- Email: [email protected]
No Applicants
973
training. Though competition for registrarjobs at these hospitals is severe, many think it better to wait some time for an appointment at one of them, rather than go elsewhere. Initial success, they believe, makes all the difference to their ultimate prospects. Clearly there is at present a conflict between
THE LANCET LONDON::
SATURDAY, NOV. 24,
1951
No Applicants REGIONAL boards, especially in the North, are increasingly worried by their inability to fill junior posts in peripheral hospitals and sometimes even in those at regional centres. The total deficit is hard to be little doubt that it is not solely caused by uneven distribution. There are not enough doctors of the right age to take all the appointments to assess, but there
seems
real, affecting all grades of posts, and
offered them, with the result that in
some places work being seriously handicapped. To find residents for outlying hospitals has never been easy, but the present difficulties have been caused chiefly by the general expansion of establishments which took place after the National Health Service was started. It is not surprising that doctors who are in a position to choose should go to hospitals near the main centres in preference to those in outlying areas. The situation in the North is made worse by the general social tendency to drift southwards and by the predominance of London as a centre of teaching, alike for the undergraduate and for the graduate. Earlier marriage and housing difficulties are other reasons why young men are reluctant to leave the larger cities where they may have established a home, while financial considerations are likely to deter them ftom living away from home for anything but short periods. The introduction of the compulsory preregistration year of hospital appointments will increase the total time spent in residence and should improve the supply of house-physicians and house-surgeons, but the local shortages of senior house-officers and registrars will continue unless doctors can be persuaded to return to hospital when they have finished their two years’ military service. This is usually a critical time, when
is
the needs of the individual doctor’ and those of the hospitals. One solution would be to increase considerably the number of doctors qualifying ; but this would be hard to justify without a substantial improvement of the prospects of permanent employment in the health service. On the other hand, a policy of deliberately restricting the more popular junior hospital posts would not make the others more attractive ; nor would it ensure that they were better filled. A practical measure which might help some peripheral hospitals would be a revision of their establishments. Most of them in 1948 adopted the system of consultant staffing with a full complement of juniors ;-, and though this scheme is administratively tidy and is in’conformity with the method of the larger hospitals and the teaching hospitals, it is not always realistic. Sometimes a more economical structure could be devised without loss of efficiency, as has been proved in practice by certain areas. The chief need, however, is to overcome the isolation of the outlying hospitals, which should be brought into closer relation with the central hospitals, especially the teaching hospitals. Hitherto little progress has been made in this direction. Yet the better staffing of peripheral hospitals was one of the purposes that the regional system was intended to serve, and despite certain practical difficulties it has many advantages to all parties. Young doctors, if they felt that they were to some extent sponsored by their parent hospitals and were sure that their future prospects would not be jeopardised, would welcome the excellent clinical experience and the greater responsibility they could have in
outlying hospitals. Prospective general practitioners would benefit particularly ; but the young consultant with two or three years of registrar training behind him, and with the added security of seniorregistrar status, would also gain much if he were seconded for a period to the periphery. The main difficulty would be with married men whose homes were in the larger centres, but proper contact between
most of them must decide on their future career and when those who are married will wish to settle down individual management committees and consultant permanently as soon as possible. Those who hope staffs of peripheral hospitals and the deans of teaching schools could do much to get over this. Cooperation to become specialists must obtain a registrar appointof this kind would benefit the young doctor and ment and a higher qualification, while those who are going to be general practitioners, though they may would provide hospitals with a better supply of welcome six months or a year of extended hospital residents. In London and at least one other region experience, will naturally be anxious to find a suitable the directors of postgraduate education have already opening in practice. In either case the peripheral made a useful beginning in this direction, but the hospital, unless it is of very high standing, will be at a field of their activity could profitably be enlarged. disadvantage because of its isolation, both professional The introduction of the compulsory year in hospital and academic. The best vacancies in general practice offers a new opportunity for establishing habits of tend to be filled by private introduction, often through interchanging house-surgeons and house-physicians, the medical schools ; so young doctors prefer to be and the system could well be extended to cover the near the centre, where they can continue their In the Manchester region it is more senior posts. education and at the same time be on the spot to seize intended that, wherever practicable, all seniorany attractive opportunity, rather than far away registrar appointments shall in future be madejointly where they fear they will be forgotten. For the with the teaching hospital, and that senior registrars future consultant the peripheral hospital is seldom shall spend about half their four years in non-teaching suitable at the beginning of his career, since at this hospitals. The practical experience thus gained by stage only a teaching hospital or a well-equipped the future consultant should usefully complement his central hospital can give him the necessary academic more academic training.
training. Though competition for registrarjobs at these hospitals is severe, many think it better to wait some time for an appointment at one of them, rather than go elsewhere. Initial success, they believe, makes all the difference to their ultimate prospects. Clearly there is at present a conflict between
THE LANCET LONDON::
SATURDAY, NOV. 24,
1951
No Applicants REGIONAL boards, especially in the North, are increasingly worried by their inability to fill junior posts in peripheral hospitals and sometimes even in those at regional centres. The total deficit is hard to be little doubt that it is not solely caused by uneven distribution. There are not enough doctors of the right age to take all the appointments to assess, but there
seems
real, affecting all grades of posts, and
offered them, with the result that in
some places work being seriously handicapped. To find residents for outlying hospitals has never been easy, but the present difficulties have been caused chiefly by the general expansion of establishments which took place after the National Health Service was started. It is not surprising that doctors who are in a position to choose should go to hospitals near the main centres in preference to those in outlying areas. The situation in the North is made worse by the general social tendency to drift southwards and by the predominance of London as a centre of teaching, alike for the undergraduate and for the graduate. Earlier marriage and housing difficulties are other reasons why young men are reluctant to leave the larger cities where they may have established a home, while financial considerations are likely to deter them ftom living away from home for anything but short periods. The introduction of the compulsory preregistration year of hospital appointments will increase the total time spent in residence and should improve the supply of house-physicians and house-surgeons, but the local shortages of senior house-officers and registrars will continue unless doctors can be persuaded to return to hospital when they have finished their two years’ military service. This is usually a critical time, when
is
the needs of the individual doctor’ and those of the hospitals. One solution would be to increase considerably the number of doctors qualifying ; but this would be hard to justify without a substantial improvement of the prospects of permanent employment in the health service. On the other hand, a policy of deliberately restricting the more popular junior hospital posts would not make the others more attractive ; nor would it ensure that they were better filled. A practical measure which might help some peripheral hospitals would be a revision of their establishments. Most of them in 1948 adopted the system of consultant staffing with a full complement of juniors ;-, and though this scheme is administratively tidy and is in’conformity with the method of the larger hospitals and the teaching hospitals, it is not always realistic. Sometimes a more economical structure could be devised without loss of efficiency, as has been proved in practice by certain areas. The chief need, however, is to overcome the isolation of the outlying hospitals, which should be brought into closer relation with the central hospitals, especially the teaching hospitals. Hitherto little progress has been made in this direction. Yet the better staffing of peripheral hospitals was one of the purposes that the regional system was intended to serve, and despite certain practical difficulties it has many advantages to all parties. Young doctors, if they felt that they were to some extent sponsored by their parent hospitals and were sure that their future prospects would not be jeopardised, would welcome the excellent clinical experience and the greater responsibility they could have in
outlying hospitals. Prospective general practitioners would benefit particularly ; but the young consultant with two or three years of registrar training behind him, and with the added security of seniorregistrar status, would also gain much if he were seconded for a period to the periphery. The main difficulty would be with married men whose homes were in the larger centres, but proper contact between
most of them must decide on their future career and when those who are married will wish to settle down individual management committees and consultant permanently as soon as possible. Those who hope staffs of peripheral hospitals and the deans of teaching schools could do much to get over this. Cooperation to become specialists must obtain a registrar appointof this kind would benefit the young doctor and ment and a higher qualification, while those who are going to be general practitioners, though they may would provide hospitals with a better supply of welcome six months or a year of extended hospital residents. In London and at least one other region experience, will naturally be anxious to find a suitable the directors of postgraduate education have already opening in practice. In either case the peripheral made a useful beginning in this direction, but the hospital, unless it is of very high standing, will be at a field of their activity could profitably be enlarged. disadvantage because of its isolation, both professional The introduction of the compulsory year in hospital and academic. The best vacancies in general practice offers a new opportunity for establishing habits of tend to be filled by private introduction, often through interchanging house-surgeons and house-physicians, the medical schools ; so young doctors prefer to be and the system could well be extended to cover the near the centre, where they can continue their In the Manchester region it is more senior posts. education and at the same time be on the spot to seize intended that, wherever practicable, all seniorany attractive opportunity, rather than far away registrar appointments shall in future be madejointly where they fear they will be forgotten. For the with the teaching hospital, and that senior registrars future consultant the peripheral hospital is seldom shall spend about half their four years in non-teaching suitable at the beginning of his career, since at this hospitals. The practical experience thus gained by stage only a teaching hospital or a well-equipped the future consultant should usefully complement his central hospital can give him the necessary academic more academic training.