Scrap the royal colleges’ fellowships
BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1609 (Published 12 March 2013) Cite this as: BMJ 2013;346:f1609
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I was sorry to hear that Des Spence is sartorially offended by the 'expensive polyester merchandising tat’ on offer to Fellows of the RCGP. I have to say that I am extremely proud of my College tie (at least 30% viscose, by the way) and my RCGP cufflinks!
Joking aside, as President of the RCGP and Chair of the College's Fellowship Committee, I feel I have to stand up for the thousands of 'ordinary' GPs who have worked hard to gain RCGP Fellowship and who value their award as a celebration of their achievements and recognition by their peers.
Far from giving them access to a £620-a-year elitist club, Fellowship is a way for the College to celebrate excellence in patient care by our Members, nationally and internationally. It is something to work and strive towards; an opportunity to showcase innovative or creative ideas for improving primary care, or simply a way of showing dedication to our noble profession.
It is also a celebration of the equality and diversity of modern general practice. As College President it is my role to oversee the Fellowship ceremonies, and listening to GPs about the work they do to improve patient care is one of the highlights of my position.
Far from being insecure, these are strong, ambitious individuals who are committed to their patients and to raising standards in primary care. The title of Fellow holds huge personal value for doctors, for the College and for patients. Why is Des Spence so vexed about taking this away?
Don't be so mean-spirited, Dr Spence. You are most welcome to come along to our next RCGP Fellowship ceremony, I guarantee you'll get a lot more out of it than a curled up cucumber sandwich!
Professor Mike Pringle CBE MD FMedSci FRCP PRCGP
Competing interests: No competing interests
Dear Editor,
Whenever the subject of members and fellows comes up, I always think of the late John Rowan Wilson writing about the Royal College of Surgeons. According to Wilson, fellowship at the college “is decided by examination, and theoretically all Fellows are equal just as theoretically all officers are gentlemen” (1). But I am sure things have changed a lot since then.
Yours Sincerely,
Dr Kieran Walsh
References
1. Richards P, Stockill S, Foster R, Ingall E. Learning Medicine. Cambridge University Press; 17 edition. 2006. Cambridge
Competing interests: No competing interests
It is difficult to know when to remove out of date privilege. Such is the nature of human groups that something else will arise to replace it.
Please, Des, give us your thoughts on the fact that since there are no longer any real general practitioners in UK, why not change title and role to what is needed, ie Personal doctors. The semi-demi quaker T.F. Fox showed us the way in 1960 (Lancet 1 743-760) but did anyone listen?
Competing interests: No competing interests
Dear Des, I enjoy your writing but this one was a little too irascible (and irrational). Honours cannot be “egalitarian” by definition. That’s why they are called “honours”. It’s sad you do not like titles – even your own - “doctor”. This distinguishes you from non-medical people (apart of course from those oddities with PhDs who like it to be known that they too are “doctors”). There will always be a hierarchy in any society or system. Half of the members will be below whatever average you take! If you are someone who wishes to abolish hierarchy you have joined a set which itself has the property of “hierarchy”. We are still living in a class ridden system, as you put it and it’s not going to vanish any time soon. There are class divides all around us but their existence does not make them wrong, unjust or immoral.
We heard about elitism during the boat race last year. The idiot who interrupted the race was protesting about it. I don’t think he knew what it meant. It’s about some individuals being better than others - for example the rowers in the boats compared to those who were not in the boats (or in the water). I do not have “mixed emotions” about the British honours system - it is manifestly and outrageously unjust. Those who deserve honours should be offered them in preference to those who do not. That’s not happening now.
I am proud of my “FRCP” and I don’t regard it so much as an honour (nearly every hospital physician gets it and even if they have failed the MRCP they are often awarded an honorary fellowship) as an indication that I withstood the journey. Just because someone nominated me and a committee wasted half a day considering my name with hundreds of others that does not devalue the award.
There are many other barriers to challenging authority Des, much more important ones. Why don’t you get angry at them? I am sure you will get your “fellowship” one day unless you refuse it of course – a much harder task. And why are you moaning about some people never getting a “gong” when you have just argued that the system should be scrapped?
Oh, and I failed my 11+ twice (Moray House test first) and went to a 4 secondary modern schools as my father, a tank driver in WW2 was posted hither and thither. My schoolmasters told me to forget about studying medicine. I started my career stacking shelves and being a hospital porter. I never worried about egalitarianism,or “the establishment” or whatever, I just got on with the task at hand; to qualify as a doctor!
Doctor David E Ward FRCP, Consultant in Cardiology and Electrophysiology
Competing interests: No competing interests
For a while, the Royal College of General Practitioners (RCGP) ran "Fellowship by Assessment" (FBA), which was a rigorous peer-reviewed assessment of the day-to-day work of the individual GP. The paperwork and day-long interview by 3 assessors required for this assessment formed a thesis from the individual on how to develop to be an excellent GP. It is sad that FBA was lost in the development of the RCGP in recent years, as it provided an focus for GPs who aspired to develop high quality care in their practices. And it rewarded those GPs with recognition by peer review, rather than a "gong" for "service".
There is an opportunity for all Royal Colleges to develop this sort of Fellowship again, incorporating leadership and management of change skills, sophisticated communication skills, IT skills and other areas appropriate to 21st Century health care excellence.
Competing interests: No competing interests
Dear Des
You might not be angry about not being nominated for Fellowship of the Royal College of General Practitioners (RCGP) but, still, you deserve sympathy. I’ve therefore taken the liberty of checking the RCGP requirements for Fellowship nomination and was struck by a couple of things which might offer hope.
The first is contained in a reassuring statement by your College President: “We have learnt that we are in the most part a humble bunch. We don’t like to put our hands up for praise, we don’t like to 'sell ourselves'. This should not hinder us from being tangibly appreciated by our profession.” Ignoring any potential irony in this description, it does look as if you are their sort of chap.
If badly painted portraits, curling cucumber sandwiches and cheap merchandise are indeed problems at 30 Euston Square that is unfortunate; but gowns for new Fellows…!
The other criterion which caught my eye was: “ A significant body of publications in the leading peer-reviewed journals.” On that count, Des, you’ll be challenging for the Presidency (with a gown) before you know it!
So much for tongue-in cheek observations about another, respected, Royal College but, on a more serious note, you should ask to see the online discussions from at least one other (much older) Royal College if you honestly think that Fellowship is a barrier to challenging authority and the establishment.
Competing interests: No competing interests
Re: Scrap the royal colleges’ fellowships
I strongly have to disagree with Des Spence on his rather broad and poorly-researched statement. As someone who holds dual qualification and has both Fellowship in Dental Surgery and Fellowship in Trauma and Orthopaedics of the Royal College of Surgeons of England, I do not recognise the institution he describes.
I obtained my Fellowships after much hard work and study for the Post-graduate exams that once passed, allowed me to be eligible to be a Fellow of the College.
After years of blood, sweat, tears, missed family and social life, I was able to finally share the award ceremony with my family, who having seen only the tough side of all the hard work and the final paper certificates, were finally able to enjoy a most memorable and impressive day, where the President and many others repeatedly thanked wives, husbands, partners, children, parents, siblings and friends for their support and contributions to the Fellows success.
Once the ceremony and dinner was over, the College has continued to provide excellent value in terms of quality journals containing material very relevant to my speciality, courses and training, discussion and interaction with faculty, research, museums, historical knowledge, even accommodation allowing cheap stays in London etc etc etc.
Looking at the list of Honorary Fellows, there is a wide range of valuable and interesting contributors and I believe that many of them have added value by their subsequent support of the Colleges and College activities.
Even the paintings of past-presidents is more useful than Des found. Not only is it inspirational to read the history of these people, many of whom came from very varied backgrounds, but for my children it was a fascinating history lesson and provided them and myself with some insights into the appearance of many famous surgeons from history.
A totally different experience from Des and his interactions with RCGP. Perhaps he should make sure he has more facts before he tars all the Colleges with the same brush? Sadly I have found, from personal experience, the vast majority of "nay-sayers" against the Colleges tend either to be those who have not taken the relevant examinations or have been repeatedly unsuccessful in them - politics of envy perhaps?
Competing interests: No competing interests