Once upon a time there were clear-cut career pathways for ambitious doctors, what are now called ‘inside tracks’. Forward-looking people in the UK, for example, realised early that in order to become a consultant or professor in a teaching hospital, it was essential to be well qualified and published. In psychiatry, this meant proof of being truly renaissance with qualifications in medicine, psychiatry and research. How this was achieved was up to the individual. At places like the Maudsley Hospital people often arrived bristling with degrees. About half the entrants had passed College exams or had research doctorates. During psychiatric training the others went for the extra qualifications. They had to; otherwise they would not make it to senior registrar. Some characters practised brinkmanship and passed the MRCP on the umpteenth occasion. Thereafter things varied, with some moving into personal analysis (no degree) and others into wet and dry laboratory research. Many eschewed both and headed for clinical work. There was a period, perhaps between 1945 and 1975, although the limits are arguable, which was halcyon. Medical trainees were actually committed to research. There were twin pathways; the scholarly going to the MRC unit or the Chair and the entrepreneurial to the teaching hospital consultant job and Harley Street practice. The teaching hospital wallahs needed about ten papers to be acceptable. An engaging feature of the system was that the pay was not particularly discrepant between researchers and clinicians. The somewhat subfusc role of researchers was, in any case, redressed in the mid 1960s and parity achieved. Amazingly, then, it was possible to have a career in research without losing money. To what did it all add up? In modern parlance, was it cost-effective and efficient? Did the clinicians with their ten papers or the MRC medical scientists give value for money? After all, with what can they be compared?
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