Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey

ObjectiveTo determine the career destinations, by 1995, of doctors who qualified in the United Kingdom in 1977; the relation between their destinations and early career choice; and their intentions regarding retirement age.DesignPostal questionnaire.SettingUnited Kingdom.SubjectsAll (n=3135) medical qualifiers of 1977.ResultsAfter about 12 years the distribution of respondents by type of employment, and, for women, the percentage of doctors in part time rather than full time medical work, had stabilised. Of all 2997 qualifiers from medical schools in Great Britain, 2399 (80.0% (95% confidence interval 79.5% to 80.6%)) were working in medicine in the NHS in Great Britain 18 years after qualifying. Almost half the women (318/656) worked in the NHS part time. Of 1714 doctors in the NHS, 1125 intended to work in the NHS until normal retirement age, 392 did not, and 197 were undecided. Of the 1548 doctors for whom we had sufficient information, career destinations at 18 years matched the choices made at 1, 3, and 5 years in 58.9% (912), 78.2% (1211), and 86.6% (1341) of cases respectively.ConclusionsPlanning for the medical workforce needs to be supported by information about doctors’ career plans, destinations, and whole time equivalent years of work. Postgraduate training needs to take account of doctors’ eventual choice of specialty (and the timing of this choice).

Key messages

• A large scale national study in the United Kingdom followed doctors from qualification to mid-career and beyond
• Most doctors had made their choice of eventual career—at least in terms of broadly defined specialty—within 5 years of qualifying
• Eighteen years on, 80% of the doctors were working in the NHS and nearly half of women doctors were working part time
• Almost a quarter of NHS doctors planned to retire early

     

The Overseas Doctors Training Scheme: failing expectations.

The Overseas Doctors Training Scheme needs appraisal. Set up 10 years ago to improve the quality of postgraduate training that overseas (non-European) doctors receive in Britain, the scheme has been popular, but it is questionable how far it has achieved its aims. If Britain is to continue to employ large numbers of overseas doctors in training grades, both through the scheme and through independent arrangements, the apparent mismatch between their expectations and the reality of what Britain offers must be tackled.     

The macrobenthos of the river IJssel

Summary This survey of the macrobenthos of the River IJssel, a branch of the River Rhine, was conducted in 1973, 1975, 1976 and 1977. The water quality was poor in 1973 and 1976 and relatively good in 1975 and 1977.The numbers of macroinvertebrate species and numbers of individuals in the stone samples taken from the jetties were lowest in 1976 and highest in 1977.The species composition of the Tubificidae showed a marked difference in various types of substratum at one locality.Decrease of water quality since a study of LAUTERBORN (1918) is reflected by impoverishment of the fauna; for instance, insects have disappeared to a large extent.     

Ecological investigations of the zooplankton community of Balsfjorden,northern Norway: Population structure and breeding biology of the chaetognath Sagitta elegans Verrill

The population dynamics of the chaetognath Sagitta elegans Verrill has been followed in Balsfjorden in 1976 and 1977. Seasonal variation in abundance, length-frequency distribution, growth in total length, and maturity stages are presented and discussed in relation to changes in hydrography.An annual generation of S. elegans was found, with a protracted and more or less continuous breeding season from May until October during 1977. The 1976 year-class consisted of two distinct length groups, both of which participated in the 1977 spawning. This spawning gave rise to possibly four sub-populations during 1977. The variation in numbers of sub-populations produced during the spawning season in 1976 and 1977 is discussed in relation to the hydrographical conditions in Balsfjorden. From November 1976 to March 1977 the abundance of S. elegans varied between 1 and 8 ind. · m^?3. The lowest value was recorded in May (0.9 ind. · m^?3). From September to December 1977 the population abundance was ≈2 ind. · m^?3.     

Career destinations seven years on among doctors who qualified in the United Kingdom in 1988: postal questionnaire survey

ObjectiveTo report the career choices and career destinations in 1995 of doctors who qualified in the United Kingdom in 1988.DesignPostal questionnaire.SettingUnited Kingdom.SubjectsAll doctors who qualified in the United Kingdom in 1988.ResultsOf the 3724 doctors who were sent questionnaires, eight had died and three declined to participate. Of the remaining 3713 doctors, 2885 (77.7%) replied. 16.9% (608/3593; 95% confidence interval 16.1% to 17.8%) of all 1988 qualifiers from medical schools in Great Britain were not working in the NHS in Great Britain in 1995 compared with 17.0% (624/3674; 16.1% to 17.9%) of the 1983 cohort in 1990. The proportion of doctors working in general practice was lower than in previous cohorts. The percentage of women in general practice (44.3% (528/1192)) substantially exceeded that of men (33.1% (443/1340)). 53% (276/522) of the women in general practice and 20% (98/490) of the women in hospital specialties worked part time.ConclusionsConcerns about recruitment difficulties in general practice are justified. Women are now entering general practice in greater numbers than men. There is no evidence of a greater exodus from the NHS from the 1988 qualifiers than from earlier cohorts.

Key messages

• This study reports the career progress to September 1995 of doctors who qualified in 1988
• Loss from the British NHS, at 16.9% (95% confidence interval, 16.1% to 17.8%), was no greater than among earlier qualifiers at the same time after qualification
• The proportion of doctors working in general practice (38%) was lower than in earlier cohorts studied
• In this generation of doctors, women in general practice now outnumber men
• Fifty three per cent of the women in general practice and 20% of the women in hospital specialties were working on a part time or flexible basis

     

Studies on the seed-borne phases of dark leaf spot Alternaria brassicicola and grey leaf spot Alternaria brassicaeof brassicas

Tests in Britain on samples of basic and commercial Brassica oleracea seed between 1976 and 1978 showed that many lots were infected with Alternaria brassicicola. A. brassicae was uncommon in basic seed in these years and in commercial seed harvested in 1976 and 1977 but was frequent in seed harvested in 1978. Most affected seeds were contaminated by surface-borne spores and mycelium of A. brassicicola but many were internally infected by the fungus situated within the seed-coat and in some seeds in the embryo tissues. Superficial contamination by the fungus declined rapidly after 2 yr in cabbage seeds stored at 10 °C, 50% r.h. but internal infection persisted for up to 12 yr. In some samples, internal infection was commonly associated with small shrivelled seeds. Surface contaminated and internally infected seeds transmitted the disease but seedling infection was more closely correlated with the latter.     

Forecasting barley mildew development in West Scotland

Observations on plots of spring barley cv. Golden Promise during May-July 1973–79 showed that escalation of mildew commenced in mid-June 1976, in late June in 1973 and 1974, in early July in 1978 and 1979, and failed to develop in 1975 and 1977. By mid-July there was 40% infection in 1976, and 13–21% infection in 1973, 1974, 1978 and 1979. Less than 2% mildew occurred in 1975 and 1977. Using as a basis the method of mildew forecasting formulated by Polley & King (1973), it was found that once mildew was established in the crop there was moderately good association between the incidence of high mildew risk according to the Polley weather criteria and the major peaks of spore concentration above the crops. It was not possible to correlate these two features during May and early June each year because of a lack of inoculum, but it is considered that the failure of mildew to develop during the entire growing seasons of 1975 and 1977, in spite of frequent high risk periods, was due in part to low atmospheric humidity during the early part of the season. The relative number of accumulated Polley factors satisfied on days when the relative humidity approx. 1 m above ground was 78% or more (at 0900 GMT) during the period mid-May to mid-June, separated the low mildew years of 1975 and 1977 from the moderate ones of 1973, 1974, 1978 and 1979, and the severe mildew year of 1976. This procedure may provide a practical means of forecasting the level of mildew build-up during the later growth stages of the barley crop.     

Work in the European Union.

Continental Europe is now only 20 minutes away by train from mainland Britain, and moving ever closer politically. Mutual recognition of medical qualifications within the European Union is well established: working in other parts of Europe is, in principle, straightforward. Working in different health care systems can offer new perspectives on British medical practice and the NHS. But the cultural differences are not always easy to overcome.     

Recruitment of doctors to non-standard grades in the NHS: analysis of job advertisements and survey of advertisers

Objectives To estimate the proportion of advertised non-consultant hospital posts that do not conform to nationally recognised terms and conditions of service and to investigate why these posts exist, who fills them, and what the doctors in such jobs do.Design Analysis of job advertisements and a cross sectional survey of advertisers.Setting Job advertisements in one of the leading UK publications listing hospital doctor vacancies (BMJ Careers).Results Nearly a quarter of non-consultant posts advertised in the two study periods (23% and 21%) were for non-standard grade posts. A questionnaire was sent to the medical staffing officer for each post. Of 430 questionnaires sent out 192 (45%) were returned. 98 trusts said they advertised non-standard grades because there was no more funding from the deanery for approved posts and 75 because service needs could not be met by doctors in training grades. In 132 posts (69%) the post holder would be required to do on-call work, and 50 advertisers (26%) required on-call duty for 1 in 5 or more frequently, which would conflict with the European Working Time Directive. 131 advertisers (68%) expected the posts to be filled by doctors from outside the European Economic Area.Conclusions Non-standard grade posts are mostly being created to meet service requirements when there is no more funding for standard training posts and are expected to be filled by doctors from overseas. Doctors in such posts can be more easily exploited and their careers hindered. The Department of Health''s annual census should include non-standard grade doctors.     

Seasonal abundance of xerophilic fungi and house-dust mites (Acarida: Pyroglyphidae) in mattress dust

Summary Arthropods and xerophilic fungi in dust from 5 mattresses and air-borne fungi were identified and counted every 4 weeks from January 1976 to October 1977.The arthropod fauna consisted mainly of the pyroglyphid mites Dermatophagoides pteronyssinus (58%) and Euroglyphus maynei (30%). The fungal flora consisted of Aspergillus restrictus (48%), A. glaucus (16%), Wallemia sebi (3%) and Penicillium spp. (25%). Air-borne fungi belonged to the same taxa but in different frequencies, 30, 7, 21 and 27%, respectively. Mattresses differed in quantities of mites and Penicillium.In July 1977, the highest population density of pyroglyphid mites was encountered: 69 specimens/g of dust. In the same month the numbers of A. restrictus rose significantly, reaching a maximum of 3.8×10⁴ diaspores/g of dust. Most air-borne fungi were isolated in the winter period of 1976/1977. No positive correlation was found between the numbers of air-borne and mattress-dust fungi. The summer of 1976 was exceptionally dry resulting in both a premature decline of the mite populations and a low level of A. restrictus diaspores.The seasonal peaks of A. restrictus and pyroglyphid mites correspond and suggest a synergistic cooperation which may result in an increased house-dust allergen production in the environment of asthmatic patients.Supported by grant no. 230 of the Dutch Asthma Foundation     

Monitoring equal employment opportunity at the workplace: The crucial role of the 1991 Census

The fact that the 1991 Census of Population included a race and ethnic question followed evidence from the 1989 test Census that this was not likely to arouse strong public opposition ‐ while the case for race and ethnic data in the Census was overwhelming. This article focuses on the necessity of the data for the proper implementation of the Race Relations Act 1976, especially in relation to employment. It demonstrates how the linking of race and ethnic manpower statistics in the Census to the analysis of local labour‐market areas could provide employers with the means by which they can measure whether or not they are achieving genuine equality of employment opportunity under the 1976 Act. The article illustrates the recommended approach and shows the substantial effect upon the ‘benchmark’ data that results from analysing each major occupation group separately. Finally, the article notes some possible weaknesses in the 1991 Census data that will be available for monitoring equal employment opportunity in Britain.     

Role of the private sector in elective surgery in England and Wales, 1986.

From a sample of 19,000 treatment episodes at 183 of the 193 independent hospitals with operating facilities in England and Wales that were open in 1986 it is estimated that 287,000 residents of England and Wales had elective surgery as inpatients in 1986 (an increase of 77% since 1981) and 72,000 as day cases. From 1985 Hospital In-Patient Enquiry data it was estimated that a further 36,000 similar elective inpatient treatments were undertaken in NHS pay beds (a decrease of 38%) and 21,000 as day cases. Overall, an estimated 16.7% of all residents of England and Wales who had non-abortion elective surgery as inpatients were treated in the private sector, as were 10.5% of all day cases. An estimated 28% of all total hip joint replacements were done privately, and in both the North West and South West Thames regions the proportion of inpatients treated privately for elective surgery was 31%. It is concluded that mainly for reasons of available manpower private sector activity may not be able to grow much more without arresting or reversing the growth of the NHS, in which case some method of calculating NHS resource allocation which takes account of the local strength of the private sector will be needed.     

Acidification of three moorland pools in The Netherlands by acid precipitation and extreme drought periods over seven decades

SUMMARY. 1. Relations between acidification by atmospheric deposition, water depth and the occurrence of dry summers in this century, as well as their effects on chemistry, macrophytes and diatoms in three moorland pools, are described.
2. Direct observations and biological data indicate a decrease of pH by c. 0.5 unit over a period of seven decades in a pool where 20% of the bottom desiccates in extremely dry years, and 2 pH units over the same period in a pool where 70% of the bottom is exposed to the atmosphere in such years.
3. Acidification promotes the growth of Juncus bulbosus L., Sphagnum and the acidobiontic diatom Eunotia exigua (Bréb.) Rabenh. and suppresses the growth of isoetids (e.g. Lobelia dortmanna L.) and of acidophilus and circumneutral diatoms. Also the acidobiontic Frustulia rhomboides var. saxonica (Rabenh.) Toni and Navicula subtilissima Cleve, characteristic of humic waters, decline by acidification.
4. In two pools where more than half of the bottom desiccated in 1976, observed concentrations of sulphate were highest in 1977–78 and decreased later on. Juncus bulbosus had a maximum in 1977–80. Eunotia exigua became the dominant diatom after 1976 and decreased after 1981 in the pool with the shortest residence time (3 years).
5. In desiccating pools the long-term decrease of pH is apparently much larger than in softwater lakes in Scandinavia and North America. During the last 50 years, pH dropped rapidly after dry summers, probably due to oxidation of sulphur and nitrogen compounds which were originally derived from the atmosphere, reduced and stored in the sediments. Rapid falls in pH were followed by an increase, presumably due to alkalinity production during sulphate reduction and denitrification.     

名医素质特征与培养规律的初步研究

目的 探索名医的基本素质特征和培养规律。方法 在文献检索和专家访谈的基础上,采用自设问卷方式进行调查,并对调查结果数据进行统计分析。结果 知名医学专家与患者及家属在名医的内涵、培养目标、成长历程等问题上的观点是一致的,但在名医的培养周期、评价标准、培养方式等问题上存在着不同的观点。结论 名医不仅要拥有精湛的医术和高尚的医德,还要得到老百姓和医师同行的认可。名医的成才需要良好的成长环境和自由发展的空间,在成长的过程中我们可以通过发挥个人主观能动性,增强科室内部凝聚力,健全医师的考核体系,缓解紧张的医患关系,改革医学的教育模式等途径来培养名医。     

Time for change in traditional working practices?

Consultants in Britain are under pressure to change the way they organise their work. Many rely on formal, but unwritten, rules and a culture of "learning by doing." Unlike their counterparts in Sweden, they are often not well integrated into the management systems of their hospitals. The result is wide differences in the NHS workloads of individual consultants and, for a minority, conflicts of interest with their private work. The training received by junior doctors varies because it is largely left to individual consultants. Clinical directorates should provide a more effective mechanism for consultants to influence trust policies and for consultants to implement these policies. Consultants must not only recognise the need for change but also seize the initiative.     

Intravenous antimicrobial therapy in the community: underused,inadequately resourced,or irrelevant to health care in Britain?

The NHS Executive is keen to promote "hospital at home" services in Britain, as part of its philosophy of keeping more care in the community and also to relieve the increasing demand for hospital beds. One such service is the provision of intravenous antimicrobial therapy in the community. Yet, compared with the United States, where home or outpatient intravenous antimicrobial therapy programmes are well developed, experience in Britain and Europe is limited, reflecting a difference in cultural attitudes and healthcare structures between the two continents. Only a few units in Britain currently run home intravenous antimicrobial therapy programmes, and several issues need to be addressed if more treatment is to be provided outside hospital. These include an assessment of the need for community intravenous antibiotic treatment and which patient groups many benefit. The main motive for community intravenous treatment should be better patient care and not simply a reduction in healthcare costs. At present the pace of change is being set by a few clinical enthusiasts and by commercial organisations, whereas the NHS deserves a more organised strategy for purchasing treatment with intravenous antibiotics in the community.     

Fluctuations in the abundance of butterflies, 1976–82

Abstract. 1. A scheme for monitoring the abundance of butterflies at about eighty sites in Britain is described.
2. Indices of abundance are presented for twenty-nine species for the years 1976–82.
3. There are marked differences between species in the scale of annual fluctuations.
4. Some species show correlations between successive index values; for example the summer generation index of Pieris brassicae is highly correlated with the spring generation index.
5. The annual changes in the index values of many species are highly Correlated. The index values themselves also show positive correlations, but these are less strong.
6. The drought of 1976 is believed to have severely depressed populations of many species in 1977.
7. The data do not indicate any general fall in butterfly numbers over the period at the sites in the scheme.
8. The sites are not representative of the countryside as a whole, but, for a number of species, it is considered that the index values reflect wider trends.     

NHS waiting list have been a boon for private medicine in the UK.

Health care: public, private or both? In Great Britain, about 13% of the population is covered by private health insurance, and everyone else is served by the public health care system known as the National Health Service, or NHS. Caroline Richmond, who examined the impact of private medical practice in Britain, says people become private patients for one compelling reason: to avoid the NHS''s notoriously long waiting lists for surgery. According to Professor Alan Maynard, a health care researcher, the mainstays of the private sector are the "three h''s" --hips, hernias and hemorrhoids-- along with some elective surgery, particularly in gynecology and opthalmology. Another small sector focuses on fertility regulation and cosmetic surgery. Although the levels are not monitored closely, physician consultants are not permitted to earn more than 10% of their income from private practice.