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HOSPITAL STAFFS
563
must be a solid weight of clinical opinion in its favour ; ,;nd neither clinicians nor administrators are widely
Something must be done for these men, who are fully trained and presumably are fully competent since otherwise they would not have reached and retained their present status. I hope that the new committee set up by the Ministry of Health will consider what practical steps can be taken to help them.
and strongly interested in the development
of an efficient this of is the fact direct evidence In service. accident Accident Hosthe of in the 14 that, Birmingham years we have lost many of our well"experiment," pital trained and experienced staff—not because the technical and human challenge of the work is unattractive but because more favourable and less exacting conditions have been offered elsewhere. If a long view is to be taken, we must consider not only the detailed planning and strategic siting of large accident departments attached to general and teaching hospitals, but also the terms of training and service of the personnel—at all levels-needed to staff such emergency services over the 24 hours of each day. Since the organisation must always be fully prepared, it cannot in heavily populated areas be a " part-time " service
Mayday Hospital, Thornton Heath. Heath, "
break-down " of figures for consultant staffs published by the Ministry of Health, reveals
SIR,—The
strikingly uneven expansion. Numerically approximately equal groups are made up by: (A) major specialties (general medicine, general surgery, obstetrics and gynaecology [2106 in 1949]) ; and (B) specialties in which full clinical responsibility is the exception (mental health, radiology, radiotherapy, physical medicine, pathology, anaesthesia [1901 in 1949]). The expansion in the number of consultants and the present numbers of senior registrars are as follows :
minor responsibility. Om rescue and ambulance services already function with commendable efficiency ; and the most seriously injured, if evacuated quickly, travel ten miles and more comparatively safely, even with our present "design of ambulance. With better ambulances the "safe distance might well extend to twenty-five or thirty miles. In a small country like ours, the strategic siting of fully equipped and staffed accident services, each attached to a large general hospital, would go a long way to ensure proper medical care for all the many people who are seriously injured on road or railway, at work or in the home. or a
Birmingham Accident Hospital, Birmingham, 15.
G. P. BAKER.
Surrey.
These figures do not take account of the further surplus in group A of potential specialists holding university and other appointments. It may be argued that it was in the non-clinical specialties that the need for expansion was greatest. But clearly the present numbers of senior registrars in group A represent highly trained man-power required to meet definite clinical needs and not merely trainees " retained for future needs. It follows that real levelling up of expansion is needed in those general categories which have been, and always must be, the basis of a hospital service. SENIOR REGISTRAR. "
WILLIAM GISSANE.
HOSPITAL STAFFS
SIR,—I was very interested in the tables issued by the Ministry of Health on the consultant and senior registrar establishment.’ Clearly little increase is likely in the consultant establishment, as will be seen from table ii which gives the numbers of consultants in each specialty. From Dec. 31, 1952, to June 30, 1954, the increase in the
SIR,—Not every good man is fortunate enough to come along at the right time for a registrar vacancy in a numbers of consultants in general medicine, general teaching hospital. For several years after the beginning of the health surgery, and obstetrics and gynaecology was 12, 0, and service many men, as good as those who obtained 4 respectively. Most of the other specialties show very appointments in teaching hospitals, went into registrar this The little increase during period. present figures the regional hospitals. The experience and training these therefore seem to be stable. men have obtained in many of the large regional hospitals I am surprised to see that the retiring age of 65 is not have been as good as are obtained in the teaching being enforced, since there are so many senior registrars hospitals. the three major specialties, clamouring for posts. In When it comes to a consultant appointment, however, where the congestion is greatest, there were 23 physicians, the regional man very frequently comes up against an 31 surgeons, and 11 gynaecologists over 65 (born in 1889 attitude of mind which immediately places him in an or earlier) who had not retired when this table was Most of these men never even reach the inferior position. compiled. Though it is quite possible that each of these short list to a hearing. There is in the hospital service get a have few their retirement would sessions, may only today one-way traffic through the teaching hospitals to make at least some vacancies. As there is to be no further appointments, particularly in the three main significant expansion of the consultant services it seems most senior in all hospitals. The interchange system for specialties, scandalous that fully trained senior registrars are being thus prevented from obtaining these retirement vacancies senior registrars was brought in with the main intention of trying to right this situation and give some incentive - now virtually their only hope of promotion. Before the health service most hospital boards made 60 the for men to take house-officer and registrar posts in regional hospitals. With few exceptions this intention retiring age. has been frustrated by the one-way traffic system at In table ill (senior registrars in each specialty), taking level. general medicine only, there are 22 senior registrars in this For nigh on two years now the profession has been their fourth year and 77 " others "-which presumably how to staff the regional hospitals. The deliberating in their means men fifth and subsequent years-making of creation a new type of post in regional hospitals, a total of 99. In other words there are 99 candidates through which will be the normal way to conseeking posts which will become, or should become, vacant passage sultant will do nothing to staff regional hospitals posts, through retirement. According to table i, there should when one-way traffic is in operation. be 13 in 1955, 18 in 1956, and 11 in 1957, but as each Honourable men have laboured with good intent to retirement may only represent a few sessions the number. to find a solution to this problem, but within try of actual appointments will be less than this, probably average of about 10 a year. Senior registrars in their fourth and subsequent years therefore only have about a 10% chance of a consultant vacancy in their specialty. ,
an
1. See Lancet,
Feb. 26, 1955, p. 448.
constraints which make the problem insoluble. These constraints are mainly attitudes of mind which stem from the past but are not applicable to the present or the
future.. .
REGISTRAR.
must be a solid weight of clinical opinion in its favour ; ,;nd neither clinicians nor administrators are widely
Something must be done for these men, who are fully trained and presumably are fully competent since otherwise they would not have reached and retained their present status. I hope that the new committee set up by the Ministry of Health will consider what practical steps can be taken to help them.
and strongly interested in the development
of an efficient this of is the fact direct evidence In service. accident Accident Hosthe of in the 14 that, Birmingham years we have lost many of our well"experiment," pital trained and experienced staff—not because the technical and human challenge of the work is unattractive but because more favourable and less exacting conditions have been offered elsewhere. If a long view is to be taken, we must consider not only the detailed planning and strategic siting of large accident departments attached to general and teaching hospitals, but also the terms of training and service of the personnel—at all levels-needed to staff such emergency services over the 24 hours of each day. Since the organisation must always be fully prepared, it cannot in heavily populated areas be a " part-time " service
Mayday Hospital, Thornton Heath. Heath, "
break-down " of figures for consultant staffs published by the Ministry of Health, reveals
SIR,—The
strikingly uneven expansion. Numerically approximately equal groups are made up by: (A) major specialties (general medicine, general surgery, obstetrics and gynaecology [2106 in 1949]) ; and (B) specialties in which full clinical responsibility is the exception (mental health, radiology, radiotherapy, physical medicine, pathology, anaesthesia [1901 in 1949]). The expansion in the number of consultants and the present numbers of senior registrars are as follows :
minor responsibility. Om rescue and ambulance services already function with commendable efficiency ; and the most seriously injured, if evacuated quickly, travel ten miles and more comparatively safely, even with our present "design of ambulance. With better ambulances the "safe distance might well extend to twenty-five or thirty miles. In a small country like ours, the strategic siting of fully equipped and staffed accident services, each attached to a large general hospital, would go a long way to ensure proper medical care for all the many people who are seriously injured on road or railway, at work or in the home. or a
Birmingham Accident Hospital, Birmingham, 15.
G. P. BAKER.
Surrey.
These figures do not take account of the further surplus in group A of potential specialists holding university and other appointments. It may be argued that it was in the non-clinical specialties that the need for expansion was greatest. But clearly the present numbers of senior registrars in group A represent highly trained man-power required to meet definite clinical needs and not merely trainees " retained for future needs. It follows that real levelling up of expansion is needed in those general categories which have been, and always must be, the basis of a hospital service. SENIOR REGISTRAR. "
WILLIAM GISSANE.
HOSPITAL STAFFS
SIR,—I was very interested in the tables issued by the Ministry of Health on the consultant and senior registrar establishment.’ Clearly little increase is likely in the consultant establishment, as will be seen from table ii which gives the numbers of consultants in each specialty. From Dec. 31, 1952, to June 30, 1954, the increase in the
SIR,—Not every good man is fortunate enough to come along at the right time for a registrar vacancy in a numbers of consultants in general medicine, general teaching hospital. For several years after the beginning of the health surgery, and obstetrics and gynaecology was 12, 0, and service many men, as good as those who obtained 4 respectively. Most of the other specialties show very appointments in teaching hospitals, went into registrar this The little increase during period. present figures the regional hospitals. The experience and training these therefore seem to be stable. men have obtained in many of the large regional hospitals I am surprised to see that the retiring age of 65 is not have been as good as are obtained in the teaching being enforced, since there are so many senior registrars hospitals. the three major specialties, clamouring for posts. In When it comes to a consultant appointment, however, where the congestion is greatest, there were 23 physicians, the regional man very frequently comes up against an 31 surgeons, and 11 gynaecologists over 65 (born in 1889 attitude of mind which immediately places him in an or earlier) who had not retired when this table was Most of these men never even reach the inferior position. compiled. Though it is quite possible that each of these short list to a hearing. There is in the hospital service get a have few their retirement would sessions, may only today one-way traffic through the teaching hospitals to make at least some vacancies. As there is to be no further appointments, particularly in the three main significant expansion of the consultant services it seems most senior in all hospitals. The interchange system for specialties, scandalous that fully trained senior registrars are being thus prevented from obtaining these retirement vacancies senior registrars was brought in with the main intention of trying to right this situation and give some incentive - now virtually their only hope of promotion. Before the health service most hospital boards made 60 the for men to take house-officer and registrar posts in regional hospitals. With few exceptions this intention retiring age. has been frustrated by the one-way traffic system at In table ill (senior registrars in each specialty), taking level. general medicine only, there are 22 senior registrars in this For nigh on two years now the profession has been their fourth year and 77 " others "-which presumably how to staff the regional hospitals. The deliberating in their means men fifth and subsequent years-making of creation a new type of post in regional hospitals, a total of 99. In other words there are 99 candidates through which will be the normal way to conseeking posts which will become, or should become, vacant passage sultant will do nothing to staff regional hospitals posts, through retirement. According to table i, there should when one-way traffic is in operation. be 13 in 1955, 18 in 1956, and 11 in 1957, but as each Honourable men have laboured with good intent to retirement may only represent a few sessions the number. to find a solution to this problem, but within try of actual appointments will be less than this, probably average of about 10 a year. Senior registrars in their fourth and subsequent years therefore only have about a 10% chance of a consultant vacancy in their specialty. ,
an
1. See Lancet,
Feb. 26, 1955, p. 448.
constraints which make the problem insoluble. These constraints are mainly attitudes of mind which stem from the past but are not applicable to the present or the
future.. .
REGISTRAR.