人為的瓶頸：打破英國醫療專科體系的壟斷現狀

打破醫療壟斷與結構性困境

英國國民保健署（NHS）目前正陷入一場由「准入門檻壟斷」所驅動的供給側危機。雖然大眾輿論往往聚焦於資金不足，但數據顯示了一個更深層次的結構性問題：醫學培訓與晉升路徑的人為限制。

一、 專業壟斷與供給限制

在英國醫學會（BMA）和各皇家醫學院的影響下，英國醫學界長期以來嚴格控制醫科生的人數，更關鍵的是控制了**「專科培訓名額」**。

透過限制專科醫生（顧問醫生）的供應，該專業確保了資深成員的高需求量。然而，在國家資助的體系下，這造成了災難性的瓶頸。我們現在看到醫學院申請者的淘汰率為 3:1，而住院醫生申請專科培訓的淘汰率更是高達 4:1。

二、 「跳板效應」的經濟代價

英國政府花費約 16 萬英鎊培訓一名本地醫生，卻未能提供足夠的專科名額讓他們發揮完整的服務潛力。為了填補即時的人手空缺，英國每年引進超過 2 萬名海外醫生。

然而，由於英國的薪資缺乏競爭力，且通往顧問醫生的道路受阻，許多醫生將英國視為「跳板」。他們在英國獲取經驗後，便轉往美國、澳洲或紐西蘭。英國納稅人資助了這段轉型期，而其他國家則收割了長期的專業紅利。

三、 解決方案：打破壟斷

要達到 OECD 的標準（追平德國或法國），英國必須採取「去壟斷化」策略：

• 培訓名額與預算脫鉤： 專科名額應由 10 年期的人口需求預測決定，而非受限於財政部的短期預算審核。

• 重新分配非生產性資金： 將預算從意識形態主導的計畫（如過度的多樣性與性別研究行政開支）轉向擴大醫學院招生。每增加一名本地醫生，能為國庫帶來的回報高達 50 萬英鎊。

• 服務契約制度： 實施「定向培養」模式，由國家全額資助醫學教育，換取畢業生在 NHS 強制服務 5 至 8 年，從而防止「跳板效應」導致的人才流失。

總結：

英國醫生的短缺是一場人為的供給危機。透過限制本地人才並依賴不斷輪換的國際人員，英國實際上是在犧牲本地患者和納稅人的利益，來補貼全球醫療移民。打破培訓壟斷是重新平衡醫患比例的唯一永續途徑。

 

The Artificial Bottleneck: Breaking the British Medical Monopoly

Analysis: The Monopoly on Medicine

The UK’s National Health Service (NHS) is currently trapped in a supply-side crisis driven by a "monopoly of gates." While public discourse often focuses on lack of funding, the data suggests a deeper structural issue: the artificial restriction of medical training and advancement.

1. The Professional Monopoly and Supply Restriction

The British medical profession, influenced by bodies like the British Medical Association (BMA) and the Royal Colleges, has historically maintained strict control over the number of medical students and, more crucially, Specialist Training Slots. By limiting the supply of specialists (Consultants), the profession ensures high demand for its senior members. However, in a state-funded system, this creates a catastrophic bottleneck. We now see a 3:1 rejection rate for medical school applicants and a 4:1 rejection rate for junior doctors seeking specialist training.

2. The Economic Cost of the "Jumpboard Effect"

The UK government spends approximately £160,000 to train a local doctor, yet fails to provide the specialty slots needed for them to reach their full earning and service potential. To fill the immediate gap, the UK imports over 20,000 overseas doctors annually.

However, because UK salaries are uncompetitive and the path to consultancy is blocked, many of these doctors use the UK as a "training camp" before moving to the US, Australia, or New Zealand. The UK taxpayer subsidizes the transition, while other nations reap the long-term rewards.

3. Proposed Solution: Breaking the Monopoly

To reach OECD standards (matching countries like Germany or France), the UK must implement a "de-monopolization" strategy:

• Decouple Training from Annual Budgets: Specialist slots should be determined by 10-year demographic demand forecasts rather than short-term Treasury whims.

• Redirect Non-Productive Funding: Shift budgets from ideologically driven programs (such as excessive diversity and gender studies administration) toward expanding medical school seats. Every new local doctor provides a return on investment of up to £500,000.

• The Service Contract: Implement a "bonded service" model where the state fully funds medical education in exchange for a mandatory 5-to-8-year service period within the NHS, preventing the "Jumpboard Effect."

Summary Conclusion: The shortage of doctors in the UK is a man-made crisis of supply. By restricting local talent and relying on a rotating door of international staff, the UK is effectively subsidizing global medical migration at the expense of local patients and taxpayers. Breaking the training monopoly is the only sustainable way to rebalance the doctor-to-patient ratio.