New cures for the doctors in trouble

March 27, 1998

People are staying healthier - and therefore living longer. As a result we need more doctors. Another 1,000 medical school entrants a year is proposed, an increase that would involve upping medical school intakes by about a fifth.

The government will not want to pay pro rata for a 20 per cent expansion of medical training nor meet the capital costs of 1,000 new training places. Indeed, the risk is that it will bow to short-term pressures and put any extra money into treatment, not education, concentrating on cutting waiting lists and avoiding patients-on-trolleys crises.

This means that if extra doctors are to be produced, as they should be, new ways of doing it will have to figure in future plans. There are plenty of ideas around that are far more sophisticated than those advanced to cure the problems of other shortage professions such as engineering.

Most popular is a three-year short-track medical degree for people with a biological sciences degree. People who decide to become doctors at 21 may make better professionals than those attracted to medicine as teenagers. However, a short track for the medical school may be a long one for the student. Three or four years of undergraduate life followed by three more years of qualifying as a medic might well look unattractive in the world of student loans and fees.

Another idea is to create a new group of health professionals who do not boast the full range of skills of today's doctors. Why does a heart or lung specialist need the full range of medical knowledge when the person you see about your teeth does not? It has long been said that a medical degree is more like 60 GCSEs in a row than a full degree in another subject, so why not reduce the number of topics to produce people faster who could still be effective?

Such medics would have problems with both the public, who would doubt their standing, and with other doctors, who might see them as presumptuous nurses or chiropodists rather than colleagues.

But creating new types of professional could help expand the social mix of doctors and the educational base from which they come. Medicine is almost entirely the preserve of old universities. A medical school is a badge of status in a way that even the best business school is not. The sooner new universities, or the Open University, get into the field to enhance educational and social diversity, the better. Such new schools might well have more feel for the needs of their students. not everyone who would make a good doctor wants to have to prove their dedication by working three times the hours that would be illegal for a lorry driver.

Plans for training more doctors should not, however, be considered in isolation. They should form part of a wider political reappraisal of the supply of medical services across the community. It has long been known that the poor get ill more often and live less long than the rich but new wrinkles are emerging in recent research (pages 22-23). Some poor communities flourish. Societies with flatter income distributions and less stress seem to be less illness-inducing. Social policies that make it easier for people to work may lead to less illness and less wear and tear on doctors. Tax changes to encourage making houses less draughty or smoking less affordable may play a role. Demand for medical services is never likely to be satisfied in the way the NHS's founders hoped but that should not excuse politicians from constantly seeking ways of providing services as even-handedly as possible.

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