Continental doctors take leadership in British medicine.

Within living memory it would have been unthinkable for the manager of the England football team to be a continental European. Not only has that happened, but also every football team in the country has players from across the Channel. In the Middle Ages, the Archbishop of Canterbury spoke with a foreign accent on more than one occasion. In the future will the Presidents of the Royal Colleges do the same? Recently, cardiovascular medicine and surgery in the United Kingdom have seen the recruitment of many senior consultants and professors from Italy, France and Germany. There has been no equivalent movement in the opposite direction, and this movement of medical staff towards the United Kingdom will probably grow. These changes are the effects of negative aspects of continental medicine and indicate both good and bad news for British medicine. The negative aspects of European continental medicine, which make a career in the United Kingdom seem attractive, vary from country to country. In Germany, the professorial structure is very strong with rigid control from the top, including the disbursement of monies from private practice. When the chief retires, there is often complete replacement of the whole pyramid by the new chief. In Italy, the appointment of professorial chairs is made in an arcane and archaic fashion, which engenders both filial respect from junior doctors towards their chiefs and also uncertainty about whether the chief can pull off a deal related to the junior’s future. In addition, Italian surgeons are often not