Personal views: Lament for missing an A award
Authors: Adrian Padfield
Journal: BMJ (2001)

I used to support the merit award system because I believed that, despite its flaws, it encouraged people to stretch themselves beyond their daily chores. From doubting its fairness for myself, I realised my specialty had a poor share of awards and this has been true for at least 35 years.

In the dozen years since a medical chairman of the Advisory Committee for Distinction Awards tried to channel more awards towards service specialties, there has been little increase in the number of awards for anaesthetists, pathologists, or radiologists. Compared with local colleagues in other specialties and other anaesthetists elsewhere I think that I deserved an A award, but I never received one.


I first heard of merit awards soon after I became a senior house officer in the early 1960s. A surgical registrar engaged me in conversation over the blood-brain barrier. He asked me why I had taken up anaesthesia, and then he said: “Anaesthetists are sucking on the hind tit as far as merit awards are concerned, but they're either young or ex-general practitioners.” 


It was worrying that awards seemed to be based on Buggins's turn



I had no idea what he was talking about. By the time I became a consultant in 1972 I knew that C awards were for local merit, B awards for regional or national merit, and A awards for national or international merit. This was confirmed in the 1990s by the now lay chairman of the advisory committee. In the late 1970s, in my 40s and a (minor) national figure in anaesthesia, I thought I ought to get a C award. I had no idea what happened so I asked a senior colleague. He told me simply that I would get one.

By 1982 I was fed up and thinking of writing a vitriolic piece for World Medicine. Early in 1983, however, a kind colleague on the regional C awards committee rang up and said: “Adrian, open the champagne.” There had been an extra award for anaesthetists that year so I and a much older colleague got one.

It was worrying that awards seemed to be based on Buggins's turn and, as I learnt more about the processes, this impression was reinforced. In 1990 a nobody from elsewhere, who had been put on the regional higher awards committee, rang to ask me about someone's eligibility for an award. At the end of his call I plaintively asked, “What about me?” Not long after, in early 1991, I received a letter saying that I had received a B award starting in April 1990. I was pleased, but I wondered why nonentities in the region had got B awards before me.

Matters became interesting. I was invited to discuss awards for other anaesthetic colleagues at Sheffield and regional meetings. Only the chairman at the regional meetings saw the curricula vitae of colleagues put forward from the different hospitals. I suggested that all members should see them if we were to discuss comparative merits, but this reasonable idea was refused. The Royal College of Anaesthetists received our recommendations. Perhaps that was why my academic colleagues were given awards when they were younger than other doctors. Curiously, I was never put on the regional C awards nor the regional higher awards committees. Was the playing field level in the region, I wondered?

Meetings for all consultants with at least a B award in North Trent were convened by an A award holder each year. Opinions were solicited about who should get a B award. After that the B award holders left so that the holders of A and A plus awards could discuss them. One year when I could not attend I telephoned the convenor with recommendations. I remarked that few anaesthetists had awards. “Ah,” said the professor (a physician), “there are a lot of young anaesthetists about.”

I pointed out as politely as I could that this comment has been made for at least 35 years. It seems that physicians believe this is true, however illogical; after all, there are also a lot of surgeons but they are divided up into specialties. Analogously, a medical professor thinks that the low number of awards for doctors from ethnic minorities will improve as they get older (BMJ 1998;317:475).

What about surgical backing for anaesthetists? When I spoke to the medical dean some years ago about my chance of an A award, he asked which surgeons supported me. I was almost speechless but depressed. I worked with surgeons who were younger than me or juniors.

In December 1993 I got the questionnaire from the advisory committee as part of its five year review to see if I had done enough to retain my B award. I thought that it was an opportunity not a threat; I would be able to show that I was still worthy and perhaps more meritorious—I've always been naive. After I had returned the form, one of my colleagues accused me of sending my curriculum vitae to the advisory committee in pursuit of an A award. This shows just how deeply people care about these things.

Nothing will change unless there is a radical shake up of the system or it is abolished. If I were in a specialty with a high percentage of awards I would not like my share of the cake reduced for the benefit of other specialties, would I?