Monday, 15 December 2014

Guest article - the real motives behind Shape?

I’d be careful not to go off on the tangents about the sadistic medical narcissists of the 1970s or to blame “The Trendy Educationalists” for these policies. This is driven, top-down, by the government, hence the involvement of lay folk (plus a few of the usual suspect Quisling collaborators from the ranks of the medical politicians). It is driven by the interests of the corporates, who have the politicians in their back pocket. We all dislike the bullying tyrannical consultants of the 1970s & the patient-averse oafs pushing Mickey Mouse reflective learning, but they are not the enemy here.

The aim is to have a very large pool of medics, who have no job security, self-confidence or professional self-respect. They needed to smash the old UK medical firm model to create US/EU-style 'attendings'. The old UK consultant grade had its faults & was by no means perfect. It was suited to the days of “generalism” in the truest (i.e. non-corrupt) sense of the term. Bottle necks & folk, lying in wait for uber-specialised tertiary centre posts, meant that, perversely, it took longer for folks to become sub-specialists, doing a very narrow range of repetitive tasks, than it took people to become generalist consultants. The consultant model was better suited to medicine than some other specialities, it did a lot for my speciality (anaesthetics), raising standards big time. But, it has had its day. The one size fits all MMC approach confused public health training with clinical training. You can randomly allocate a mixed bunch of medics & non-medics to random sequences of QUANGO placements & give them a chit saying they are trained PH specialists after 3 years, you cannot do the same with surgeons. Yet, this is precisely what is being proposed.

The stuff about generalists is despicable. They have realised that subspeciality–ologists don’t do acute medicine & they reckon that scrapping current training pathways to create a pool of accredited generalists will make it easier to staff the few remaining major acutes that will be left when cold sites are sold to private companies, who’ll run them to rake it in from elective surgery. A few doctors will get work in these privatised units, the rest will just end up doing shifts in the major acutes. This is about herding doctors to do skivvy work instead of the work we aspire to.

Expect the medical establishment to make it as difficult as possible for generalists (and existing consultants) to acquire the essential credentials to do any meaningful elective surgery/-ology. Such restrictive practices will suit the corporate subcontractors, who’ll have no problem recruiting medics, with huge student debts & mortgages, who’ll be desperate for scraps of work. Doctors are like scouts, they love acquiring silly badges, without realising how tacky it looks & how their egos are being massaged. It is a con trick. Credentials are barriers, limiting people in what they can do. Fools think they'll do an online course & get the leadership credential, enabling them to lord it over others. Dream on! Things like Breast Surgery will get credentialed, which means that generalist cst-holders wont be able to do it, so they'll have to continue doing shifts at the local major acute, doing back-to-back abscesses & laparotomies. The "Sell" is that this system will enable you to show what you can do. In reality, it will prohibit what you can do & you'll be at the mercy of employers, who'll offer you jobs doing stuff you'd rather not do (shifts in acute surgery) rather than training for the stuff you want to do (major cancer work, bariatrics etc). Create cst oversupply & then limit what cst-holders can do [most elective work]. Suddenly, acute surgery gets a whole lot cheaper!

Remember, the DH know that doctors will always happily kick the ladder away from their younger colleagues. They figure that we'll figure that a new SR grade would be in our interests. It is classic divide & rule. Naturally, the guys doing their PhD in the cell biology of Ca Oesophagus will figure that they will effortlessly become credentialed in upper GI surgery, whilst their younger colleagues will simply become shift-working acute surgeons, doing the "low level" stuff. Please lets not fall for this. They are not redesigning medical careers to cater for some indescribably brilliant doctors, who are head & shoulders above their peers. They are doing this to undermine the profession & make it easier to errode our pay & T&Cs to suit their corporate cronies, who'll end up hiring (and firing) doctors. Wake up!

We need to oppose this & that means jettisoning the traitors in the medical establishment, who’ll try to stifle proper resistance.

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