A recruitment crisis? Perhaps - but some of the answers are in our own hands.

In the July Issue of the newsletter about Workforce (p9), I mentioned an up to date survey of consultant recruitment in our specialty. This was carried out to inform the Council debate reported in July and was basically a ‘point prevalence’ snapshot on the 1st May 2002. Twenty BGS regional representatives including 4 from Scotland, 1 from Northern Ireland, 1 from Wales and 14 from England, were asked to count consultant posts in their region and to note vacancies, (empty posts + locums), and new posts (filled and unfilled) in the last 12 months. They were also asked to comment on recruitment difficulties. All but 4 regional representatives replied, so the results (see table) are based on 16 regions and 703 WTE posts.

What were the headlines?
Overall, the vacancy rate was 8.5% but 6 regions (see table) had 10% or more vacancies. Fourteen posts (6 in the West Midlands) had failed to appoint at least once. The reasons cited were:

• geographical remoteness
  
• poor quality and number of applicants
  
• jobs too busy
  
• poor medical and administrative support
  
• lack of SpRs in the service

In the last 12 months, 47 new consultant posts have been created of which half are unfilled. There are 2 main reasons:

• the European Working Time Directive is resulting in an increase in consultants in acute specialties (and geriatric medicine – for better or worse is the largest specialty contributing to acute medicine)
  
• the NSF for Older People, the creation of new Intermediate Care services, a shortage of GPs and the new found power of Primary Care Trusts is pushing for more community based posts which to date, have proved unpopular with our trainees.

What did we learn from the survey?
If not a crisis, we certainly have a problem. The strictures of SpR training (and slow output into the consultant grade), coupled with expansion in consultant posts can only widen the gap. Some ways of tackling this issue and making jobs more attractive are about recognising the reality of the market. They are described in the previous workforce article, yet some regions (or should I say nations - Scotland) seem to have got it right and the rest of us need to learn from them!

A mismatch between trainees’ aspirations and job content is evident from this survey. Jobs in which the general medicine component is too dominant are unpopular, as are the innovations in intermediate care. This training ‘crisis’ has been recognised by the BGS Training Committee. Hopefully as geriatricians become actively involved in these schemes, and indeed in other community based work, the training opportunities will increase, and with them the trainees’ confidence to tackle this new area of work – but only if the acute medicine demands on their time allow it. Rather than offering these new posts to SpRs, existing consultants should perhaps be prepared to develop these and to offer ‘safer’ posts to new consultants.

There is undoubtedly a patchy problem in recruiting good quality motivated doctors into our specialty (it was ever thus!). What is new and poses a particular problem is the opportunity for our SHOs to move into other specialties, also expanding as a result of the European Directive on Working Hours. We need to attract the best. For me the last word goes to Cath Church, the current SpR Chair who, describing what attracted her into the specialty said (if I can paraphrase her views set out in the July issue of the BGS newsletter), the influence of enthusiastic consultant role models and their approach to patients, the opportunity to develop a sub-specialty interest, and the recognition that the geriatrician’s skills are useful in all settings

Alistair Main
Chair, BGS Workforce Committee

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