Læknablaðið - 01.06.1972, Blaðsíða 57

LÆKNABLAÐIÐ
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of graduates working in hospitals and who are not established in
senior posts to established seniors, and this also occurs in the Federai
Republic of Germany. But in Scandinavia the younger graduate, even
if he has not the clinical independence expected by the established
consultant in Britain at an earlier age, has remuneration at a level
which compares favourably with that of others with comparable
academic backgrounds in other professions. In Britain this was nct so
and the pattern of remuneration was based rather upon the thesis
that training would be completed in 7 or 8 years from passing
the qualifying examinations and would be followed by establishment
as a consultant in the hospital service. There were no opportunities
for large increases in earnings by consultation privately or under an
insurance system and the great majority of such consultations occurred
in hospital out-patient departments which patients only reached after
reference by their general practitioners and where no fee was payable.
At the same time the pattern of remuneration in general practice
offered little encouragement to the establishment of more doctors in
that field and the provision of group practices or health centres from
which doctors could work was very limited. In 1960 there was
therefore both a low level of intake to the medical schools, poorly
organised. training systems whether for specialist or general practice,
and difficulty and delay in establishment in either. The high level
of emigration of medical graduates to Australasia and North America,
where both the demand for doctors and the pay offered was high, was
therefore not surprising.
If systematic preparation for establishment in any form of practice
was ill organised and to an extent unencouraging, organised con-
tinuation training was also inadequate. Yet the method of organisation
of general practice in Britain was such as to emphasise the need for
training of this kind. Only a minority of doctors in general practice
had any direct association with hospital work, particularly in those
specialties most likely to be helpful in general practice such as general
medicine, psychiatry and paediatrics and there was therefore little of
the opportunity that hospital staff members have of refreshing their
knowledge from one another. True, in the six years up to 1960 there
had been an increase in the number of general practitioners working
together as groups and the provision made under the National Health
Service for assistance in taking postgraduate courses, which were
provided by the universities, was being used on a slowly increasing
scale. The Royal College of General Practitioners had been established
long enough for its influence on educational and research work in
general practice to be felt, but it had not yet the authority it has
since achieved. In fact there were few incentives to increase partici-
pation in postgraduate work and there was too little general prac-
titioner participation in the planning of what was presented to them
in postgraduate courses.
Early in 1960, quite independently, senior doctors from Stoke-on-
Trent and Exeter came to see me to seek help in obtaining hospital
land for the development of postgraduate centres in those two cities.