Medical staffing and training in chest diseases.

A survey of 164 area departments of chest diseases in England and Wales presents details of 321 consultants and 176 chest physicians in other career grades. During the past 10 years there have been 99 consultant and 76 senior hospital medical officer vacancies, with 61 and 23 replacements, respectively, of which only 22 and 8 were whole-time in chest diseases. Of the total, 119 consultants and 45 in other career grades are now aged 55 and over.In most chest clinics the slowly diminishing work load from tuberculosis has been more than offset by increasing admission of other chest diseases, usually to fewer beds. Many areas need an increase in senior establishment and many require improved clinical facilities; some need both to bring them into line with official policy based on the recommendations of the Scadding report.During the next five years there will be 52 consultant and 11 other senior career posts in chest diseases vacated through retirement. At least eight consultant appointments a year, in terms of whole-time equivalents, will be mandatory for at least five years and probably for 10 years to maintain existing standards without allowance for essential improvements or the development of regional thoracic centres.Present training schemes in the specialty cannot produce more than two or three trained candidates a year for these eight vacancies. The description of prospects in the specialty as "uncertain" deters young doctors from entering it and discovering how broad a spectrum of medicine it embraces. It is urgently necessary for schemes of training to be set up immediately in conjunction with a considerable increase in training posts at senior registrar level embracing both general and chest medicine.