Saturday, March 17, 2007

UK Doctors Protest "Modernising Medical Careers"

We have posted several times, most recently here, about the controversy over the new system developed by the UK National Health Service (NHS) to select physicians for senior specialty training positions, part of the the new "Modernising Medical Careers" (MMC) program. Since the last post, criticism of the selection process, called the Medical Training Application Service (MTAS), has been growing. The Telegraph, which has been providing most of the coverage of this story, reported,

Prof John Bell, president of the Academy of Medical Sciences, and Prof Sir John Tooke, chairman of the Council of Heads of Medical Schools, criticised the scheme for undervaluing applicants' research experience and academic potential. In an open letter released yesterday, Prof Bell and Sir John said: 'Academic trainees - those doctors wishing to pursue careers which encompass research as well as patient care - have been particularly badly affected by the decision to anonymise applications and deprive the assessors of details of previous clinical and research experience. Without a scientifically informed and research-orientated medical workforce throughout the country, the Government's vision of the UK as a world-class centre for biomedical research and healthcare cannot be realised.'

Prof Ian Gilmore, the President of the Royal College of Physicians, added his voice to the criticism, saying the system was 'at the point of breaking down.'

Nine out of 10 doctors who have taken part in an online poll called for the resignation of those responsible for the MMC/MTAS debacle.

Meanwhile, The Lancet called for MTAS to be suspended and said the new system, combined with EU laws preventing junior doctors from working longer than 48 hours per week, would produce inexperienced consultants.

Many phases of the MTAS have been criticized. A Telegraph physician columnist, Dr Max Pemberton described his personal experience with the interview phase of the MTAS.

I am one of the lucky ones. I am here for one of the much coveted Medical Training Application Service (MTAS) interviews....

Any doctor awaiting an interview and hoping that the interview process will in some way be superior to the ludicrous, Kafkaesque application form should be warned: it isn't.

The grey man led me into a room filled with work stations manned by confused, bewildered looking interviewers. Some of them were doctors, some, I learned later, were not. None was properly introduced to me. It was clear they hadn't read my form and knew nothing about me. Each asked a series of formulaic questions to which I had a few minutes to provide equally formulaic answers.

There was no provision for me to discuss anything, to show my strengths and qualities, or to talk about the things that interest me. The bland questions were designed to elicit responses that could be ticked off on a form.

In all honesty, I wouldn't trust this system to select someone to water my plants, let alone look after me when I'm sick.

Dr Pemberton came to a clear realization what the larger problem is.

This is a clear attempt to undermine the medical profession; to ensure that we become compliant, unquestioning automatons in a system that can be presided over by managers and politicians.

He has hit the nail on the head. This seems to be the same problem that plagues us here in the US, and maybe plagues health care around the world.

When I interviewed physicians about what they thought was wrong with health care, many cited cases of bad decisions by, and conflicts of interest and outright corruption affecting health care leaders, who were often managers and politicians. Yet at the time, most of the physicians saw thess as their unique local problems, not as part of a largersystemic problem. Perhaps because physicians see the problems only as local, are too busy just trying to keep up with their patients' needs, or tend to be conflict-averse and apolitical, few physicians have protested the systemic problem. But maybe in the UK that is changing. Pemberton also wrote,

Doctors are notorious for being apathetic when it comes to fighting their corner. Not this time. We are so horrified by what is happening that there is now even talk of a strike.

In fact, doctors' protests were planned today in both London and Glasgow. The Telegraph reported on preparations for the London rally,

Speakers at the march in London and rally in Glasgow will call for the new online selection system, Medical Training Application Service (MTAS), to be suspended.

Andrew Lansley, shadow health spokesman, who will address the London march, says that MMC is 'an appalling shambles.'

'It risks undermining the morale and the future of the medical profession. What is the point of expanding medical school places and then destroying the career progression of juniors?'

'We cannot, we must not, abandon thousands of junior doctors; we must ensure that they can fulfil their vocation, for them and for our patients,' he said.

The junior doctors have increasingly been supported by senior doctors including some of the most eminent names in medicine.

The demonstrations have been organised by a grassroots doctors’ group, RemedyUK.

The BBC just reported that 200 doctors rallied in Glasgow today. And NHS Blog Doctor has a first report on the London march with some video. Maybe doctors in other countries should think about following their example. Grumbling to ourselves hasn't done much good.

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