Anthony Daniels: Who wants to be a doctor these days?

Once before, the high proportion of women doctors was taken as a sign of social advance: in the Soviet Union
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The Independent Online

The white male doctor is a creature of the past, verging on extinction, according to an article in this week's British Medical Journal. Henceforth, the medical profession will be dominated, at least numerically, by women and the children of immigrants.

No doubt there will be many who rejoice at this. The white male, they will say, has had his way for too long, in everything from the literary canon to politics. And even those who have no such ideological antagonism to white males may see in it a heartening sign of a new openness in British society. Indeed, the fact that nearly a quarter of British medical students are of Indian subcontinental descent is a powerful argument against the idea of institutional racism.

But every silver lining has its cloud, and the cloud is this: a steep decline in the attractiveness of medicine as a vocation, profession and career. The demographic change, so lauded by some, may well be a symptom of this.

Once before, the high proportion of women among doctors was taken as a sign of social advance: in the Soviet Union. Books extolling the achievements of the Soviet Union rarely failed to mention the high proportion of women in the medical profession, omitting that the profession itself suffered a serious decline in prestige after the revolution. Doctors were often paid less than factory workers. No one who ever experienced an ordinary Soviet hospital (and not one of its showcase institutions) will be in any doubt as to what a decline in the prestige of the profession meant to patients.

It has long been the goal of the government to deprofessionalise medicine and to turn its practice into a mere job. An independent profession, with its high standards and old traditions, is dangerous to the government, especially when it is as respected as the medical profession (doctors repeatedly come out in surveys as the people the general public most trusts), in a way in which a mere group of shift workers will never be.

And junior hospital doctors are now shift workers, proletarians of the wards. There is no doubt that shift work is appropriate to a proportion of hospital medicine - intensive care and accident and emergency, for example - but it is totally unsuited to most of it; it both dehumanises patients and deprives the work of most of its satisfaction. It is also grossly inefficient.

This is far from the only way in which the attractiveness of medicine has been undermined. The independence of doctors has eroded almost completely in the past two decades, and you cannot expect highly educated people who have undergone a long and strenuous training to remain contented for very long with being harried and reprimanded by people who are of lower calibre than themselves.

I refer, of course, to the managers. Perhaps the most vivid exemplification of the New Hospital Order - the healthcare equivalent, perhaps, of the New World Order - was the noticeboard in the corridor of the hospital in which I worked until my recent retirement, which informed the public of the senior staff of the hospital. The senior consultants, all men of considerable distinction, appeared on the fifth and bottom row, under four rows of bureaucrats. The impression was given that they were of very minor significance.

The shortening of training, both graduate and postgraduate, is another straw in the wind. New hospital consultants do not have the breadth of experience that old consultants had at their appointment, and this is because doctors are increasingly regarded as technicians and nothing more.

Of course, the prestige of a profession, and the respect accorded to it, does not evaporate in a trice. Thus, women and the children of immigrants who become medical students will for a time think that they are storming the bastions of privilege and exclusivity; but they will soon enough discover that the bastions have merely crumbled away and they have been fooled into taking possession of a ruin.

I write this in the house of an old friend of mine, a distinguished physician who came to England from India. His daughter has just qualified in this country as a doctor, and not long ago was enthusiastically looking forward to her career. A couple of years of shift work, however, have changed all that: the medical profession is no longer good or satisfying enough for her, and she is seeking a career elsewhere, as are 25 per cent of new medical graduates.

So the passing of the white male doctor has several meanings, and one of them will be ominous for those who are foolish enough to fall seriously ill in tomorrow's Britain.

The writer is a retired GP and prison doctor

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