Læknablaðið - 01.06.1972, Blaðsíða 54

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LÆKNABLAÐIÐ
in hospitals designed rather to provide workers for the hospitals
than opportunities for young graduates to complete their training in
a purposeful and expeditious manner. By contrast the young graduate
in the United States or Canada after an intern year enters a residency
training programme which is intended to bring him to a position
where he can establish himself in some 3-5 years. There are obviously
conflicting interests here. A comprehensive National Health Service
includes hospitals which must be run primarily in the interests of
patients and for that a balanced pattern of medical staff is necessary.
In the British National Health Service the great majority of all
medical practice is within the Service and so far as specialist work
is concerned, the percentage is probably more than 95%, including
most of the most highly specialised work and nearly all the long-stay
care.
In the tradition of British medical practice, young doctors sought
opportunities of working as juniors to those they wanted to emulate,
if they hoped ultimately to be speci: bsts, and for the rest it was left
to chance or casual opportunity whether the posts they took as
juniors in hospital were of a kind that prepared them for general
practice or preventive medicine or whatever other avenue they wished
to follow. The former design of staffing of the teaching hospitals,
which was primarily directed toward training specialists, was adopted
generally in the National Health Service in 1948 without any serious
thought being given to designing anything else. Moreover the pattern
of training was thought to be essentially a concern of the profession
rather than the Service, and neither the Health, Department nor the
profession applied themselves to its planning.
It also happened during the later 1950s and through the 1960s
that there was a large influx of graduates from abroad, especially
from India and Pakistan, where the output of medical graduates had
greatly increased (India 18-86, Pakistan 1-12), and the opportunities
for them gaining further experience in substantial hospital units were
far below requirements. This made it possible for junior hospital
staffs in Britain to be greatly inflated so that a relatively few qualified
specialists, supported by many juniors at varying stages of training,
could provide a service irrespective of the future that that service
then offered to British graduates. Had there been no influx of
graduates from outside, the need for an increase in the British medicai
schools would have been much more apparent and the importance
of arranging things so that British graduátes could become established
in hospital specialties after a reasonable period of training, would
have been so obvious that the balance might have been adjusted
much earlier. As it was, a Committee of Inquiry reached quite fal-
lacious conclusions about the intake required for the British medical
schools and actually recommended a reduction in 1956 at a time when
a clearer view would have caused evei'y effort to be applied to in-
creasing the production of doctors.
In Scandinavia generally as in Britain there is a high proportion