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WOMEN DOCTORS' RETAINER SCHEME
850 Menstrual regulation (uterine evacuation within 14 days of the expected period) is becoming an established procedure in Asia, even while it is still a novelty in Britain. In Singapore 4000 such procedures have been performed without incident. In the four countries in Asia which have not yet reformed their abortion laws-and Bangladesh is now the largest in this category-menstrual regulation is especially welcome. It is being used in Dacca and some provincial capitals. Despite the restrictions of a traditional society, in which, for example, it remains a great rarity to see anyone but men in the streets, women are seeking the operation. As in many other countries, the Governmental family-planning programme and the effort put in by large international agencies have had frustratingly poor results. Bottlenecks in distribution have not been overcome. Contraceptives are virtually unobtainable in all parts of the country, although there are good supplies in the warehouses.
But, even at the eleventh hour, changes are taking place, and many people, down to the remote villages, aware of the worsening economic and food situation, now want to control their fertility. The Government policy permits non-prescription pill distribution, encourages sterilisation and menstrual regulation, and is reviewing abortion
legislation. Newer, smaller, voluntary organisations are valiantly trying to bring the resources to where they are needed. The work in surgical methods of fertility regulation supplements that of Population Services International, who are about to conduct the social marketing of pills and condoms through 20,000 retail outlets. By contrast, there are 449 family-planning clinics in the country, mostly seeing a handful of patients each day.
asked whether the resident always recognises a situation that he needs help with. Who provides the payment to the house-staff ? The
hospital or medical school, or both, do, with private, governmental, and insurance funds. The attending doctor furnishes not a dollar, other than through whatever voluntary contributions he cares to make. In short, it is the senior who gains most from the present arrangement. Newspaper accounts describe the pay of residents as ranging from about$1000 a month to$1600. Despite this, moon-lighting is not uncommon, with §1000 to be gained during a weekend of 48 hours in an emergency room in another hospital. It would seem that the complaint of overlong hours is really one of overlong hours in the employing hospital, which does not leave enough time for an additional job. Early marriage, early parenthood, and the desire to redress as quickly as possible the not-infrequent economic strains of premedical and medical-school years, not to speak of social pressures, surely all play their part "
"
in the matter. What can be done to
help correct the situation, without entirely restructuring what now exists ? Perhaps the resident’s day should be divided into three parts, with one period of 12 hours for himself, free of all professional duties, either in his own or in any other hospital or clinic, one period of 4 hours for the educational programme, and a maximum of 8 hours to be used for service to the attending staff’s patients and in no other hospital. Such service should be paid for by the senior on an hourly basis, with no distinction made between day and night work; after all, illness is not confined to any one part of the day. Housestaff members should be forbidden to take outside employment, with dismissal the penalty for violation.
Urtated States THE
HOUSE-OFFICERS’
DISPUTE
The New York house-officers’ dispute is now over. It has been agreed that there should be a rearrangement of hours on duty, but, neither during the walk-out nor since, has any attention been directed to what seems to lie at the base of the dispute-the house-officer’s need for training and the simultaneous demand for service from him. The two have thus far been scrambled together, with hospitals . and attending physicians talking about the education provided, and the young doctors about the service required of them. Each side, in its own fashion, has sought to exploit the other, with everyone else the sufferers. Internship (a status fast disappearing with ever-increasing specialisation) and residency are basically periods of postgraduate education. Practical experience during this process necessarily takes in service to patients, but where does education with ancillary service end, and service with ancillary education begin ? There are, of course, intermediate grey areas, but their existence does not cause the two main territories to merge or cease to exist.
Many hospital departments approved for residency have full-time heads and often full-time staff members; where they do not, a member of the attending staff assumes responsibility. Thus, the residents assist their teachers who, in their turn, assist their students, with the senior residents helping the juniors. The attending staff call upon the house-officers for assistance on the principle that by such service the education of the younger men is fostered. What has happened, with payment by third parties for medical care in hospital only, and the disappearance of house-calls, is that hospital admissions have increased greatly. The visiting doctors call more and more on the house-staff to assume the burden of care, and come to the hospital on a more-or-less routine schedule. The seniors assert that, if the junior thinks his presence is needed, the senior comes to the hospital. But it may be
Special
Article
WOMEN DOCTORS’ RETAINER SCHEME GOVERNMENT financial support for the Women Doctors’ Retainer Scheme, which was introduced in 1972 to encourage women to continue working in medicine, and which was concentrated on the hospital service, has now been, extended to general practice from April 1. The scheme is open to any woman doctor under 55 who is unable to work more than two sessions a week because of domestic commitments. Doctors in the scheme are required to attend a minimum of 7 educational sessions and to undertake at least 12 paid service sessions each year. They are paid an annual retainer of E50 to help cover their expenses (including the cost of registration). The aim of the scheme is to enable women doctors to maintain a link with their profession while they are bringing up their families, and to encourage them to resume their medical careers, either part-time or full-time, as soon as their domestic commitments permit. Up till now women doctors in the scheme wishing to work in general practice have had to make their own arrangements to be employed by a general practitioner, who had to meet the full cost of employing them himself. Following consultations with representatives of the professions, the Statement of Fees and Allowances has been amended so that family practitioner committees will now make payments to family doctors who employ a member of the scheme at the rate of E6.15 per session up to a maximum of 1 session a week. Clinical tutors will arrange for doctors in the scheme to work in practices assessed as suitable by the regional postgraduate education committee. The terms of employment of women doctors in the scheme will continue to be a matter for agreement between them and the members of the practice concerned.
But, even at the eleventh hour, changes are taking place, and many people, down to the remote villages, aware of the worsening economic and food situation, now want to control their fertility. The Government policy permits non-prescription pill distribution, encourages sterilisation and menstrual regulation, and is reviewing abortion
legislation. Newer, smaller, voluntary organisations are valiantly trying to bring the resources to where they are needed. The work in surgical methods of fertility regulation supplements that of Population Services International, who are about to conduct the social marketing of pills and condoms through 20,000 retail outlets. By contrast, there are 449 family-planning clinics in the country, mostly seeing a handful of patients each day.
asked whether the resident always recognises a situation that he needs help with. Who provides the payment to the house-staff ? The
hospital or medical school, or both, do, with private, governmental, and insurance funds. The attending doctor furnishes not a dollar, other than through whatever voluntary contributions he cares to make. In short, it is the senior who gains most from the present arrangement. Newspaper accounts describe the pay of residents as ranging from about$1000 a month to$1600. Despite this, moon-lighting is not uncommon, with §1000 to be gained during a weekend of 48 hours in an emergency room in another hospital. It would seem that the complaint of overlong hours is really one of overlong hours in the employing hospital, which does not leave enough time for an additional job. Early marriage, early parenthood, and the desire to redress as quickly as possible the not-infrequent economic strains of premedical and medical-school years, not to speak of social pressures, surely all play their part "
"
in the matter. What can be done to
help correct the situation, without entirely restructuring what now exists ? Perhaps the resident’s day should be divided into three parts, with one period of 12 hours for himself, free of all professional duties, either in his own or in any other hospital or clinic, one period of 4 hours for the educational programme, and a maximum of 8 hours to be used for service to the attending staff’s patients and in no other hospital. Such service should be paid for by the senior on an hourly basis, with no distinction made between day and night work; after all, illness is not confined to any one part of the day. Housestaff members should be forbidden to take outside employment, with dismissal the penalty for violation.
Urtated States THE
HOUSE-OFFICERS’
DISPUTE
The New York house-officers’ dispute is now over. It has been agreed that there should be a rearrangement of hours on duty, but, neither during the walk-out nor since, has any attention been directed to what seems to lie at the base of the dispute-the house-officer’s need for training and the simultaneous demand for service from him. The two have thus far been scrambled together, with hospitals . and attending physicians talking about the education provided, and the young doctors about the service required of them. Each side, in its own fashion, has sought to exploit the other, with everyone else the sufferers. Internship (a status fast disappearing with ever-increasing specialisation) and residency are basically periods of postgraduate education. Practical experience during this process necessarily takes in service to patients, but where does education with ancillary service end, and service with ancillary education begin ? There are, of course, intermediate grey areas, but their existence does not cause the two main territories to merge or cease to exist.
Many hospital departments approved for residency have full-time heads and often full-time staff members; where they do not, a member of the attending staff assumes responsibility. Thus, the residents assist their teachers who, in their turn, assist their students, with the senior residents helping the juniors. The attending staff call upon the house-officers for assistance on the principle that by such service the education of the younger men is fostered. What has happened, with payment by third parties for medical care in hospital only, and the disappearance of house-calls, is that hospital admissions have increased greatly. The visiting doctors call more and more on the house-staff to assume the burden of care, and come to the hospital on a more-or-less routine schedule. The seniors assert that, if the junior thinks his presence is needed, the senior comes to the hospital. But it may be
Special
Article
WOMEN DOCTORS’ RETAINER SCHEME GOVERNMENT financial support for the Women Doctors’ Retainer Scheme, which was introduced in 1972 to encourage women to continue working in medicine, and which was concentrated on the hospital service, has now been, extended to general practice from April 1. The scheme is open to any woman doctor under 55 who is unable to work more than two sessions a week because of domestic commitments. Doctors in the scheme are required to attend a minimum of 7 educational sessions and to undertake at least 12 paid service sessions each year. They are paid an annual retainer of E50 to help cover their expenses (including the cost of registration). The aim of the scheme is to enable women doctors to maintain a link with their profession while they are bringing up their families, and to encourage them to resume their medical careers, either part-time or full-time, as soon as their domestic commitments permit. Up till now women doctors in the scheme wishing to work in general practice have had to make their own arrangements to be employed by a general practitioner, who had to meet the full cost of employing them himself. Following consultations with representatives of the professions, the Statement of Fees and Allowances has been amended so that family practitioner committees will now make payments to family doctors who employ a member of the scheme at the rate of E6.15 per session up to a maximum of 1 session a week. Clinical tutors will arrange for doctors in the scheme to work in practices assessed as suitable by the regional postgraduate education committee. The terms of employment of women doctors in the scheme will continue to be a matter for agreement between them and the members of the practice concerned.