Dev Lall

Facing up to a recruitment crisis in Scotland

I wonder how the provision of a trained doctor service in anaesthesia can be maintained in Scotland.

To begin with, our training posts numbers are below that required to replace those expected to retire. On top of this, it is proving more and more difficult to recruit doctors to the posts we have. When we do succeed, it is hard for them to progress in our specialty along the default timeline and, worryingly, it seems less and less likely that they will stay and work here having gained their CCT.

The first point is being addressed by the Scottish government and we should have an additional 10 CT1 posts to recruit to next round. This is less than the 14 that were calculated to be required, based on the previous five years of attrition at this level. There has always been an attrition rate of 25% at this (or SHO) level of training. This was due to trainees deciding that the specialty was not for them or failing to pass the primary exam.

These factors may increase further post MMC as trainees need to apply to a programme straight from foundation training (without sampling extended periods in other specialties) and due to the increased logistical difficulty in passing the Primary FRCA exam.

The rigid timetabling of examinations by the college, and national recruitment to specialty training are not synchronised to one another. While each process has its deeply embedded and sound reasoning for when it takes place, the fact remains that it is very difficult to do both these things together, at the expected time. Our core trainees are now required to have  passed all parts of the primary examination by month 18 of a two-year training programme to be eligible to apply for the ensuing ST3 post commencing that August.

This is by no means easy. Passing said exam within the full two years was often difficult, taking more than one attempt for many. Now, passing the last part in May is too late and leaves trainees unable to apply to ST3 the same year (however, should they fail at that sitting, a six month extension to training ensues allowing time to pass and apply to ST3 for the following February).

So while we can recruit to CT1, it does not mean we fill our ST3 posts. We still have gaps in Scotland despite clearing systems, LAT appointments and additional February recruitment. Of those who do take up ST3 posts the majority will take longer than the basic five years to complete the training programme.

Maternity leave, sick leave, repeating a year, doing research, going out of programme, inter deanery transfers out of region are not new phenomena, but additionally we see an increasing proportion of trainees training LTFT  (and doing so earlier in their career s); we also see intensive care medicine training adding at least one year onto training time(possibly more for non-anaesthetists) and we seem to be supporting an ever increasing number of ‘doctors in all sorts of difficulty’ which impacts upon their ability to work and train as required to progress at the required rate.

Thus it seems training is now a journey to be enjoyed at a leisurely meandering pace rather than as getting to a destination, arrived at via the shortest, fastest route. Prolongation of training leads to a reduction in the annual production of CCT holders compared to that projected when these people were recruited at CT1 level.

But why rush to get a CCT in anaesthesia in Scotland? Consultant posts are advertised with 9:1 DCC to SPA contracts with no guarantee of this division being revised (although this has occurred in some Health Boards). This has created a real ‘us’ (new guys) and ‘them’ (established consultants) feeling. Further, there are resident on calls and weekend shifts built into most new and replacement posts.

With uncertainty around posts and no time for professional development we have seen many trainees leave Scotland post CCT following MMC. We now wait with baited breath to see how many return in due course.

While undesirable, 9:1 contracts threaten our ability to train and the quality of training for which anaesthesia is renowned. New consultants have no time to be educational supervisors, to take on teaching, to help with exam preparation, to complete workplace based assessments with trainees. These activities all take time out of theatre and the goodwill is all but gone.

As time passes and departmental workforces consist of proportionately more and more new consultants, I fear high quality training and intensive input to our trainees will be lost. When word gets out we will see fewer and fewer foundation doctors being attracted to our specialty and recruitment to core training will become harder and a ‘cycle of doom’ will be perpetuated.

Does anyone have any solutions?

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