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60 seconds on . . . Black Wednesday

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3574 (Published 26 July 2017) Cite this as: BMJ 2017;358:j3574

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Re: 60 seconds on . . . Black Wednesday

‘Black Wednesday’ is the name given by the popular press to the start date for new junior doctors, coined following a 2009 study which showed that the first week in August had a 6-8% higher mortality rate for patients when compared to the last week of July.1 As mentioned by this article, several responses to this research were made by organising bodies. This included joint recommendations from Academy of Medical Royal Colleges and NHS employers which suggested introducing mandatory inductions, flexible and intelligent rota design, a reduction in elective procedures and ensuring consultant availability.2

Maintaining consultant staffing levels is a challenge during August which is in the middle of summer holidays for schoolchildren. This is highlighted by information obtained via a freedom of information request (FOI) to The Royal Cornwall Hospitals NHS Trusts.3 In Theatres and Anaesthetics, the average total days of annual leave taken by consultants in August from the years 2013-2015 respectively was 196.7 days, a nearly two-fold increase from June where the average was 102.2 days. Similarly, in the Emergency Department from 2013-15, a total 38 leave days were taken in the June versus 131 in August.3 These trends were mirrored in other specialties including Oncology, Clinical Imaging and Pathology.

This data shows that contrary to recommendations more days leave are taken during the month that junior doctors begin work. It is unsurprising that professionals who often have children are taking time off in their summer holidays to be with them. If these trends are consistent throughout the health service then perhaps we should reconsider when junior doctors begin work. However, this is only crude data from one trust. For this reason, we intend to investigate the amount of consultant leave during these dates more systematically.

1. Early In-Hospital Mortality following Trainee Doctors' First Day at Work, Min Hua Jen et al PLoS One. 2009; 4(9): e7103. doi: 10.1371/journal.pone.0007103
2. Academy of Medical Royal Colleges, NHS Employers. Recommendations for safe trainee changeover. June 2013. http://www.nhsemployers.org/case-studies-and-resources/2013/06/recommend...
3. The Royal Cornwall Hospitals NHS Trust Response To Information Request https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHo...

Competing interests: No competing interests

31 July 2017
Raphael PZ Rifkin-Zybutz
Medical Student
Thomas Taylor and Jonathan I Spencer
Oxford University
Medical Sciences Divisional Office University of Oxford Level 3, John Radcliffe Hospital Oxford OX3 9DU