Consultant Vacancies Research Articles

Findings of the British Association of Dermatologists Career Survey of Dermatologists in Training and New Consultant Dermatologists 2023.

Previous surveys of UK dermatology trainees have identified key patterns regarding future career intentions that can help to inform workforce planning as consultant vacancies continue to grow. We invited all doctors training in dermatology, as well as all dermatology doctors who have completed training between 2018-2023 to complete separate surveys over a six-week period. These surveys explored: career locations, working patterns, pull factors towards particular posts, and push factors away from NHS consultant posts. The findings of these surveys confirm persisting trends towards less than full time working, ongoing limited geographical mobility of trainees, and a reducing appetite for academic work all identified in previous surveys. This survey offers the first insight into the working lives and factors influencing these career choices of consultants who completed their dermatology training between 2018-2023.

Rise in Scotland’s consultant vacancies is “extremely worrying,” says BMA

The BMA has called on the Scottish government to urgently tackle the rising number of vacant consultancy posts in Scotland. The call came after a report by Information Services Division (ISD) Scotland showed that, at the end of June 2014, 6.9% of consultant posts were vacant—up from 6.5% in March 2014 and 4.7% in June 2013.1 The …

G134(P) Workforce Planning in Community Child Health

AimTo find out what community child health services are delivered in our region, by whom, and what gaps in medical workforce can be predicted.MethodsA single interviewer went to every trust...

Paediatric CCTs exceed consultant vacancies by 150 a year, college warns

The Royal College of Paediatrics and Child Health has raised concern that numbers of newly qualified paediatricians exceeds the number of consultant posts available. The college has estimated that, between 2014 and 2019, there could be an average surplus of 150 holders of certificates of completion of training (CCTs) in paediatrics.1 The findings come after a survey by the Royal College of Physicians found that, across the profession as a whole, the number of newly qualified …

How to provide consultant peer support – the south coast new consultants group

IntroductionPeer support is identified though the NHS appraisal process and national bodies such as Royal Colleges, as being essential for the on-going wellbeing and professional development of consultants. It is...

Recruiting and retaining psychiatrists

Recruitment and retention of psychiatrists is a major concern in commissioning and providing mental health services. With consultant vacancies overall in the UK running at over 12% for many years, current services are stretched and in some areas only locum provision enables them to be maintained. This means that plans to reshape services with new teams, strengthening community-based work, could founder. Most professions within mental health share similar difficulties. The different stages of the career pathway of aspiring psychiatrists, from interested teenagers through to post-retirement consultants, are described. Difficulties at each stage in attracting and retaining the most appropriate people are discussed, and solutions at each point of the career cycle that could add up to a permanently better staffed service and a happier workforce are offered.

Views of junior doctors on the specialist registrar (SpR) training scheme: qualitative study of UK medical graduates.

To report junior doctors' views on specialist registrar (SpR) training. In 1999, as part of ongoing studies of doctors' careers, we surveyed all doctors who had qualified from UK medical schools in 1993. Structured questions about recipients' careers were accompanied by a form inviting free text comments. Comments about the SpR scheme were extracted for analysis. Doctors commented that there were insufficient national training numbers (NTNs) for those who wanted them, and that more than the minimum entry requirements seemed necessary for shortlisting. Strengthening curricula vitae through research and published work could prolong the duration of training and did not guarantee success. Specialist registrar training was considered by some respondents to be narrow and inflexible, with service work taking priority over training needs. As a result, some respondents feared they would not be competent to practise as consultants. There was a perceived shortage of consultant vacancies and 6 months was considered insufficient time for obtaining a suitable post. It is inevitable that doctors may not necessarily be able to pursue their initially chosen career paths. Trainers need to provide realistic advice about career opportunities. Provision of information about NTN availability and formal career counselling could help to prevent delays in career progression. The shortened and more structured programme of training has reduced its flexibility in some doctors' experience. Improvements in educational content will need greater input from consultants, which may require an increase in consultant posts. Time will tell whether concerns about competence to practise as consultants and consultant post availability will be justified.

Mismatch between trainees' subspecialist interest and advertised jobs; worrying implications for upper gastrointestinal trainees

AIMS: The aim of this study was first to assess the primary subspecialist interests of general surgical specialist registrars who were accredited and still looking for a consultant position, or who were within 3 years of their CCST (certificate of completion of surgical training). These interests were then compared with subspecialist interests declared in consultant vacancies advertised in the British Medical Journal over the preceding 16 months. METHODS: All trainees in general surgery holding a national training number in six regions (Mersey, North West, Trent, Yorkshire, Northern, West Midlands) were identified, and those accredited or within 3 years of their CCST (n = 136) were telephoned to ascertain their primary subspecialist interest, whether they had a higher degree and what their desired consultant job would be. The consultant vacancies advertised in the British Medical Journal between 3 January 1998 and 8 May 1999 were assessed according to the required subspecialist interest. RESULTS: Upper gastrointestinal surgery is the second most popular subspecialty (n = 37; 27 per cent of trainees) after colorectal surgery (n = 40; 29 per cent of trainees). However, there were fewer consultant vacancies in upper gastrointestinal surgery (31 of 226; 14 per cent of jobs) than in any of the other three main subspecialist areas of general surgery (colorectal, vascular and breast/endocrine). The ratio of percentage of jobs to percentage of trainees was lowest in upper gastrointestinal surgery (0.50), compared with colorectal (0.77), vascular (0.89) and breast/endocrine (2.23) surgery. CONCLUSIONS: Upper gastrointestinal surgery appears to be the most competitive of the general surgical subspecialties at present, having by far the lowest ratio of jobs to trainees. In addition, 87 per cent of upper gastrointestinal trainees have or are completing a higher degree, and 43 per cent expressed a desire to work in a teaching hospital.

The effect of Calman reforms on recruitment training and service provision.

The 1948 Spens report on the remuneration of consultants and specialists anticipated that a medical graduate 23−24 years old would achieve specialist status by the age of 32.1 In practice, most doctors are appointed to their first consultant post between the ages of 35 and 40. Sir George Pickering commented in his 1962 review of postgraduate medical education, “I cannot believe that any responsible body would have so long a period of training (10−15 years) . . . the situation has got out of hand.”2 The introduction of the specialist registrar grade in December 19953 was the first major change in speciality training since the inception of the UK National Health Service (NHS). This change was prompted by the need to meet European models and to provide a means to a certificate of completion of specialist training (CCST); to provide a shorter, more structured training programme; and to control the numbers of people entering this grade relative to expected consultant vacancies. These changes have been met with scepticism and in some cases antagonism. They have caused greater focus on what is required and desired in the making of a competent specialist. There is, however, continuing concern that the training period is too rigid and too short for many. The implementation of this change has come on top of the “New deal” in 1990, which had already significantly increased the number of junior doctors required to provide for service. New rotas have led to the loss of the “firm” structure, and responsibility for continuity of patient care has meant longer working hours for consultant staff. At the same time the demands of formal provision of postgraduate education and the organised supervision and appraisal of junior doctors has eroded consultant time, which previously was spent on service, personal professional …

Malaise in psychiatric recruitment and its remedy

Aims and methodSurveys of career intention among medical students, Membership Examination results and manpower figures are used to examine trends in recruitment to psychiatry over the last 10 years.ResultsProblems of recruitment to psychiatry have increased. Consultant expansion contrasts with a fall in the number of medical students. The increase in the number of career senior house officers and specialist registrars is insufficient to fill existing consultant vacancies notwithstanding new and replacement posts. The popularity of general psychiatry and psychotherapy have declined.Clinical implicationsProposals include an increase in the number of medical students, the introduction of psychiatry in the pre-registration year, increased specialisation and closer integration of general adult psychiatry with general medicine.

The effects of the Calman reforms on training, service provision, and recruitment.

The proposals by Kenneth Calman1 to restructure the training of middle grade staff were introduced to “produce a shorter, more structured and organised training pathway so that independent clinical competence as a consultant can be achieved much earlier than in the past in many disciplines”.2 By the allocation of a National Training Number (NTN) and a more formalised training programme, the goal was to provide the health service with doctors of a consistently high quality in appropriate numbers for the forecast consultant vacancies. From the registrars’ point of view they would receive their NTN, which guaranteed, subject to satisfactory progress, training in their chosen discipline, and a training post within a specific region. Unfortunately the realisation has differed somewhat from these ideals. The key weaknesses in the current implementation are: These points are discussed in more detail and I propose amendments to the current system to address these shortcomings. I speak from the position of a paediatric specialist registrar, just starting my third year of higher specialist training. Much of my time has been spent trying to understand the Calman training programme and to make the best use of the bureaucracy that has evolved to support it. Unfortunately, the rapid introduction of this system has lead to many omissions. Notably, it does not cater for the diverse needs of trainee generalists, academics, and subspecialists.2 3 It …

Consultant vacancies in the NHS--a short term solution?

There has been much concern recently about the inability of the NHS to attract consultants in many specialties and localities and anyone who has seen the curriculum vitae of applicants for consultant posts cannot fail to have noticed the decline in the number and quality of applicants. Historically, there has always been greater competition in certain specialties and in certain hospitals than in others, but at present even consultant posts in short stay medical and surgical specialties, which have previously been regarded as attractive, remain unfilled. There are several causes for the present shortfall of consultant applicants: insufficient medical students; a fall out of graduates, particularly women, within three or four years of graduation; and unattractive postgraduate training programmes, which place little emphasis on education, and an undue emphasis on service. Other factors include the change in the work permit regulations, which have abruptly reduced the flow of overseas doctors, and the declining attraction of the consultant post as the pressure on consultants increases as ever more tasks have been allocated to them such as management, training of junior doctors, …

Recruitment into psychiatry

The major problem of manpower planning in psychiatry has until fairly recently been one of securing enough posts in the training grades to place doctors wishing to train in psychiatry and to ensure an adequate supply of applicants for consultant posts. Numerous consultant vacancies and a ‘bottleneck’ between registrar and senior registrar grades was the frustrating combination largely consequent upon the failure of some regional health authorities to fund the posts which Joint Planning Advisory Committee (JPAC) had approved.

Staffing in cardiology in the United Kingdom 1990. Sixth biennial survey: with data on facilities in cardiology in England and Wales 1989.

The Sixth Biennial Survey of Staffing in Cardiology was conducted in July 1990. This report summarises the data that were collected, together with the results of a survey of facilities in cardiology made in 1989. The total number of cardiologists in the United Kingdom, defined as individuals trained in the specialty and spending at least 40% of their time working in it, is now 323. Six individuals work part time only, making 320 whole time posts. This number has increased over the two years from 1988 to 1990 by 32, of which 23 work only in the specialty and nine as general physicians with a major interest in cardiology. The rate of increase in numbers over the past decade has been reasonably consistent with an average of approximately 4.4% per year. Thirty one districts in England and Wales still have no cardiologist and 13 other districts have little provision with an average of three (visiting) sessions each per week. The population in these 44 districts is 8.3 million. Scotland also has an inadequate distribution of service in the specialty. If recommendations for cardiac surgery and angioplasty made in the Fourth Report of a Joint Cardiology Committee of the Royal College of Physicians of London and the Royal College of Surgeons of England are to be met, we calculate that we need 63 more cardiologists in our major centres. To provide one cardiologist in every district hospital and two for larger districts would require 94 more specialists, making a total shortfall of 157 individuals. We have no excess of senior registrars to provide for a major expansion at consultant level. Time spent within the senior registrar (or academic equivalent) grade has tended steadily to decline and very few now reach the end of their contracts. The need for more individuals to pass through the senior registrar grade will be met in part by a planned reduction in the training period to three years. This will be inadequate, however, because projected retirements show that the number of consultant vacancies will increase sharply from 1997. We believe that additional senior registrar posts must be created if a serious shortfall in service provision by consultants is to be avoided. The provision of non-invasive facilities in cardiology is reasonable. The need for additional equipment for invasive cardiology has not been assessed. The number of physiological measurement technicians varies considerably between regions and is generally inadequate.

What Puts Medical Students off Psychiatry?

At present about 4% of doctors opt for a career in psychiatry. Between 1974 and 1977 almost a quarter of the consultant posts in general psychiatry remained unfilled; in 1981 there were no less than 220 unfilled consultant vacancies. This shortage is regarded by many as representing a deficiency in quality as much as quantity of applicants. If the consultant grades are expanded in the future to the levels suggested by the Short Report these problems are likely to increase rather than decrease, unless recruitment into the speciality is enhanced.

The Recruitment of Psychiatrists in Mental Handicap

In most parts of the country today it is often difficult or impossible to fill consultant vacancies in mental handicap. According to the DHSS there were 146 consultants in mental handicap in post in 1978 compared with 102 in 1968, an overall growth of 43 per cent, compared with 34.7 per cent in general psychiatry. Nevertheless nearly one quarter of posts were vacant on 30 September 1978. The number of new consultants in mental handicap required to replace losses from death and retirement is about 6 to 10 per year. If an expansion of 10 is to be achieved some 16 to 20 fully trained senior registrars will be required each year. For this 60 senior registrar posts will be needed, assuming that senior registrars have three to four years training. At the end of September 1978 there were 34 established senior registrar posts of which 9 were vacant.

The state of medical education in the United Kingdom.

The state of medical education in the United Kingdom.

Anaesthetic staffing and training requirements in Scotland.

In Scotland there is an average of 12 consultant vacancies and 14 Fellows qualifying per year, but these are insufficient to meet all the vacancies as several emigrate or return abroad. The existing registrar and senior registrar establishments are inadequate to meet the numbers of consultants required if full allowance is made for special factors, such as the high proportion of women graduates and the rising proportion of overseas trainees.A backlog of understaffing in Scotland relative to England and Wales is shown by comparison of the ratio of anaesthetists to surgeons. The existing rate of expansion of 6% per year must continue for many years or be increased if staffing levels are to come into line with those elsewhere in Britain.