Sunday, 17 February 2008

Is there a doctor in the house?

I wrote before about the bizarre state that we find ourselves in regarding staffing. Despite the ridiculous shambles of MMC 2007 that left the majority of junior doctors in specialist training either displaced or unemployed, we now find ourselves in a position where there aren’t enough doctors in the hospital to staff a rota.

The situation has now been picked up by Channel 4 and The Telegraph (the BBC, as always remain silent).

Junior doctor jobs are vacant, and trusts up and down the land are having to scrabble around to find emergency locum appointments at the cost of thousands of pounds per week.

The situation is getting worse and worse on almost by the week. Doctors are completing their training and are taking up consultant jobs, taking a break or going to work elsewhere and, because or MMC, NewTown NHS trust is not able to replace them until August.

This means more positions are being left vacant, more pressure is put on the remaining doctors to do the work and the NewTown NHS Trust is having to fork out more and more money to pay for locums to cover the shifts.

To put into perspective how bad things have become, in February 2007 (pre-MMC) there were 12 junior doctors (SHOs) on the anaesthetics rota at NewTown Hospital, today, there are five. Five doctors are doing the work of twelve.

This is obviously unsustainable and in reality, it’s meant that the consultants are doing many of the duties previously done by the juniors. This is good in that the work gets done and our patients don’t suffer delays or poor treatment, but you have to ask; is paying locums and consultants to do the work of junior doctors a sensible use of resources?

I think not.

My colleagues in general medicine and surgery say the situation for them is very similar.

Once again, I’ll say that Liam Donaldson has a hell of a lot to answer for.


AndrewSouthLondon said...

As a doctor you will n0 doubt recognise the diagnosis of multiple but unrelated problems.

1. DH is fundementally useless, especially when it comes to workforce planning.
2. Trained doctors have no "right to a job". Train as an architect or lawyer and "demand" some one employs you. Only doctors seem to think they have a right to a job.
3. We have now trained too many doctors for the number of doctors jobs that are funded - welcome to the real world.
4. A lot of what doctors assume is their job can be done by people with much less expensive training with a lower expectation of salary. Specialist nurses, ambulance paramedics, allied health professionals. Welcome to the real world.
5. Overseas doctor are cheaper and willing to do the shit jobs. Welcome to the real world.
6. Doctors have perks from the drug company freebies, and private practice. The only comparably corrupt profession is Members of Parliament.
7. If you are still with me? NHS hospitals have a fixed budget and all the money has gonelong before you get to it.Five vacancies unfilled is five salaries unpaid to bail out the deficit caused by that unfunded service development in the Cancer Unit. WTtRW.
8. Medical education is blissfully unaware of the economic and political context in which healthcare is funded in the NHS. How do I know? Forty years experience.

Anonymous said...

Interesting, but how are points 1, 2 & 3 unrelated?

3 is a result of 1, and 2 is a position adopted by affected trainees as result of 2.

Back to point 3. Anyone outside public service that pissed £240k/person on training up said unrequired doctors would be out on their arse.

Point 6. Seems a bit naive, most businesses have some freebies and entertainment by suppliers.

Overall some going points though. Doesn't stop my wife or me feeling shit about her lack of interviews again this year for ST2.

Michael Anderson said...


I live in the real world and I know what I’m talking about. While you make a couple of valid points, I think you’re misinformed (or deliberately obfuscating the truth) about a couple of things.

In the interests of a sensible debate, let’s take thing point by point

1. Agreed
2. I know that doctors have no right to a job. I have no illusions that I have a right to a job. Nowhere on my blog or in real life have I stated that I have a right to a job. I’ve been to about a dozen job interviews over the last 3 years (pre- and post- MTAS) and without exception, they’ve been highly competitive. Sometimes I was successful, more often than not, I wasn’t. Trust me, I know from first-hand experience that doctors have no god-given right to employment. Most of my colleagues share my view, so it surprises me that you think we believe we have a “right to a job.” You are missing the point, which is that we believe we have the right to be treated fairly and like decent human beings.
3. Agreed
4. This is a total load of codswallop if you ask me. Where is your evidence for this? I agree that specialist paramedic staff can be trained to do PART of a doctor’s job, but it’s only part of it. Employing several different people to each do part of a doctor’s job will inevitably end up being more expensive than employing doctors to do the whole thing. I’ll blog about this more fully in the near future. I live in the real world, I work in a hospital every day.
5. I never mentioned foreign trained doctors in my post and this post is not about them. Since you brought it up, I’ll try and put you point into context and say that they are cheaper in that we don’t have to pay for their training, but by the time they come to work for the NHS, they are paid exactly the same as their UK trained equivalents. It would be unfair and illegal for it to be any other way. NHS trusts save no money by employing foreign trained doctors. I live in the real world, I work in a hospital every day.
6. Just about all my friends in the private sector get better perks than I do. Free transport, company cars, entertainment expenses, Christmas bonuses, trips abroad, the list goes on and on. As a trainee anaesthetist I have no private practice (which is not really a perk IMO, just more work, but I admit that I know almost nothing about private healthcare), no drug company freebies, my only perks are medical advice from my work friends (as a man in my 20s, I need this very rarely) and my pension, which is the same for ALL NHS STAFF, not just doctors. Every day I go to work and I see medics, surgeons, anaesthetists etc… trying their damn hardest to give their patients the best care they can. Today I started work at 0745, finished at 2130, came home, I’ll be studying until midnight, then up again at 0630 to do it all again tomorrow. I have no idea why you think I am self-serving or corrupt, I can only assume you don’t really understand what junior doctors (or senior doctors) do.
7. Ummm, this just doesn’t make any sense at all. You’re forgetting that the workload will remain the same, regardless of the staffing levels, and you’re forgetting that junior docs actually do a hell of a lot of work. If you take 7 doctors off the rota, then the work of those seven doctors still has to be done. So the trust has a choice of either cancelling surgical lists so patients have operations delayed (unacceptable) or find someone else to do the work. It doesn’t take a genius to work out that paying a consultant (basic salary £75 000) to do a list that could be done by a SHO (basic salary £30 000) costs the trust MORE, not less money. I live in the real world, I work in a hospital every day.
8. I don’t get what you mean by this. Surely having a well trained and happy workforce is good for the patients? How would you like to see post-graduate medical education run, Andrew? I’m interested to know.

- Michael

Sam said...

"AndrewSouthLondon said...

2. Trained doctors have no "right to a job". Train as an architect or lawyer and "demand" some one employs you. Only doctors seem to think they have a right to a job."

The very strange thing AndrewSouthLondon is that the majority of doctors (very wrongly) now think that they do not have right to a job, despite the fact that, unlike architects or lawyers, or any other profession for that matter, doctors were 'commissioned' to work for the NHS! No where else! They have no right to set up in private practice nor can finish their long training outside of the NHS! Hence,

no job meanz no career! As a parent of junior doctors myself, I'd say, the juniors have 'every' right to expect a job and the opportunity to progress since they were 'commissioned', hand picked and trained @"250 - 300K to do just that; doctor people to good health!