THERE ARE CONSTANT COMPLAINTS THAT BRITISH PUBLIC HOSPITALS ARE SHORT-STAFFED: MEANWHILE:

Dr Michael Daley, 24, had every expectation of making steady progress through the training grades on his way to a consultant post in an English hospital. He did not expect to be signing on the dole. Last week he applied for the job seekers' allowance and on Wednesday he returned to the job centre to sign on. He is now officially unemployed. Dr Daley, a medical graduate from Manchester University, had completed his first "pre-registration" year as a house officer and confidently began looking to the next step on the career ladder, a training post as a senior house officer (SHO).

He made about 30 applications to no avail. More recently he has put himself on the books at four locum agencies but there is no work for him there either. He has a student debt of œ25,000 and a share of a œ200,000 mortgage on his home in Manchester. He says that he is only looking for work in the North West of England, but does not think it is unreasonable to try to find work in one area of the country. He wants to become a physician but has been flexible, seeking SHO posts in a number of specialities, including paediatrics, intensive care and accident and emergency medicine.

Dr Daley entered medical school with five grade A A-levels and his CV is good enough for at least one of the locum agencies to be surprised that he had not secured a permanent post. "When I started in medicine I never imagined I would have this kind of difficulty," he said. "Signing on is not what I wanted and not what I had planned. The position is now that I have three months to look for a job in my field. After that I have to look in other fields. I have also signed on as a bit of a protest." Dr Daley told the British Medical Association News Review that he had been prepared to seek a "trust doctor" post, which was not part of the consultant training system.

He is now looking to work abroad and has approached recruitment agencies in Australia. "It's the sheer number of applications per place here - 600 to 700. It is very hard to get through," he said. Dr Daley is one of a number of young doctors who have been caught out by a mismatch between the increased number of doctors coming up through the system and the number of SHO training posts available, as well as a change in the training structure. Last month the BMA identified more than 100 young doctors who could not find jobs and an average of 200 applications per post, although some had attracted as many as 1,000.

Dr Andrew Rowland, the chairman of English regional junior doctors committees of the BMA, said yesterday: "It is quite worrying as these doctors have cost hundreds of thousands of pounds to train." In Australia, where they are short of about 3,000 doctors, medical recruiters said they would be taking advantage of the situation in Britain. It costs nearly œ250,000 to train a doctor. A spokesman for the Department of Health said: "There is simply no question of hundreds of doctors being 'on the dole'. "It's not unusual for new graduates to either work abroad or travel after their pre-registration house officer year.''

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"Expert patients" make healthier people: "Over in Britain they've started a new program on the BBC network (Channel 4), designed to empower and assist those suffering from chronic pain and other prolonged disease. It's called 'The Expert Patient' and it is getting mixed reviews from the medical profession. As the first episode of the show itself acknowledges, when a physician some 30 years ago made the pronouncement to a group of interns that 'This patient knows more about her disease than I do,' he was not being complimentary to the patient. But nowadays even the British government, and the officials in its state-sponsored health system, are moving toward a more self-aware patient model, whereby those actually suffering from chronic pain and other lasting ailments can play a more active role in their own care and treatment. The TV program is designed to promote knowledge in those patients, and the people who care for them, so that the physician's job becomes simpler, and focuses on the larger questions of healthcare."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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