Continental doctors take up top posts in UK heart medicine and surgery

Leading jobs in cardiovascular medicine and cardiac surgery in the United Kingdom are increasingly being filled by doctors from Italy, France, and Germany, says an editorial in the European Heart Journal by leading members of the two specialisms.

British doctors are being put off academic jobs by lack of flexibility in training and the rewards of private practice, says the article (European Heart Journal 2004;25:1568-9).

“The pursuit of private practice, which generates enormous incomes among NHS physicians and surgeons, produces role models for junior doctors who aspire to material wealth as opposed to intellectual advance,” say the authors.

They say that cardiovascular medicine and surgery in the United Kingdom have recently seen the recruitment of many senior consultants and professors from Italy, France and Germany.

The authors—Professor John Martin, director of the Centre for Cardiovascular Biology and Medicine at University College London, Dr Philipp Bonhoeffer, chief of cardiology at Great Ormond Street Hospital for Children, and Professor Gianni Angelini, professor of cardiac surgery at the Bristol Heart Institute—say that continental doctors are attracted to the United Kingdom partly by the belief that merit is rewarded.

At the same time, they say, there are “fewer and fewer natives wishing to pursue academic careers.”

They say that several medical and cultural changes are influencing British doctors against pursuing a career in academic medicine.

“Calman training has produced uniformity, which tends towards mediocrity. In the past, flexibility of training allowed academics to experience and enjoy research and build a training that was suited to their own career needs. This gave a diversity of skills and ways of thinking.”

They add, “Once junior doctors have achieved their training number, they know they are almost certain to be appointed as consultants. This removes incentive for initiative and differentiation.”

The authors say that many specialist registrars expect a consultant post immediately their training finishes and a private practice to go with it.

“On the continent, especially in Germany and France, although private practice does occur, the proceeds often are used for the good of the department as a whole and not for individual gain,” they say.

“British doctors choose private practice partly because they see that their contemporaries, for example in financial services, earn more money than they do and partly because of the failure of academics to act as role models.”

The editorial says that little is likely to change in the short term and that Calman training will tend to produce homogenous trainees with an inclination towards mediocrity and private practice and away from the excitement of discovery.

But the editorial—whose authors are British, French, and Italian in origin—suggests that the continental takeover may have its advantages.

“A system where many of the leaders of academia are continentals and the foot soldiers of the health service are natives, is not necessarily a bad thing. It may produce a new flowering of British research led by a mixture of continental ideas and flair which is combined with the unique British system of funding research.”