BMJ

Medical ManpowerAuthor(s): Mary WhiteSource: The British Medical Journal, Vol. 280, No. 6213 (Feb. 23, 1980), p. 571Published by: BMJStable URL: http://www.jstor.org/stable/25439053 .

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BRITISH MEDICAL JOURNAL 23 FEBRUARY 1980 571

London. It set up two study groups in turn, but apparently gave them a remit to include

services throughout the four Thames regions. These related to cardiac surgery and to radio

therapy and oncology respectively. There was

abundant London representation on these

study groups, but none from the periphery, and the recommendations show scant regard for the needs of the community in areas more

distant from the metropolis (whose name was

expunged from the regions in 1974). We

learn, with relief, that the consortium is one

of the quangos that are to be axed, but the

evil that men do lives after them.

Very short times have been allowed for

consideration by those who bear the brunt of

patient care in the region, and in the South

east Thames Region the regional medical

officer has clearly stated his intention to

implement the centralisation proposed by the

cardiothoracic study group, and this region has arbitrarily forbidden the replacement of

retiring consultants before discussion has

taken place. We stand to gain little from the abolition

of the area tier of administration if it is to be

replaced by this sort of decision making.

Robert Percival Chairman, Consultants'

Executive Committee

West Kent General Hospital, Maidstone, Kent

The scandal of the notional rent

Sir,?I read with interest Dr Krystyna B

Melichar's letter (2 February, p 336) regarding notional rent. Although I agree that notional

rents are inadequate it would appear that the

problems could be reduced if doctors "shopped around" for the money they wish to borrow.

I recently needed money for a new surgery and was surprised to find that my bank was

willing to lend me the required sum under a

scheme called "business development loan."

The money is repaid over a maximum of 10

years at fixed interest rates?below the

current base rate. Acceptance of such a loan at

least narrows the discrepancy between the

notional rent and the money one has to spend.

J K Richmond

Barry, S Glam

Revised consultant contract

Sir,?There has been considerable cor

respondence recently about the changes in the

consultant contract whereby consultants in

post must decide before 31 March which of the

three contracts?whole-time, maximum part

time, or nine-session?they wish to adopt. However, there has been little said about the

contracts available to senior registrars

appointed to consultant positions after 31

March, and there is a widespread belief that

the same choice of contracts will be available

for new appointments. Mr Bolt's resume (19 January, p 202),

however^ makes no mention of new appoint ments, and once 31 March has passed there

would appear to be no question of this

"choice" for new consultants. They will

merely have the option, as before, of full-time

or maximum part-time contracts, particularly as there is little reason to suppose that

employing authorities will offer less than a

maximum part-time option. Have the juniors been sold out by those in secure posts ?

M A Thompson Department of Anaesthesia, Guy's Hospital, London SEI 9RT

%*The Secretary writes: "Dr Thompson is correct in saying that the prospective consultant will, after 31 March, still have the

basic choice of holding a whole-time or

maximum part-time contract. The maximum

part-time contract holder will now receive a

salary which reflects more accurately his work

commitment?that is, 10/11 rather than 9/11 of the whole-time salary. Employing authorities are now, however, able to advertise a limited nine-session consultant post where

appropriate."?Ed, BMJ.

Not a career for academic high fliers?

Sir,?Professor Sam Shuster is to be congratu lated on highlighting the problems of our

technological society and our responsibilities in attracting a disproportionate number of the

nation's top brains into medicine. However, I

feel that the problem requires far more radical

changes than can be achieved by merely leaning

heavily on our deans to recruit the less brilliant

school leavers.

Professor Shuster states that "we must

moderate our desire for ever more and brighter students." However, my impression has been

that selection committees were themselves

unhappy recruiting on the basis of school

examinations only, but felt unable to devise more appropriate methods. Should the

problem of massive potential applications therefore be tackled in society itself? Parents view medicine as prestigious (for themselves as much as for their children), secure, and well

paid; while the school leaver still sees it as a

glamour career.

To undermine any of these conceptions might be the answer, but in our materialistic world who would accept the Russian philo sophy of paying the glamour careers less while

the dreary, unskilled jobs got more ? Perhaps a scheme whereby the aspiring medical

student was granted provisional entrance on

the understanding that he completed two years'

voluntary work at home or abroad before

hand?or what about resurrecting the idea of

direction of labour to the needy areas for the

first five years after qualifying? Howls of

derision. Then perhaps the answer lies in

upgrading the attractiveness of the jobs

producing the country's wealth?students in

these professions to be paid a salary on entry to university, career prospects guaranteed, and fringe benefits such as housing thrown in :

in fact, major generals by 30.

In the meantime, however, having recruited

these precious young brains to medicine how

do we maximise their potential? General

practice is attracting its fair share, so has

modern practice become so complicated that we require a potential nuclear physicist to

ponder whether Johnny's sore throat is viral or bacterial? The attributes of a good GP, even today, would still seem to be more related to a stable temperament, an obsessional

personality to continue doing repetitive work

well, and an ability to communicate with

people?but who has screened our bright young scholars for these traits ?

Yes, we live in a muddle-headed society. Or

perhaps Professor Shuster and I are being too

pessimistic about the future and even now our

great institutions are tackling the problem as a

top priority. F L P Fouin

Peterculter Health Centre, Aberdeen

Sir,?I was interested to note Professor

Sam Shuster's (2 February, p 335) observa

tion on the selection of medical students. It

may or may not be true that highly intelligent and scientifically biased undergraduates make

bad doctors. The corollary that rather stupid

undergraduates make good doctors is equally open to question. Quite seriously, though, the use of a crude yardstick like A-level results is

never likely to be satisfactory and is really a

rather idle academic reaction to the problems of processing large numbers of applicants. A skilled interviewer may well be better,

coupled with careful attention to the views of

school teachers. And anyway what's wrong,

left-wing egalitarians apart, with saying, "He

must be all right, I knew his father" ?

J C Griffiths Salford Royal Hospital, Salford, Lanes M60 9EP

Medical manpower

Sir,?From time to time I hear the anxieties

of doctors, both peripherally and centrally, who are concerned about our present graduate output. It is interesting that many of the

doctors who approach me on this matter are

in an age group when it may be thought they would be unconcerned as they should not be

directly affected, being already in career

posts. This is not the case, as they wisely realise the long-term implications to the

profession as a whole if we produce too many

graduates. I write now as last week, following the

meeting of Council, I was approached on

several occasions and asked how we had dealt

with the debate (9 February, p 419). Those in

quiring were anxious, as they considered that

we are not sufficiently concerned and that we

were concentrating only on the structure and

paying little attention to total numbers. At

the time of the publication of the report of the

Working Party on Medical Manpower, Staffing, and Training Requirements (19 May, p 1365) I attempted to make clear my dissent and

anxieties at the omissions in the report, and I forecast the consequence of those

omissions. I know it is not possible to give a

full report of Council proceedings, but I

would like to reassure those doctors who made

inquiries of me that I did not omit my

grave warnings to Council. Mary White

Department of Surgery, Bromsgrove General Hospital, Bromsgrove, Worcs

Points Chest pain and disc lesions

Dr S E Browne (Dartford, Kent DAI IRE) writes : I have seen two patients recently with severe chest pain who had been discharged from hospital after investigation without any firm diagnosis being made. Both were under

standably relieved when examination of the

spine revealed acute tenderness and led to a

presumptive diagnosis of referred pain from a

disc lesion. . . . My experience in general

practice is that many patients do present with

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