The UK’s capacity to contribute to scientific research and educate medical students is at risk without investment in the clinical academic workforce, the Medical Schools Council has said.The representative body for UK medical schools has published data showing that the clinical academic workforce is ageing, with many academics approaching retirement.1 In 2023 over a third (36%) of all UK clinical academics, doctors who undertake teaching and research alongside treating patients in the NHS, were aged over 55, as were 65% of professors. By comparison, in 2004 just 24% of all UK clinical academics were aged over 55, as were 37% of professors.The Medical Schools Council warned that, if the pipeline of clinical academics was not maintained, delivering the ambitions of the NHS Long Term Workforce Plan, such as doubling the number of medical school places in England to 15 000 a year by 2031-32,2 would become far more of a...

LanguagesThe definition of a [natural] language in the Oxford English Dictionary (OED)1 is “The system of spoken or written communication used by a particular country, people, community, etc., typically consisting of words used within a regular grammatical and syntactic structure.” A good clear definition, although I rather prefer the less rigorous but more succinct definition postulated by the US linguistics expert Leonard Bloomfield (1887–1949) in 1926: “the totality of utterances that can be made in a speech-community.”2 Bloomfield further defined an utterance as “an act of speech” and a speech-community as “[a community within which] successive utterances are alike or partly alike.” So there it is—a language. Humans have about 5000 of them, give or take 1000—they’re hard to enumerate.Of course there are other kinds of languages. For instance, computer languages. Well over 1000 of them, from A.NET to Z++.3Then there are the specialised languages espoused by the members of...

Geijteman and colleagues tackle a very pertinent issue in cancer care.1 They rightly ask whether there is too much care towards the end of life in cases of incurable cancer. Many non-oncologists are sceptical of cytotoxic chemotherapy.2The most important driver of potentially futile care towards the end of life are the patients themselves. Multiple patient preference studies have shown that patients with advanced cancer opt for toxic treatments for minimal benefit.34Patients with advanced cancer have an emotionally torrid time, and they use hope to cope with the illness. Cancer treatments are the main source of hope that help them to cope with the impending end of life.56 It is a challenging situation for everyone, but ultimately oncologists respect patients’ wishes in favour of continuing with palliative cancer therapy.Newer molecular targeted therapies and immunotherapies have made the situation even more challenging because they provide the opportunity to extend prognosis by years...

Dyer reports on the junior doctors striking in South Korea in response to plans to increase medical school places.1 The underlying deeper crisis—a shortage of doctors in lifesaving specialties2—is due not to a lack of willing professionals but to systemic barriers preventing effective medical practice.Doctors who work in lifesaving specialties face a tangible threat of criminal prosecution when patients’ outcomes fail to meet the expectations of the patients’ families. In 2020 a physician and her resident were detained over the death of an octogenarian patient with cancer who underwent standard treatment. They received suspended sentences despite the complexities of the case.3 The legal right to initiate lawsuits and the ensuing lengthy legal battles impose an immense burden on doctors who have dedicated themselves to patient care. South Korea sees over 700 criminal cases against doctors annually, a sharp contrast to the 1-2 in the United Kingdom.The burden of funding medical...

Consultants in England have voted to accept the government’s improved pay offer, with 83% voting in favour of a deal that will also see reforms to the pay review body, the DDRB.The deal, which will be backdated to 1 March 2024, will see most consultants receive pay uplifts of between 2.85% and 12.80% in addition to the previously announced 6% pay award for 2023-24.1 Both the BMA and the Hospital Consultants and Specialists Association had recommended that their members accept the deal.2Altogether, 22 700 consultants took part in the BMA referendum from 14 March to 3 April—a 61.9% turnout, with 18 778 (82.7%) voting in favour of the offer and 3922 (17.3%) against. The acceptance of the deal by the BMA’s Consultants Committee ends the current dispute with the government, which has lasted for over a year.This comes after consultants narrowly rejected a pay deal in January, when just over...

What you need to knowHeart failure should be considered in any patient presenting with breathlessness in primary careB-type natriuretic peptide (BNP) is an important initial test for heart failure, with a negative result usefully ruling out the conditionHeart failure encompasses various causes, many of which have specific treatment optionsHeart failure is prevalent worldwide, impacts quality of life, and is associated with high morbidity and mortality. Global prevalence estimates indicate that 1-2% of adults in the developed world have known heart failure.12 In the UK alone, almost one million people have diagnosed heart failure, placing a substantial demand on specialist cardiology services.3 Heart failure often presents in primary care, where many patients have risk factors and long term treatments are usually indicated even after symptoms have improved. This update focuses on recent evidence and changes to heart failure clinical practice guidelines, emphasising aspects most relevant to primary care.Stages and classes of...

There is considerable evidence of the role of commercial actors, particularly harmful commodity producers, and the trade associations and third party organisations they fund, in shaping policy and public discourse to their own ends.12 These actors undermine the adoption of effective prevention policies3 while presenting themselves as health experts and self-regulators.4 The cross-industry use of such strategies, including by the alcohol industry, is well documented. The World Health Organization (WHO) thus recommends that alcohol producers should not be part of policy considerations, beyond policy implementation.56Despite this, in the UK, the alcohol industry remains an active participant in alcohol policy development. A recent parliamentary oral evidence session7 focused on preventing alcohol harms serves as a pertinent reminder of how industry influence is an important obstacle to progress at a time of record highs in alcohol harm.8The first oral evidence session of the Health Select committee’s work stream on preventing alcohol harm7...

The rise in the number of people in England waiting for diagnosis and treatment of autism or attention deficit hyperactivity disorder (ADHD) demands a rethink of the organisation of services, which should include agencies outside the health and care sector, an analysis by the Nuffield Trust has concluded.1The number of people with suspected autism waiting to see a specialist in England reached 172 022 in December 2023, the highest ever recorded and a more than fivefold rise since 2019, it found. The average wait between referral and first appointment was nine months, with some areas having waiting times of more than two and a half years, showed the figures, which are based on NHS Digital experimental statistics.2 This compared with a four month wait in 2019. In 2023 only a fifth of people were seen by specialist services within the NICE target time of 13 weeks after first referral.Without a...

Attorneys general from 25 states have urged the US Supreme Court to protect the ability of emergency department doctors to perform abortions when that conflicts with state laws, challenging Idaho’s almost complete ban on abortion.1The attorneys general from 25 Democratic states asked the US Supreme Court on 29 March to confirm that emergency department doctors could perform abortions in states that ban the procedure in medical emergencies. Doctors who violate the bans face civil and criminal penalties.2The attorneys general argued that Idaho’s ban conflicts with the federal Emergency Medical Treatment and Labour Act, which requires doctors to provide necessary medical treatment, including abortions, to stabilise patients in emergency medical situations. Federal law usually over-rules state law in the US.Kris Mayes, attorney general of Arizona, one of those suing, said, “Access to emergency abortion care is critical for the health and safety of patients facing medical emergencies. Emergency medical decisions should...

This month has been one reeling with uncertainty. For many medical students, March is one of the most difficult months. For some it was the looming pressure of formative, or maybe even summative examinations; for others it was that final rotation rush to get sign-offs. But for final year medical students across the UK, 7 March marked “deanery day,” the day where incoming doctors were assigned to areas of the country where they’ll spend the next two years. This year the new Preference Informed Allocation system has created waves, as explained in a news analysis. Incoming foundation year 1 doctor Nathanael Leaf criticised it in an opinion piece, asking whether the NHS can afford to lose more doctors through taking agency away from them as they set out in their careers.Some BMJ Student and Sharp Scratch alumni spoke candidly to BMJ journalist Adele Waters about their finances, as an independent...

Reuben Thomas, 29, lies motionless in Tanzania’s largest orthopaedic hospital, the Muhimbili Orthopaedic Institute (MOI). A bodaboda (motorcycle taxi) driver, he had been navigating Dar es Salaam’s chaotic traffic in pursuit of a potential passenger when he collided with a minibus. His left leg is now fractured and held together by costly intramedullary nails, as his hospital bill mounts.With no daily income and his meagre savings swallowed by the initial costs, his future remains uncertain. He is not covered by any health insurance scheme. Some 9-10 people who have been in motorcycle crashes arrive daily at MOI for emergency treatment—and, like Thomas, 80% of them do not have any health insurance.“I was brought to the hospital by friends, but they can’t afford to help me foot the bill. My sister has been going from family member to family member, asking for contributions,” says Thomas, whose average daily income of around...

In 2009, my old friend from medical school, Ann McPherson, wrote a powerful personal view in The BMJ in support of assisted dying when she herself was dying of pancreatic cancer.1 Despite receiving the best palliative care that Oxford could offer, this well respected GP had a horrible and lingering death, later described in another personal view by her daughter Tess, a consultant dermatologist, who despaired that: “It is an honour to care for someone you love, but it no longer felt honourable to try to care for someone who wanted to be dead.”2In Scotland, unlike in the rest of the UK, it is not a specific criminal offence to help someone to end their own life. However, there is still a risk of prosecution for murder, culpable homicide, assault, and breach of the peace. As a result, any attempts to help a person die are necessarily covert, completely unrecorded,...

Healthcare in the UK is facing a crisis. At issue is the creation of new groups of health workers called physician associates (PAs) and anaesthetic associates (AAs).1 Originally PAs and AAs were envisaged as assistants to doctors to increase their productivity by relieving them of some routine tasks. However, in many hospitals and general practices they are being deployed to replace doctors, taking on increasingly complex roles, including the assessment and management of patients with undiagnosed problems.2 This is despite them having completed only a two year training programme. While most will also have a science degree, this need not be in a subject related to medicine. Concerns have been exacerbated by the simultaneous reduction in medical specialty training posts,3 the fact that many PAs and AAs are paid substantially more than foundation doctors despite much less training than the doctors they work with,4 evidence that they are illegally prescribing...

There were more people from ethnic minority backgrounds in executive and senior managerial roles in NHS trusts in England in 2023, but because of a rise in the proportion of ethnic minorities in the workforce there has been minimal progress in diversity at the top of trusts, show latest data.Staff from ethnic minorities held 180 (11%) executive roles in English NHS trusts in 2023, up from 161 (10%) in 2022, shows the latest NHS Workforce Race Equality Standard (WRES), which aims to capture how NHS trusts are tackling race inequalities.1The gap between ethnic minority representation in the workforce and among executive directors increased from 13.5% in 2021 to 15.7% in 2023 because more people from ethnic minority backgrounds have joined the NHS in the past year (from 22.4% to 26.4%).Overall, 26.4% (380 108) of people who worked for trusts in England in 2023 were from minority ethnic backgrounds, up 13%...

Trust is central to the practice of medicine, but recent events have shown it to be fragile, even within our professional communities.In 2022, the Ipsos Global Trustworthiness Monitor asked people from 29 countries what attributes were most important when deciding whether to trust an organisation or institution.1 The top three responses were: “If it is reliable/keeps its promises,” “If it is open and transparent about what it does,” and “If it behaves responsibly.” Recent events have shown that our medical community has lessons to learn.The announcement by the UK Foundation Programme Office (UK FPO) that the appointment process for the Specialised Foundation Programme will change in 2025 to preference-informed allocation, a system that does not take account of previous academic attainment, has left many medical students feeling distressed.2 The change in the recruitment process impacts many students who made decisions based on the current system, only now to find the...

Are you a medical student interested in learning how a medical journal is run? Do you have a passion for creating engaging content for medical students? If so, apply to be The BMJ’s next editorial scholar.The editorial scholar takes one year out of medical school to work with The BMJ’s international team of editors and lead BMJ Student, the student section of The BMJ.In this role you will:Be trained in journalism and editingCommission, peer review, select, and edit articlesPlan, produce, and host episodes of The BMJ’s student podcast Sharp ScratchBe involved with publishing the journal for print and onlineHave the opportunity to write your own articles for BMJ Student as well as other sections within The BMJRun BMJ Student’s social media channelsMaximise the potential of The BMJ’s student offering.We are particularly interested in candidates who have clinical experience and can communicate ideas effectively. You will be motivated, creative, and preferably...

Since it was published, this Opinion article by Sarah Clarke (BMJ 2024;384:q61810; doi:10.1136/bmj.q618) has been updated to include a revised competing interests statement.

The addition of new clinical staff on hospital wards is welcome. The steady introduction of physician associates (PAs), advanced nurse practitioners (ANPs), and advanced clinical practitioners (ACPs) has undoubtedly helped to manage the ever increasing demand in UK hospitals. However, this new blend of different clinical ward roles is disrupting the training, skill development, and professional autonomy of rotating doctors. Given that these non-traditional clinical roles are likely to stay and expand,1 attention needs to turn to navigating the new dynamics these roles bring and to ensuring that clinical work remains collaborative and safe.Rotational training brings several challenges.2 Doctors arriving on hospital wards need to navigate new systems and adapt to new processes of working every three to six months. It takes time to develop professional relationships with colleagues, nursing staff, and ward consultants. The presence of permanent ward clinicians can be valuable in easing this transition, helping disoriented doctors...

This Viewpoint discusses policies the Biden administration can enact to reduce costs, including benchmarking Medicare Part B drug payments to the lowest price paid in similar countries, preventing Part D plans from negotiating confidential rebates with manufacturers, and patent reform to promote generic drug use.

This Viewpoint reviews evidence that higher hospital prices reflect greater market power more than higher-quality services and proposes that backstop price caps can mitigate harms from the most excessive prices without constraining or distorting competitive health care markets.