The joint manpower initiative by the Department of Health and Social Security and the Joint Consultants Committee provides the latest and perhaps the most hopeful stimulus to solve the problems of medical manpower in the acute hospital services.' It has been recognised for some time that career prospects for junior doctors in the acute medical and surgical specialties have become intolerable.2 In general surgery the once orderly career structure has deteriorated, resulting in a surfeit of over trained and expensively trained "junior" surgeons unable to obtain career appointments. This paper emphasises the importance of the new proposals and should help intending surgeons to calculate their chances of future employment. We also hope that it will encourage both senior and junior members of the profession to respond to the requests made by the authors of the manpower initiative that opinions be offered soon in order that a final plan may be agreed in the near future.

The changes in inumigration rules that bring overseas doctors and dentists in line with other workers' have clearly been stimulated by the view of the Advisory Committee for Medical Manpower Planning2 that any need for short term reduction in the supply of doctors will be more readily effected by a reduction in net immigra- tion than by a reduction in medical school intake.Although the changes might prove successful they will not do anything to cope with the dilemma presented by long serving registrars and senior house officers.That there is such a dilemma was shown by an earlier study in one region and is confirmed by the observations of this inquiry.Junior doctors are well aware of the problem but shy away from one of the more obvious potential solutions.4 Method and resultsDuring August and September 1984 personnel staff in district health authorities in the Northern, Trent, and Oxford regions extracted information from curricula vitae of senior house officers and registrars.This enabled the length of time in each grade to be calculated for substantive and locum posts.The age structure of the doctors in the two grades was also examined.The figure shows the age distribution of senior house officers and registrars combined for the three regions but separated to show any variance between teaching and other districts.Although most senior house officers are under 29 and registrars under 32 in the teaching 102 A 90 ,