In a word: revalidation.
Amongst his medical friends, Dr No knows of two doctors who have already decided they will have no truck with revalidation. This is not because they are dodgy doctors, with dark secrets to hide – truth be told, they are very good doctors – but simply because the concept of the state deciding whether a competent, independent truly professional individual is indeed competent to practice is anathema, and a travesty of all that a true profession stands for. They would rather be out, than submit to state controlled ritual humiliation.
To know such honest thoughts of another doctor, one needs to be on adequately intimate terms. Dr No estimates – he makes no claims for rigorous statistical practices here – that the pool of doctors he knows on such terms, and has had opportunity to discuss the matter with, might number between ten and twenty doctors. Doing the sums, that gives between ten and twenty percent of this quite possibly absurdly biased sample (these doctors after all are on intimate terms with Dr No); but if we for a moment apply those percentages to all 245,026 (Aug 2011 figures) doctors on the General Medical Council’s register, then, on this basis alone, we can expect to see, in round terms, between 24,500 and 49,000 doctors fall off the register as revalidation kicks in.
So far, we have only considered those doctors who leave because they find revalidation repugnant. Let us now add in the dodgy doctors, the hopelessly unorganised for whom the appraisal folder remains forever blank, the victims of Responsible Officer vendettas, and all those locum and independent practitioners who fall outside the machinery of managed environments. Dr No simply has no idea how many doctors will fall within these categories; your guess is as good as his. Purely speculatively, Dr No wonders whether it might be about as many as those who choose to leave on repugnance grounds. If so, in round terms, some fifty to a hundred thousand doctors are set to leave the profession as the first revalidation round is executed.
The reason why this cull will be so devastating in absolute numbers of doctors lost is because it is in effect what epidemiologists call a prevalence screening round. When we introduce a new form of screening, and here we might consider revalidation as a way of screening doctors for fitness to practice (ha ha, very funny – Ed.), the first round picks up not only recent new cases – so called incident cases, but also all the other cases that have been around for some time – so called prevalent cases. Because of this, the first, or prevalence, round of a screening programme picks up more cases, sometimes dramatically more, depending on the natural history of the condition, than subsequent incidence rounds, which only pick up new cases that have arisen since the last screening round.
The impact of this initial prevalence round on the numbers of doctors left able to practice medicine in the United Kingdom seems to have wafted like a cloud in a summer’s sky over the heads of those so keen to set revalidation in motion. But never mind: the Daily Wail will scale new orgiastic heights of anti-doctor fetish; the government and its GMC goons will have effectively cleansed the profession of undesirables; and Niall Dickson, the GMC’s Chief Pongo, will become known as Nero Dickson, for fiddling while the profession burns. The rest of us will be left wondering: where have all the doctors gone?