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How To Get Rid of Doctors

Posted by Dr No on 25 August 2011

gmc_squad_1.jpgIn 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?


I think probably at the lower end of your estimate, with a cull of 10 to 20% of current practitioners. I think the principled refuseniks are outnumbered by the "can't be arsed" and those who are thinking of early retirement anyway. I think very few will be discharged by the system, as their employers will be required to produce remedial training in whatever the revalidation daleks require. I already do some remedial training for the deanery, so have some insight into the process. In practical terms the hoops will be sufficiently humiliating that the subject will not need to be put before a firing squad, just handed the revolver, and will take the hint.

The casualties will be at both ends of the career ladder, the youngsters will either migrate or go to other careers, the seniors will retire early. The winnowing will leave some like me, resentful but with no practical alternative, and a considerable number who either tacitly or overtly support the medical police state. Whistleblowers will be Particularly badly treated.

And what if the feminist culture collapses?

We are bringing in 60% - 70% plus of females into medical schools. Many of them will want to work part-time as they bring up their families. What proportion of say a 5 session a week contract will require to be spent on CPD, appraisal and revalidation? It should be the same amount of time as those on a full time contract since the knowledge and introspection required for these activities is not curtailed by working less hours. So two women working 5 sessions each will require double the amount of time away from patients. This is neither cost effective nor in the interests of patients.

What about the university fees that have to be paid back? Many children of these woman doctors will have a father who is also a doctor. He will probably work full-time, since, in spite of the feminism lobby, it is often still the father who is regarded as the main breadwinner. There may be two loans to be paid back. Many woman doctors will be nowhere near the breadline. They may choose to work notional hours to keep in touch yet not qualify for loan repayment, or stop working completely.

What about child care / nanny wages?

What about the indignities and lack of professionalism surrounding revalidation?

What about the strain and expense of living apart as parents when two junior doctors are, by necessity, training in different parts of the country?

The Witch Doctor predicts that women doctors hold the card that will make governments panic.

They will say "I want to have a decent life and watch my children grow up. Life is too short for working in the monstrosity that medicine has become. Enough is enough."

And we will be back to this again. A true story.

This is what doctor shortage looks like.

Why are you so frightended of revalidation. It wont be a big deal. Across the Pond the doctors have to resit finals every five years - not that is a big deal
All best
Love your blogs

Medical careers are very different here, with nearly all of us employed by the state. In a free Market health care economy revalidation may have a role in ensuring quality. In Britain the revalidates will be our employers, greatly increasing the power of the state. Dissent can be punished either overtly or covertly, with little in the way of possible response.

I think WD is right, and that one group that will be very hard hit will be women part times and on career breaks. It would be good if the HCSA, Remedyuk or even the spineless BMA were to take up an indirect discrimination case.


I don't think most doctors are frightened of revalidation. They just think it is a juvenile, pointless, stupid time-wasting, demeaning activity draining off some more NHS money into the private sector. If and when revalidation finally kicks in just follow the money and watch the private companies appear out of the woodwork with their wonderful "Tool-kits" to help all of us child-like doctors to get ourselves revalidated "Blue-Peter" style.

Those of us that carry the witching gene, (possibly Dr Phil is a recessive witch), can see that revalidation has the potential to creep so that the state dictates what doctors are expected to do. For example, there is a movement afoot to reintroduce capital punishment into the UK. If this movement were to be successful, what ultimately would be the doctor's role in that?

The most important part of revalidation/ appraisal is CPD and keeping up to date. An exam every five years is much more sensible than the hoops of revalidation. But exams have their own limitations too and there are better ways of doing it but they all require that doctors are trusted as a profession. We have to be trustworthy and to be trusted. Most of us are. That's what we need to build upon. After all, patients every day trust us with their lives. What greater trust is there than that? Compared to that, revalidation and appraisals are petty things. CPD, altruism, ethics, compassion and trustworthiness are not. They cannot be accurately measured and so it is not a good idea to waste public money trying to do so because somebody up there thinks it is a good idea to be "seen to be doing"

As I am one of those that left a little while back, I would like to know about the situation with private hospitals especially the big set ups. Are they going to do their own re-validation and therefore allow all sorts of “strange” practices to go on. Technically if one consultant will stick his neck out, he could sponsor some doctors on a contractual basis even if the doctor is “unemployable” in the NHS. We had it good, most of the time and the politicians either did not know it or pretend that they did not know.

There is a chilling irony in the very use of the word 'revalidation'. To (re)validate something or person carries a whole raft of overtones quite absent from other more apposite words, like accreditation, or even (re)certification, even if the latter's parallel sometime use in mental health renders it embarrassingly ambiguous. One suspects the word 'revalidation' may have been chosen because of its overtones of truth and trustworthiness - but as the WD points out, trust and trustworthiness have always been inherent to, and at the heart of, medical practice. The irony is that, by introducing revalidation, we also introduce the opposite state of non(re)validation - which sounds most untrustworthy - and, even worse, make that untrustworthy non-(re)validated state the default one.

As it happens, one of Dr No's earliest posts, The Lies of Others, touched on how revalidation can damage trust. In it, he quoted a passage from the 2002 Reith Lectures, and it seems as pertinent now as ever:

“We say that we want to end the supposed crisis of public trust, and we've tried to do so in part by making many professions and institutions more accountable so that they are trustworthier. In these lectures I have queried both diagnosis and remedy. We may constantly express suspicion, but it is not at all clear to me that we have stopped placing our trust in others: indeed that may be an impossible form of life. We may constantly seek to make others trustworthy, but some of the regimes of accountability and transparency developed across the last 15 years may damage rather than reinforce trustworthiness. The intrusive methods that we have taken to stem a supposed crisis of trust may even, if things go badly, lead to a genuine crisis of trust.”

Meanwhile, the chiropractors (who you may recall increasingly like to present themselves, US-style, as 'primary healthcare professionals') have decided NOT to have revalidation.

They tell us this is because chiropractors are all so exceptionally competent (apparently), and you can't do any harm with chiropractic (errmmm...)

You couldn't make this stuff up.

Loved reading your posting. I am going to bookmark this post, so I can come back and read more later. Take care of yourself. cyberbullying

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