Recruiting in hard timesBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7122.2 (Published 13 December 1997) Cite this as: BMJ 1997;315:S2-7122
The consultant shortage is officially here - and it may be several years before it passes. What practical steps can trusts take in the meantime… and how far can prospective consultants push it? Trust chief executive Joan Rogers discusses
Medical manpower shortages are upon us with a vengeance. They have occurred for a variety of reasons: poor medical manpower planning, trusts' opportunistic business developments, the New Deal, changes to the content and requirements of training posts, early retirements, the employment of more women doctors, and the accreditation requirements of some of the royal colleges. The list is not exhaustive - but while the reasons for shortages are many, the final result is now clear - a medical manpower crisis with the potential for far reaching consequences for hospital services in particular, with shortages often at their worst in those parts of the country where health is the poorest.
The focus of this article is upon some best practice in the recruitment of senior medical staff. It is written from my perspective as chief executive of a trust, but in particular should have value for medical directors of trusts.
I would like to have said that pay is not critical to the recruitment of senior medical staff, but it would not be strictly true. I have had some grim and greedy discussions with consultant medical staff seeking trust appointments in the past, and it has taught me a lot. While some salary enhancement can be accommodated through a genuine leadership contribution, my view is that, as a general rule, trusts would do well to steer clear of differential pay. The kind of doctor who is motivated to join a trust and a clinical team purely for monetary reasons is not the kind of doctor most trusts benefit from, nor is he or she usually a good long term bet. Moreover, inflated pay deals create a poor image of a trust, its management, and its values. Good medical staff may well wonder what kind of doctor wants to work in a trust that is desperate and steer clear as a result. Any short term gain accrues a loss for the longer term. There is no substitute for the trust trying to get the best medical staff possible, and when this is achieved (with a lot of hard work) word gets around quickly, and other medical staff become interested. To conclude: the adverse effect of differential pay on other staff in clinical teams far outweighs any merits it may have as a recruitment tool. I am pleased to find for once that I and the BMA are in agreement on this.
Catering for the individual
But this is rather negative: what are the positive things that help to recruit senior medical staff? There is no single answer. I work as a counsellor in the NHS, and odd as this may sound, the values I work to, based upon respect for the individual in a one to one encounter and a belief that the other party knows what is best for them, have proved germane to my handling of recruitment.
I am also reminded of the value of silence. Chief executives get an awful lot of air space: I may have seen off many potential recruits in the past, as I rattled on about the trust' s strategic direction. It is worth taking the time to learn from the doctor concerned what he or she wants and needs, rather than presenting them with what you think they want to hear.
Even so, most clinicians do want to know where the trust sees itself going. Like it or not, therefore, trusts with a relatively secure future will find it easier to recruit than those for whom major service reconfigurations are in progress.
I have found it surprising, but encouraging, to note how important positive management is for clinicians. Service stability combined with a “following wind” in terms of the prevailing management really seems to matter. A following wind may be many things - a revenue gaining health authority, so that development is possible; new equipment for the clinician; commit- ment to the clinician' s service vision; or simply catering for individual personal needs. For example, our new consultant in accident and emergency is a woman: she particularly valued being able to work flexibly. She surprised me by saying that the human resources meeting after her appointment (whose agenda was to ascertain her personal development needs) had made her feel nurtured in a way that her colleagues in other trusts did not seem to experience. I hope we are this good; it needs to be worked on. Certainly a little effort here has gone a long way in this instance.
Leadership as a motivator
Clinicians seem more mobile now than ever before. Alongside a service vision, therefore, established consultants considering taking up new appointments elsewhere may be motivated by the opportunity to take on a leadership role within the new trust. The chance to be clinical director - if not immediately, then forseeably - can be a real attraction. Our new female obstetrician and gynaecologist really valued the opportunity to take on clinical risk management. We had a major need for this in the trust; she was able to pursue a strong personal interest and to take on a leadership role as a newcomer. These meetings of complementary minds can occur only if there is time to meet and get a real understanding of the individuals' strengths and aspirations.
This is a very different process from the days of full recruitment, when the interview may have been the first time the chief executive met the candidates. The NHS has been a very large and sometimes uncaring employer in the past. It seems to me that scarcity in recruitment has created a more sensitive way of dealing with potential applicants. We should not lose this in the future. Even more exciting, though harder to achieve, is the chance to run a combined service across two trusts. Locally we are moving towards “hub and spoke” arrangements, and also what I call “trust swops”: one trust runs one clinical service while a neighbouring trust runs another. Each trust gets a viable clinical “mass” - itself attractive to clinicians - with better rosters, and the lead clinician gains the chance to be part of a larger, more challenging service.
Other areas of leadership are not hard to find. The average trust has more than enough difficult areas that need leadership. It felt odd at first to offer a new candidate the chance to take on our problems (what managers call “challenges”), but never- theless for some the chance of getting their teeth into infor- mation technology strategy, theatre management, education, research, audit, or being a college tutor has created a real buzz and may offer a legitimate opportunity for reward.
Part time working
Part time working seems to be especially attractive to women doctors. My advice is not to hesitate to take on a part timer. Their contribution can be excellent if they are encouraged to par- ticipate fully in trust business, and the trust gains a committed clinician.
The rules that follow will increase the chances of successfully employing a consultant from overseas. Use the right journals (see box), and remember the time differences for responders: pay a member of staff to be on call or use a 24 hour answerphone. Name a senior consultant within the department rather than requesting potential applicants to “call the personnel department.” Doctors want to talk to doctors. Keep the information pack supple, and give information about work permits and other relevant matters. Make sure the information is timely: we developed a video to give overseas candidates a sense of the hospital and its staff - only to find the videos waited for weeks in Customs. When applicants call, ring back; don' t expect them to foot the international phone bill. Give personal attention to every serious expression of interest, and make travel arrangements to the last detail. Arrange meetings with clinical colleagues for visiting candidates, and a social function. Maintain contact after the appointment is made; spouses and families can lose their nerve as well as candidates. Make good domestic arrangements for arrival in the UK, and make sure that GMC and royal college requirements are met - before and after appointment.
Recruiting overseas: principal journals for doctors' recruitment advertising
British Medical Journal
Ugeskrift For Laeger (Denmark)
Nederlands Tijdschrift Voor Geneeskunde (Holland)
Deutsches Arzteblatt (Germany)
South African Medical Journal
Monthly: 1st week
New Zealand Medical Journal
Twice monthly: 2nd and 4th Wednesday
Australian Medical Journal
Twice monthly: dates vary from month to month
Canadian Medical Association Journal
Twice monthly: 1st and 15th
Journal of the American Medical Association
Much can be done by clinicians and managers to improve a trust' s ability to recruit medical manpower at a difficult time. While some success is down to good practice, some lucky breaks are unique to each situation. Good luck to you, therefore! And perhaps the hard times have made us less cavalier, more aware, and more caring in regard to the needs of our medical staff than ever before. I hope so.