Half of paediatric consultants would not take part in shift working

More than half of paediatric consultants who responded to a survey said that they would not take part in resident shift working, despite the Royal College of Paediatrics and Child Health advocating consultant resident shift working as the best model for improving the quality of paediatric care.

A total of 52.2% of the 2352 consultants who responded (72% response rate) to the college’s biennial workforce census of senior paediatricians said that they would not consider resident shift working “under any circumstances.”

Just over a quarter (29.3%) said that they would support consultant shift working if it was time limited and a structured part of career development, but only 4.7% said that they would happily work resident shifts for their entire careers.

Only 8.1% of consultants who responded to the survey and 14.6% of staff, specialty, and associate specialist grade doctors were currently working resident shift patterns, with doctors under 50 years of age more likely to work shifts than those aged 50 or over.

In 2012 the Royal College of Paediatrics and Child Health suggested that consultant paediatricians should move towards working on a resident shift basis to ensure availability of a consultant 24 hours a day, seven days a week.1 Earlier this month the college warned that there still were not enough consultants available to review acute admissions at night and at weekends, putting care of patients at risk.2

Not having a consultant paediatrician present with a registrar at the busiest times of the day could mean that units became too full, decision making was slower, and on the job training of junior doctors was less effective, said David Shortland, the college’s vice president for health services.

However, paediatric consultants often came into hospitals when there was a medical emergency—whatever the time of day or night—and often covered for an absent registrar, he added.

“We need to strike a balance between ensuring that paediatrics is an attractive specialty for doctors but also ensuring that the service we provide is absolutely in the best interests of patients,” he said. “There are plenty of examples of good practice in this area: of units operating effectively under a ‘consultant of the week’ model and managing to achieve 24/7 consultant presence.”

Shortland pointed out that only a third (38.8%) of general paediatricians, the group most likely to work resident shifts, said that they would not consider this way of working, and 20.7% of generalists said that they already worked in a resident shift pattern. In addition, younger consultants were less reluctant to work resident shifts, with only 36.6% of 30-39 year olds saying that they would not work in this way.

“Encouragingly, there is growing consensus that resident working is part of the job,” he said. “The number of paediatricians accepting resident roles has more than doubled over the last year, from 111 to 288, so we know that this kind of working is not wholly unattractive to paediatricians.”

The college has advocated that consultant paediatricians undertake different tasks during different stages of their careers, “accepting that resident working is part of the job, but recognising that as doctors get older, so the nature of their shifts should be adapted,” said Shortland.