Mangling Medical Careers

I hope most people are aware of the Medical Training Application Service (MTAS) fiasco. Whilst it has served me reasonably applying to foundation training, the plight of thousands of applicants to specialist training, who have been selected without acknowledgement of skills or experience, or suitability for the individual post, is henious.

But MTAS is just part of the joke that is Modernising Medical Careers (MMC). This government 'project' was designed to reform the medical training process. All well and good. But it has created a monster that has the potential to alter the shape of medicine forever in this country, and not for the better.

The European Working Time Directive (EWTD) has served as a convenient catalyst for many of these changes. By refusing to allow doctors to be exempt from the short working week imposed by EWTD, the government are able to find alternative 'solutions' to fill the service gap. Hospital At Night schemes, which replace juniors overnight, and endless 'practitioners' (anaesthetic care practitioners, emergency care practitioners, nurse practitioners, emergency nurse practitioners, surgical care practitioners etc.) all contribute to the dissolution of skills to professionals outside of medicine. No bad thing in itself necessarily, but part of an erosion of the profession.

The next step in the MMC plan is the sub-consultant specialist grade. Rather than being rewarded for completion of specialist training by consultancy, doctors will be forced to become 'specialists'. This will of course attract less pay and less clinical prowess than the consultant grade. And it will be 'justifiable' because we will have worked about 1/3rd of the hours required by today's consultants, thanks to EWTD. Our clinical skills and experiences will have been limited by fewer hours and the fact that 'practitioners' will be seeing many of the patients with which we would have gained that experience.

There are other flaws in MMC. For example, the rigid process makes it almost impossible for doctors to get experience in alternative specialities and there is no easy way to change speciality mid-way through. Experiences such as a year overseas or aid work will become harder.

This is all before considering the MTAS issue.

MMC arrives conveniently alongside a raft of other changes to the profession. The Chief Medical Officer has decided that doctors accused of professional misconduct will no longer need to be guilty "beyond reasonable doubt", but there will simply need to be a likelihood that guilt is present. Changes to the GMC will see the lay public increase its regulation of doctors - already proven to be a problem with their involvement in the failed MTAS process.

I am categorically not against change. It is a necessary part of progress. But this change is ill-devised, unintelligent and lacks support of anyone other than peerage-hunting, government saps. We've sat on our laurels for too long saying "it won't happen", well now it is, and if we don't start making a fuss, we'll lose out. There has already been talk from the government about "downward pressure" on wages. This has been confirmed by insulting pay rises this year for doctors. Plan announced today discuss walk-in centres and other services "filling gaps" in GP cover - not recruiting more doctors.

As a doctor or medical student you have 2 choices. Sit back and proclaim that it will all work itself out in the end, and end up an ill-treated pawn working for Tesco Health (today's other new initiative). After 5 years hard work, is that REALLY the profession you want to work for??