Physician shortage worsened by cuts in job ads and lack of trainees, colleges warnBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6011 (Published 14 October 2019) Cite this as: BMJ 2019;367:l6011
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Retired and retiring consultants - An unrecognised and undervalued resource to address the issue of physician shortage.
Cuts in job ads and a lack of trainees have been blamed for the shortage of physicians in the NHS according to the 2019 census report of the Royal Colleges of Physicians. Calls for taking measures to improve retention by reducing stress amongst existing consultants and increasing the number of medical students are not new and would take a long time to improve the situation that has already reached the breaking point now.
An important category of resources readily available and in waiting that could help ease the situation greatly is that of recently retired and retiring consultants. Unfortunately, it has been completely ignored and undervalued by all concerned.
If given a degree of flexibility in terms and conditions of employment that would allow them to do what they feel comfortable with, they may be very happy and willing to help and take the ever-increasing pressure off the existing consultants.
Shortage of consultants and junior medical staff has become almost an accepted part of the scene. Normally, managing the process to fill a vacant consultant’s post is largely in the hands of junior managers of the directorate and the HR department who may not go much further than simply advertising the posts. They may feel more comfortable with letting a post remain vacant in the absence of a suitable applicant rather than offering retired or retiring consultants contracts with less rigid terms and conditions that would allow them to engage in less onerous and part time roles of their choice (such as running clinics, teaching, training etc.), with no compulsion to cover colleagues and to have favourable leave allowances (unpaid if so desired). This would take the edge of the pressure under which the regular consultants find themselves.
What also does not help is the GMC’s policy of putting pressure on retired consultants to voluntarily give up their licence to practise as soon as they have retired unless they have engaged in further clinical work almost immediately. Once the licence to practise is surrendered, it becomes almost irrecoverable for all practical purposes and that consultant has then lived all his or her professionally useful life, sadly. Let us not allow the story of what happened with nurses in the NHS to be repeated for the physicians also.
Competing interests: No competing interests
I find the lack of consultancy posts being filled, concerning. I fear the consequences for my training, staff morale and, ultimately, patient safety.
As a medical student who will be joining the system in a couple of years, I struggle to see how effective training will occur if teams are not being taught from the top-down. Registrars will be forced to work the jobs of consultants, SHO’s will work the jobs of their registrar and so on. None of these staff will be competent, nor appropriately trained for the roles they are unofficially assuming. Further to this, the staff will not have the time to teach their juniors, only worsening the situation. Despite these doctors working in the best interests of their patients, this practice is dangerous and unsafe. I worry about the support and training I will receive as a foundation doctor if this scenario is still present.
It is the proposed solution to this crisis, though, that concerns me most. The suggestion of Andrew Goddard to “double the number of medical students” is a plan that is destined to fail. In the experience of my peers and myself, wards are already overwhelmed with medical students. A ward could be home to 18 students in varying stages of their training. All of these students are looking to take histories, examine patients, have their clinical skills competency approved and receive teaching. Doctors do not have the time to give effective teaching to all their medical students, patients are overly-disturbed for history and examination practice and consultants don’t have the time to monitor their progress. This is all before the proposed doubling of students.
I do not believe that there aren’t enough medical students being trained, I agree more with Derek Bell that the NHS has been unable to look after the wellbeing of staff, support their development and value their experience. With all medical practitioners now listed on the Migration Advisory Committee’s (MAC) shortage occupation list, the NHS clearly lacks the ability to retain their staff.
Perhaps the NHS should re-evaluate the “sticking plaster” approach of increasing student influx and shift focus on preventing doctor efflux.
Competing interests: No competing interests