850

Menstrual regulation (uterine evacuation within 14 daysof the expected period) is becoming an established pro-cedure in Asia, even while it is still a novelty in Britain.In Singapore 4000 such procedures have been performedwithout incident. In the four countries in Asia which havenot yet reformed their abortion laws-and Bangladesh isnow the largest in this category-menstrual regulation isespecially welcome. It is being used in Dacca and someprovincial capitals. Despite the restrictions of a traditionalsociety, in which, for example, it remains a great rarityto see anyone but men in the streets, women are seekingthe operation. As in many other countries, the Govern-mental family-planning programme and the effort putin by large international agencies have had frustratinglypoor results. Bottlenecks in distribution have not beenovercome. Contraceptives are virtually unobtainable inall parts of the country, although there are good suppliesin the warehouses.

But, even at the eleventh hour, changes are taking place,and many people, down to the remote villages, aware ofthe worsening economic and food situation, now want tocontrol their fertility. The Government policy permitsnon-prescription pill distribution, encourages sterilisationand menstrual regulation, and is reviewing abortion

legislation. Newer, smaller, voluntary organisations arevaliantly trying to bring the resources to where they areneeded. The work in surgical methods of fertility regula-tion supplements that of Population Services International,who are about to conduct the social marketing of pillsand condoms through 20,000 retail outlets. By contrast,there are 449 family-planning clinics in the country,mostly seeing a handful of patients each day.

Urtated States

THE HOUSE-OFFICERS’ DISPUTE

The New York house-officers’ dispute is now over. Ithas been agreed that there should be a rearrangement ofhours on duty, but, neither during the walk-out nor since,has any attention been directed to what seems to lie at thebase of the dispute-the house-officer’s need for trainingand the simultaneous demand for service from him. Thetwo have thus far been scrambled together, with hospitals

. and attending physicians talking about the education

provided, and the young doctors about the service requiredof them. Each side, in its own fashion, has sought toexploit the other, with everyone else the sufferers. Intern-

ship (a status fast disappearing with ever-increasingspecialisation) and residency are basically periods of post-graduate education. Practical experience during this

process necessarily takes in service to patients, but wheredoes education with ancillary service end, and servicewith ancillary education begin ? There are, of course,intermediate grey areas, but their existence does not causethe two main territories to merge or cease to exist.

Many hospital departments approved for residency havefull-time heads and often full-time staff members; wherethey do not, a member of the attending staff assumes

responsibility. Thus, the residents assist their teacherswho, in their turn, assist their students, with the seniorresidents helping the juniors. The attending staff call

upon the house-officers for assistance on the principle thatby such service the education of the younger men isfostered. What has happened, with payment by thirdparties for medical care in hospital only, and the disappear-ance of house-calls, is that hospital admissions haveincreased greatly. The visiting doctors call more andmore on the house-staff to assume the burden of care, andcome to the hospital on a more-or-less routine schedule.The seniors assert that, if the junior thinks his presence isneeded, the senior comes to the hospital. But it may be

asked whether the resident always recognises a situationthat he needs help with.Who provides the payment to the house-staff ? The

hospital or medical school, or both, do, with private,governmental, and insurance funds. The attending doctorfurnishes not a dollar, other than through whatever

voluntary contributions he cares to make. In short, it isthe senior who gains most from the present arrangement.Newspaper accounts describe the pay of residents as

ranging from about$1000 a month to$1600. Despitethis, " moon-lighting " is not uncommon, with §1000 tobe gained during a weekend of 48 hours in an emergencyroom in another hospital. It would seem that the complaintof overlong hours is really one of overlong hours in theemploying hospital, which does not leave enough time foran additional job. Early marriage, early parenthood, andthe desire to redress as quickly as possible the not-infrequenteconomic strains of premedical and medical-school years,not to speak of social pressures, surely all play their partin the matter.What can be done to help correct the situation, without

entirely restructuring what now exists ? Perhaps theresident’s day should be divided into three parts, with oneperiod of 12 hours for himself, free of all professionalduties, either in his own or in any other hospital or clinic,one period of 4 hours for the educational programme, and amaximum of 8 hours to be used for service to the attendingstaff’s patients and in no other hospital. Such serviceshould be paid for by the senior on an hourly basis, withno distinction made between day and night work; after all,illness is not confined to any one part of the day. House-staff members should be forbidden to take outside employ-ment, with dismissal the penalty for violation.

Special Article

WOMEN DOCTORS’ RETAINER SCHEME

GOVERNMENT financial support for the Women Doctors’Retainer Scheme, which was introduced in 1972 to en-

courage women to continue working in medicine, andwhich was concentrated on the hospital service, has nowbeen, extended to general practice from April 1. Thescheme is open to any woman doctor under 55 who isunable to work more than two sessions a week because ofdomestic commitments. Doctors in the scheme are re-

quired to attend a minimum of 7 educational sessions and toundertake at least 12 paid service sessions each year.They are paid an annual retainer of E50 to help cover theirexpenses (including the cost of registration). The aim ofthe scheme is to enable women doctors to maintain a linkwith their profession while they are bringing up theirfamilies, and to encourage them to resume their medicalcareers, either part-time or full-time, as soon as theirdomestic commitments permit. Up till now women doctorsin the scheme wishing to work in general practice have hadto make their own arrangements to be employed by ageneral practitioner, who had to meet the full cost of

employing them himself. Following consultations withrepresentatives of the professions, the Statement of Feesand Allowances has been amended so that family practi-tioner committees will now make payments to familydoctors who employ a member of the scheme at the rate ofE6.15 per session up to a maximum of 1 session a week.Clinical tutors will arrange for doctors in the scheme towork in practices assessed as suitable by the regionalpostgraduate education committee. The terms of employ-ment of women doctors in the scheme will continue to be amatter for agreement between them and the members ofthe practice concerned.