Senior clinicians regularly have to make difficult and unpopular decisions, none more so than the Rota Consultant.
I have never been the rota consultant or indeed the rota trainee, largely due to a fear it would leave my brain like a pan of overcooked spaghetti.
That was back in the day when, with hindsight (a marvellous invention don’t you agree?), the rotas were relatively straightforward. When our last (fantastic) rota consultant was leaving the role after many years, there was a period where all eyes looking silently to the floor.
We run a daytime rota for 12 theatres, a labour ward and an intensive care unit and although we are a relatively small department, our numbers have increased from 16 to 28 in the last 10 years and our consultant on-call has increased to include partaking in a ‘3rd person available’.
Modern job planning of half sessions here and there means the elective slots are covered variably on alternate weeks of the month. (Does this continue to roll with a five week month or go revert to week 1 being Dr X and Mr Y? Not sure. Hopefully someone is though).
Modern work life balance means many consultants have ‘a day off’ in the week, often with a surprising level of inflexibility and others have compensatory day time off for overnights and weekend working.
Yes, weekends but I’ll say no more on that.
Some take summer holidays and modern medical careers mean that many consultants now do regular evening sessions meaning they cannot be on call those nights.
As they receive day time off as ‘payment’ for these sessions this leaves elective work to be covered by…?
There are many blanks in the rota. It can’t be the trainees; there are too few of them and their service is confined to nights and weekends, with daytime shifts spent being trained.
Maybe consultants can slot in if they have flexible sessions or extra payment is found by management to ensure at least the hips are replaced.
But often the gaps are filled by the specialty doctors and associate specialists we were far thinking enough to appoint several years ago. This cohort work tirelessly, and incredibly flexibly, usually without complaint.
I don’t think our department could run without them.
But I digress.
The rota constraints are such that it drives some to book annual leave 18 months in advance to guarantee the school holidays (admittedly a benefit of the electronic diary). And despite wide advertising of the imminent closure of the diary each month before the theatre schedule is conjured up, there are always one or two with their last minute requests: ‘oh I really need that day off’, ‘I could swear I entered it into the diary’ and ‘my flight leaves at 6am so I literally can’t be on call that night’.
None of this makes the rota consultant’s job any easier. And for this I apologise.