One big problem that no one in the medical establishment has even dared to think about addressing is the European Working Time Directive (EWTD). The phrase 'head in the sand' comes to mind when describing the attitude of the government, Royal Colleges, PMETB, BMA and other institutions to the EWTD.
By August 2009 all doctors in training will have to be compliant with 48 hour a week rotas. The Surgeon has published a piece detailing what a failure the pilot introduction of these new EWTD compliant rotas has been. Not only did the new 48 hour rotas result in poorer quality training for the doctors but it also resulted in a large majority of doctors feeling that patient's care had been compromised by a lack of continuity.
The naive proponents of MMC believe that their revolutionary new methods of training, consisting of lots of paperwork and lots of hot educationalist waffle, will increase the quality of training so much that a reduction in hours will have no effect on training. Any trainee on the ground will tell you how dumb this approach is, as the reduced hours has resulted full shift rotas replacing older more training friendly rotas, while there is far more cross cover than ever before, meaning that more time is spent doing mundane admin as opposed to the juicy training bits of the job. I won't comment on the paperwork burden, other than to say that chopping down trees only trains lumberjacks.
EWTD in its current form will further worsen patient care in an already fragmented service that lacks any continuity of care, and it will arguably worsen the quality of training even further in a system which is not giving enough exposure or experience to trainees as it is. Firstly training doctors need to realise that if we are to remain highly skilled professionals then we must remain apprentices in our trade and we cannot allow our hours to drop yet further. Secondly we must force those who represent us to listen to our views, and those who represent us must then force those in government to listen. If we do not, then the effects of EWTD could be quite catastrophic.