Characteristics of consultants who hold distinction awards in England and Wales: database analysis with particular reference to sex and ethnicity
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38062.639190.44 (Published 03 June 2004) Cite this as: BMJ 2004;328:1347
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Editor,
Lambert et al comprehensively describe the distribution of
distinction awards amongst consultants and our attention was particularly
drawn to their observation of differences in B awards between
specialities1. Under the auspices of the Advisory Committee on Clinical
Excellence Awards (ACCEA), clinical excellence awards have replaced
distinction awards and local discretionary points, with a principle of
“equality of opportunity”2.
We have analysed the distribution of discretionary points for the
last year within our large trust and compared the odds ratio of receiving
a discretionary point. Our data correlates closely with the data on
distinction awards in their paper. For example, the odds ratio compared to
general medicine for receiving a discretionary point is 0.24 for
anaesthetics (0.32 in Lambert’s paper), 0.31 for radiology (0.4) and 0.83
for pathology (0.71).
It appears that for both local and national wards, there is a
consistent lack of representation of some specialities, especially the
service specialities. It may be that some specialities are more “worthy
of reward than others”, or it may be that the assessment system that is in
place inherently discriminates against some specialities1. We believe
that the ACCEA should examine the data and question whether the clinical
excellence awards scheme follows their guidance in allowing a fair
distribution of awards between specialities.
Dr Paul Sigston
Consultant Anaesthetist
Dr Charles Wetton
Consultant Radiologist
1. Lambert TW, Goldacre MJ, Vallance E, Mallick N. Characteristics of
consultants who hold distinction awards in England and Wales: database
analysis with particular reference to sex and ethnicity. BMJ 2004;
328:1347-9 (5 June.)
2. Department of Health The new NHS consultant reward scheme:
Clinical Excellence Awards. London: Department of Health, August 2003.
Competing interests:
Both authors have received discretionary points and belong to specialities that receive few awards
Competing interests: No competing interests
Lambert and his colleagues are brave in trying to make sense and
apply scientific analysis on the results of a process that does not lend
itself to science. The first step in analysing the process is the
assessment of the methodology of the process itself from the point of
nomination, shortlising, scoring of candidates, selection and finally the
awarding of the distiction awards. The robustness of the methods of
selection need to be assessed from the point of view of reliability and
reproducibility. The mere fact that award holders come from many
backgrounds does not in itself guarantee fairness and should not be seen
to reflect equity.
Lambert et al, provided odds ratios for individual variables with
interesting results. White consultants trained abroad have an odds ratio
of 0.7 (CI 0.54-0.91) and that for non-white consultants trained abroad is
0.68 (CI 0.54-0.85). Also doctors working in district general hospitals
have an odds ratio of 0.38 (CI 0.32-0.46). The odds ratio for those who
work outside London is 0.78 (CI 0.67-0.91).
I found that the most interesting finding in this paper is the combination
of all the statistically significant variables. The combinations make the
chances for consultant, who was trained abroad and works outside London in
a district hospital, to receive distinction award very slim indeed.
Competing interests:
None declared
Competing interests: No competing interests
Now that we have set to rest the issues of sex and ethncity as
discriminators against achieving higher awards it is time to address the
huge inequalities between specialties. My own, anaesthesia, is no less
clincally demanding than any others. However, surgeons and physicians
still hold the limelight in the opinions of the profession and the public
as to who the really hard working, skilfull and clever doctors are. This
of course is not evidence-based.
I suspect that another reason is related to research publications.
Anaesthesia, Intensive Care and Pain Management are not easy areas to
undertake classical clinical trials. It was evident whilst sitting on a
regional Awards Committee for 3 years that the number of papers published
was still a very strong determinant of success in awards. Furthermore
those doctors who achieved national and international reputations and who
were able to sit on important committees seemed to come from departments
that would be well-staffed with juniors, research assistants etc.
Commonly, having read many applications, I was left wondering who was
really doing the everyday work; who was working through the night with the
emergencies; who really was doing all the hard slog producing the research
papers? There did not seem to be enough hours in the day for everything. I
perceived that many unsuccessful applicants were clearly very hard working
clinicians who were worthy of recognition but who had only limited time to
persue some the activities that lead to success in the awards race.
I hope that the system can be improved further and eliminate the
current clear inequalities. However, I believe that the methodology for
assessing for higher awards needs much more scrutiny. There may be benefit
in studying the emerging methodologies being used at local levels,
previously for Discretionary Points and now for Clinical Excellence
Awards.
Competing interests:
I am an Anaesthetist. I hold a "B" award. I was a member of a regional awards comittee until 2 years ago.
Competing interests: No competing interests
Other goals in life!
This paper is fundamentally flawed by not having checked that the
'lifestyle goals' of the various consultant groups, white and non-white,
are the same.
To achieve a distinction award often involves considerable sacrifice of
family life in the pursuit of distinction in one's career. It is a very
moot point amongst many consultants that I have spoken to as to whether
the reward is worth this sacrifice - certainly many women do not think so.
So all this paper may be showing is that award holders value distinction
more highly than non-award holders value family.
It would be no surprise to me if it was shown at some future date that
ethnic minorities and women value families more highly!
Competing interests:
I held an 'A'award
Competing interests: No competing interests