Doctors turn their backs on stresses of British medicine: Of the five trainees on Jane Jones's GP course only one is seeking a career as a family practitioner in the UK

THREE days ago Dr Jane Jones completed three years of vocational training as a general practitioner in north-west London. In January she will start work in the casualty department at a hospital in Toowoomba, an hour's drive inland from Brisbane.

Dr Jones is well qualified and entitled to high expectations of a substantial career in medicine in Britain. Her first degree is in biochemistry from Oxford, her second is an MSc in immunology from Glasgow.

She then spent five years as a medical student at St Mary's Hospital, Paddington, west London, and three training as a general practitioner. In Australia she will earn 50 per cent more than she could in the NHS in Britain. She will work a 40-hour week and her overtime will be paid at time-and- a-half or double-time, not at half the rate, as junior doctors are paid in Britain.

Her GP training involved five months in an inner-city practice, two years in junior hospital posts in useful specialities including paediatrics, geriatrics, psychiatry, casualty and obstetrics and gynaecology and a final seven months back in general practice.

She had always intended to take time out after completing training. But this is more than a chance to see the world. She has a year's contract, renewable for another one year, but her intention is to return to the UK.

She is not unusual. Of the five young doctors on her GP course, only one is seeking a formal career as a family doctor in Britain.

Another is going to Australia, one is pregnant, and the fifth, also pregnant, is going abroad with her husband. This small group alone cost approximately pounds 1m to train.

Health service changes, low morale in medicine and uncertain expectations after years of hard work in the training grades are fuelling dissatisfaction.

'I know many people who had a real vocation but they just got to hate it. The hospital work is so stressed. The atmosphere has changed enormously since I started,' she said.

Dr Jones first experienced general practice three years ago before a new contract was imposed on GPs.

'The first time, I really loved it. I was really looking forward to my final seven months. The demands on you have changed enormously in the meantime. In an inner-city practice you can see there has been a decline in general health because of social factors. Patients' demands are different since the patients' charter. There is more out- of-hours work, much more 'on call'. It has made me wonder whether I want to make a career in general practice.

'I love medicine and I love my job. There is a great need for people like me, but we are being put off.'

There is plenty of sympathy in the senior ranks for doctors like Jane Jones. Dr Alan Shrank, a consultant dermatologist from Shropshire, and vice-president of the Hospital Consultants and Specalists Association, says that in his day training was fun.

'I know we had to live in the hospital all the time. But the work was far less demanding. We had a mess. We had a very good time.

'I was told one junior was working where the shower did not work, the sheets were not changed and there was no canteen. If we cannot attract our own graduates then we have to look to doctors from abroad,' he said.

'There are many factors involved. In the hospital service doctors just cannot see any light at the end of the tunnel. In the past, once you got to consultant level there were rewards. Now they see it as being on a treadmill for the rest of their lives.'

In his own area, Telford, there were 150 applications for the six GP training posts 10 years ago. 'Seven or eight years ago this was down to 30. This year it was less than one for one. There are now seven posts, we had six applications and eventually we have filled the last position with a young Australian,' he said.

In April 1993, the Department of Health announced an increase in medical student intake because of potential shortfall in 10-20 years. It increased the intake by 240 and also agreed to increase the desirable proportion of overseas students - from 5 per cent to 7.5 per cent.

One reason for the increase is that German medical training rules have changed. Instead of doing six months' hospital work after graduating, German doctors must now complete 18 months before they can be registered as doctors.

Professor Brian Pentecost, the officer reponsible for training at the Royal College of Physicians, said: 'Large numbers of medical graduates from Europe are now exercising their EU rights to train here. And they are starting to stay on into senior house officer and registrar levels. They are finding the UK very attractive.

'The college exists to maintain standards. We would be very concerned if doctors from abroad started to displace our carefully chosen, carefully nutured British graduates.'

The Royal College of General Practitioners is so concerned that it has embarked one its own counting exercise and data should be available by October.

Dr Jamie Bahrami, GP training adviser for Yorkshire, who is in charge of the statistics, said: 'There now no doubt that there is a national crisis in GP training. In Yorkshire in 1989 we had 30 applications for every GP training post. Last year it was one to one. In February there were four schemes with no applicants at all.

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