, a too free absorption of refugee practitioners coming to this country with the object of acquiring British qualifications and gaining complete and permanent freedom to practise medicine here ; and even then the leaders of the association had difficulty in convincing the rank and file of the profession that they had not yielded too much. It is equally true, however, that the Central Medical War Committee was urging the employment of foreign practitioners on the Government long before the regulations were made which authorised their employment and before the Robinson Committee specifically recommended it. The suggestion, therefore, by medical Members of Parliament that some of the delay might be attributed to an unsympathetic attitude on the part of the central committee was
justifiable. regrettable that the absorption of foreign practitioners, once it became possible, should have been so slow. Even the Ministry’s figures seem to be
not
It is
tentative and provisional, but it appears to have been admitted that the number of such practitioners in the country is about 1350, and that not more, and probably less, than 200-250 had been placed after four months’ endeavour.2 By that time, however, the machine had begun to work smoothly and 100150 are now being passed through each week. There is still room for acceleration, but, as Miss Horsburgh pointed out, no part of the " vetting " of foreign
applicants is dispensable. They must be acceptable employing body, they must be placed where they are really needed, their qualifications must be satisfactory, their proficiency in the English language must be adequate (despite rather flippant parliamentary remarks on this subject) and their loyalty to the Allied cause must be beyond question. Differ-
to the
ent authorities are, and must be, concerned with these requirements, and it is not necessarily a waste of time
-
that one of them, the Central Medical War Committee, should act as a clearing house for the others. The procrastination has occurred in the operation of the machine. The circular (No. 2312) of the Ministry of Health giving sanction to the employment of such medical men and women in hospitals was not issued 1. See Lancet, May 24, 1941, p. 678. 2. In his address opening the G.M.C. session on May 27 the President said that there are now 294 names on the temporary register of practitioners from the Empire, the U.S.A., and Allied and enemy European countries.
17. Hospital authorities were not convinced that these doctors would be immediately their engagement might when acceptable, especially entail the removal of some of their existing and experienced British doctors to the fighting services. When they did take steps they found to their consternation that a post they had hoped to fill quickly must remain vacant for as long as two months before the practitioner was finally approved at the centre. It was pointed out in the debate that the delay was mainly at the Home Office, where the credentials of the doctor as an alien are looked into, but it was cogently remarked that everything that the Home Office could by any means ascertain should already have been known to them, since most of these men and women had already been in our midst for a long time. The truth appears to be that the Home Office is not the only Government department concerned, and that the blockage occurs in another office which already has an unenviable reputation in this respect, and which was not mentioned in Parliament. Another difficulty which was ignored has arisen from the fixed proportion of foreign doctors to total staff which may be allowed in any one institution. At first sight it seems reasonable that not more than ten per cent. of the medical staff should be aliens in hospitals over 100 beds in size and not more than twenty per cent. in smaller hospitals, these being the proportions laid down in the Ministry’s circular. But many special hospitals, which have even greater staffing difficulties than general hospitals, carry a small number of medical officers in proportion to their bed accommodation. They seldom have the five or ten doctors necessary, if their accommodation is respectively under or over 100 beds, before the employment of even one foreign doctor is permissible. For instance, a large tuberculosis organisation controlling nearly 2000 institutional beds has not one
March
institution which could comply with the Ministry’s requirements, and is yet anxious to give employment to doctors from abroad. It seems reasonable that such an organisation should be regarded as a simple unit for this purpose, provided that there are sufficient safeguards against excessive staffing with foreign doctors in any one institution. When all these impediments have been overcome there still remains the fact that doctoring on the continent of Europe is not just the same as it is here, a fact brought out by Prof. M. GREENWOOD on p. 706. The training and experience of foreign practitioners may be better or worse than ours but it is different ; and they are accustomed to deal with people with other traditions and outlook. Many of them have specialised in a way which would not qualify them to rank as specialists in this country, but has nevertheless unfitted them to cope immediately with the general work expected of a resident medical officer in a general hospital. Some time must elapse before they can -pull their full weight in the posts now open to them. It would be foolish, on the strength of one or two exceptional instances known to members of Parliament, for anyone to suppose that British-trained doctors can be replaced straight away, and on a large scale, by foreign ones without at least a temporary loss of efficiency. Hospitals are ready, however, to make the necessary adjustments as soon as the for recruitment is tightened up.
machinery
until
THE LANCET LONDON:SATURDAY, MAY 31, 1941
FRIENDLY FOREIGN DOCTORS THE debate in Parliament on May 13may do
something to clear the air in regard to the difficulties which have arisen in making full and rapid use of the medical men and women from enemy and occupied countries who have sought refuge with us. It was clear that some of the speakers had an imperfect understanding of all the ramifications of this problem. Even the reply by Miss HORSBURGH, parliamentary secretary to the Ministry of Health, left some of them unexplained. Laymen might be excused for suspecting that professional obstruction was causing the delay, since it is true that the British Medical Association resisted, in the pre-war years, a too free absorption of refugee practitioners coming to this country with the object of acquiring British qualifications and gaining complete and permanent freedom to practise medicine here ; and even then the leaders of the association had difficulty in convincing the rank and file of the profession that they had not yielded too much. It is equally true, however, that the Central Medical War Committee was urging the employment of foreign practitioners on the Government long before the regulations were made which authorised their employment and before the Robinson Committee specifically recommended it. The suggestion, therefore, by medical Members of Parliament that some of the delay might be attributed to an unsympathetic attitude on the part of the central committee was
justifiable. regrettable that the absorption of foreign practitioners, once it became possible, should have been so slow. Even the Ministry’s figures seem to be
not
It is
tentative and provisional, but it appears to have been admitted that the number of such practitioners in the country is about 1350, and that not more, and probably less, than 200-250 had been placed after four months’ endeavour.2 By that time, however, the machine had begun to work smoothly and 100150 are now being passed through each week. There is still room for acceleration, but, as Miss Horsburgh pointed out, no part of the " vetting " of foreign
applicants is dispensable. They must be acceptable employing body, they must be placed where they are really needed, their qualifications must be satisfactory, their proficiency in the English language must be adequate (despite rather flippant parliamentary remarks on this subject) and their loyalty to the Allied cause must be beyond question. Differ-
to the
ent authorities are, and must be, concerned with these requirements, and it is not necessarily a waste of time
-
that one of them, the Central Medical War Committee, should act as a clearing house for the others. The procrastination has occurred in the operation of the machine. The circular (No. 2312) of the Ministry of Health giving sanction to the employment of such medical men and women in hospitals was not issued 1. See Lancet, May 24, 1941, p. 678. 2. In his address opening the G.M.C. session on May 27 the President said that there are now 294 names on the temporary register of practitioners from the Empire, the U.S.A., and Allied and enemy European countries.
17. Hospital authorities were not convinced that these doctors would be immediately their engagement might when acceptable, especially entail the removal of some of their existing and experienced British doctors to the fighting services. When they did take steps they found to their consternation that a post they had hoped to fill quickly must remain vacant for as long as two months before the practitioner was finally approved at the centre. It was pointed out in the debate that the delay was mainly at the Home Office, where the credentials of the doctor as an alien are looked into, but it was cogently remarked that everything that the Home Office could by any means ascertain should already have been known to them, since most of these men and women had already been in our midst for a long time. The truth appears to be that the Home Office is not the only Government department concerned, and that the blockage occurs in another office which already has an unenviable reputation in this respect, and which was not mentioned in Parliament. Another difficulty which was ignored has arisen from the fixed proportion of foreign doctors to total staff which may be allowed in any one institution. At first sight it seems reasonable that not more than ten per cent. of the medical staff should be aliens in hospitals over 100 beds in size and not more than twenty per cent. in smaller hospitals, these being the proportions laid down in the Ministry’s circular. But many special hospitals, which have even greater staffing difficulties than general hospitals, carry a small number of medical officers in proportion to their bed accommodation. They seldom have the five or ten doctors necessary, if their accommodation is respectively under or over 100 beds, before the employment of even one foreign doctor is permissible. For instance, a large tuberculosis organisation controlling nearly 2000 institutional beds has not one
March
institution which could comply with the Ministry’s requirements, and is yet anxious to give employment to doctors from abroad. It seems reasonable that such an organisation should be regarded as a simple unit for this purpose, provided that there are sufficient safeguards against excessive staffing with foreign doctors in any one institution. When all these impediments have been overcome there still remains the fact that doctoring on the continent of Europe is not just the same as it is here, a fact brought out by Prof. M. GREENWOOD on p. 706. The training and experience of foreign practitioners may be better or worse than ours but it is different ; and they are accustomed to deal with people with other traditions and outlook. Many of them have specialised in a way which would not qualify them to rank as specialists in this country, but has nevertheless unfitted them to cope immediately with the general work expected of a resident medical officer in a general hospital. Some time must elapse before they can -pull their full weight in the posts now open to them. It would be foolish, on the strength of one or two exceptional instances known to members of Parliament, for anyone to suppose that British-trained doctors can be replaced straight away, and on a large scale, by foreign ones without at least a temporary loss of efficiency. Hospitals are ready, however, to make the necessary adjustments as soon as the for recruitment is tightened up.
machinery