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BRIEWE instances the effect of the new system will be to concentrate interns in the cities, and utilise the more peripheral hospitals for CS. Some of the provinces, however, have taken up the challenge to re-look at the staff establishments of their more peripheral hospitals and to strengthen their supervisory support for interns. In those institutions that will not be able to offer all 6 rotations, the substitutions of CS doctors will be the solution in that they will be better prepared after 2 years of supervised practice in all domains. The year 2008 presents particular challenges, with a maximum of only 356 potential CS applicants countrywide, less than one-third of the usual number. This figure is likely to be even less owing to failure and dropouts along the way. Since CS was introduced in 1999, most public service hospitals have become very dependent on CS to provide a constant source of medical staff. This has been a largely positive experience for all concerned, and the temporary withdrawal of these young doctors could be disastrous for the health services, particularly in the 'difficult-to-staff' institutions in rural and under-served areas. However, every threat is also an opportunity. All stakeholders involved in the change process need to put differences aside, tackle the challenge and show that good planning, transparent negotiations and commitment to a common goal can succeed. The common goal in this instance is the production of young doctors who can meet the challenges of the health needs of the entire South African community. The HPCSA will ensure that only institutions adhering to the standards and regulations with regard to internship training will be accredited. This remains a continuous process and is not a once-off occurrence. As employer, the Department of Health must help identify the most suitable institutions within their human resource plan that will offer sustainable supervision and quality of care as required for internship training. Interns must realise that internship is an apprenticeship and that they also have a responsibility towards their employer, their patients and themselves to develop into responsible professionals who will honour our profession and its values. To the Editor: Having recently returned from a holiday I was extremely dismayed to read in the 11 February issue of Medigram that from 1 January general practitioners may charge the same as specialist anaesthesiologists for the first hour of an anaesthetic. Such authorisation indicates nothing less than …

Changes in reimbursement for anaesthetic valid from January 2005.