22 JULY 1972, Page 35

Specialist abortion

John Rowan Wilson The recent suggestion in a Bow Group Pamphlet that hospital boards will soon have to start advertising for abortion a.pecialists springs from a widespread anxiety among gynaecologists that the situation in women's wards is beginning to get out of hand. It ties in with a report from the United Bristol Hospitals in the British Medical Journal of July 8 which records an increase in gynaecological waiting-lists of 200 per cent caused largely by the demands for termination of pregnancy. This is accompanied, say the authors of the report, by an atmosphhere of discontent and frustration among doctors and nurses.

The frustration arises not so much from Overwork as from being compelled to engage in a form of practice which they had never bargained for when they took 1,113 the speciality. It raises in a particularly acute form the question of medical staffing for unpopular branches of practice. For Who on earth, under the system of equal remuneration we have in the Health Service is prepared to spend day after day doing nothing else but scrape out the Products of conception?

This problem arises also in other areas. Venereal disease clinics all over the world are notoriously understaffed. In the US a quite ludicrous state of affairs has arisen. Gonorrhoea is now the most important infectious disease in the country, yet few people wish to treat it and in many medical schools the students learn nothing about it. The fashion among university faculties is to allow them to study special aspects of medicine on an ' elective ' basis. Not surprisingly, the students opt for subjects like brain surgery or organ transplantation, and venereal diseases are hardly taught at all.

Doctors are not saints and their natural instinct is to choose what is interesting to them as individuals rather than what is useful to society as a whole. For this reason there is a queue of ambitious young doctors trying to get into general medicine, cardiology, abdominal and thoracic surgery, plastic surgery and neurology. These are the ' smart ' areas to be in. Whatever the shortage of doctors, there will never be any trouble filling consultant posts in these aras of practice.

Other specialities of a less glamorous nature contain a proportion of doctors who came to rest in them as a second or third choice. In psychiatry and dermatology, anaesthetics, radio-therapy, or ear, nose and throat surgery, you will find consultants, many of them men and women of very high ability, who will admit that they turned from general medicine or surgery because their promotion was blocked, or because of illness or some other misfor

tune. Right down at the bottom of the reference list are the branches of medicine populated very largely by doctors who have simply got stuck in them because they couldn't find anything better to do.

The trouble is that these depressed specialities are just as important from the patient's point of view as the more glamorous forms of practice. When there is a surplus of doctors they get staffed somehow or other. But when there is a world shortage, as there is at present young doctors will prefer to emigrate to the Commonwealth and North America than do work that is uncongenial to them. Already there is a long list of jobs in the Health Service which can only be filled by importing graduates from Africa and Asia.

So how are we going to get any applications for jobs as abortion specialists? There are plenty of doctors doing abortions in the private sector, true enough, but they are earning perhaps E50,000 a year and there are people who will put up with any amount of frustration and boredom for money like that. At NHS rates nobody will touch that kind of work with a bargepole. With the gynaecologists beginning to dig in their toes, there is every possibility of an impasse. The best hope we have is in new techniques which may make it possible for the products of conception to be removed by administration of a drug or a mechanical device which can be safely used, by someone else than a doctor. There are signs that this may be on the way. If so, it will rescue the Health Service from a highly embarrassing situation.