UK "Modernising Medical Careers" Initiative Spirals Downward

Last week we discussed the controversy over the new UK system for selecting physicians for senior specialty training positions. Things only seem to be going downhill. Again, commenting at risk of misunderstanding the context in the UK…

A group of senior surgical consultants suspended interviews of “short-list” candidates because they had no confidence in the system that selected them. Per the Daily Telegraph, Bob Spychal, the Chair of the interview panel, said,

The 10 surgeons were unanimous. We know we have disappointed the candidates and we have spoken to all of them, but we have no confidence that the system is robust and fair. It is not fit for purpose. Someone had to do something. Perhaps other panels in other specialities will do the same thing.

Meanwhile, the Academy of Medical Royal Colleges urged the Ms Patricia Hewitt, the Health Secretary, “to undertake an urgent review of the process of selection.” Dr Jonathan Fielden of the British Medical Association warned “we now have no faith in the system.”

Then, the Department of Health did agree to review the system, but, according to the Guardian, it did not agree to stop or immediately modify the interview process. In fact, according to the Telegraph, a government official insisted the system continued to work “well.” This provoked the British Medical Association to accuse the government of arrogance. Said Dr Fielden,

The arrogance of the department in ignoring this has resulted in the most devastating effect on a generation of junior doctors.

And the Dean of the Royal College of Psychiatrists, alarmed at the “total lack of transparency” in the selection process, warned of the effect on the “human rights and mental health of trainees.”

Meanwhile, in a separate report in the Guardian, “the British Medical Association accused the government yesterday of instilling a ‘culture of fear’ across the NHS to stop doctors revealing how health service reforms are putting patients’ lives at risk.” Dr Fielden said, “there is a culture of fear in the NHS and doctors are under severe pressure to meet targets and keep their mouths shut.”

What a mess. Of course, it appears to be a perfect example, writ large, of the effects of transferring power over health care from physicians and other health professionals to executives, managers, and bureaucrats. In the UK, most of these health care leaders are government employees. In the US, many of them are executives of for-profit and not-for-profit corporations. But, in general, putting in charge people with inflated ideas of their own managerial powers and little notion of how health care works or the values of health care professionals seems to have the same effect whether they are in charge of government agencies or private, for-profit or not-for-profit corporations. We see disorganization, seeming lack of concern for effects on the health of patients or the morale of physicians, lack of transparency, and attempts to silence critics and restrict free speech, in sum, mission-hostile management

At least in this case, the UK doctors have had the courage to speak up, maybe before things go irreversibly wrong. In the US, we physicians seem afraid to hold our heads up individually, lest we be hammered down. But we are hammered down anyway.