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Editor,—As one of the most “overtrained”(!) ophthalmologists in the United Kingdom at the present time, I was delighted and stimulated to read the excellent, erudite, and witty commentary by James Acheson.1 I think that the issue that lies at the heart of the matter is, as Mr Acheson himself puts it, “It all depends on what you mean by training . . .” Surely one of the driving reasons behind the length of all specialist training in the UK has always been the high demands of the service commitment of the senior house officer and registrar grades alike. Until the issue of doctors' numbers can begin to be tackled at a meaningful level in the UK we shall forever have the push-pull politics of service versus training. It is still worth pointing out that we have the lowest number of doctors per capita in the developed world, bar only Greece and Albania.
It is also very true that the standards of ophthalmology training in the UK are regarded very highly by trainees from oversees, who regularly come to the UK to complement and polish off their training. However, they come mainly for subspecialty training and often go to superspecialist regional centres, where they act as fellows, often in a somewhat privileged position. They are able to benefit from the high level of internationally renowned expertise in their chosen field that the UK is still able to provide. We in the UK face a rather unique situation, in that superspecialist fellowship training is quite rightly becoming the norm while still being outside the national Calman training programme. This sends a very mixed message about its value to the powers that be. It is also far from easy for every trainee to find a suitable fellowship and funding.
So, on the one hand the length of training could be shortened by tackling the issue of service versus training demands, and on the other hand perhaps training could formally be lengthened to ensure that British ophthalmologists are able to stay at the forefront of their chosen fields in the international arena.
We all await developments with interest!