So, hang on, let me get this straight. It’s now officially recognised that for some juniors the WTD has been an unmitigated disaster. And this is because a 48-hour week has produced rota gaps, which mean the service has been prioritised over training, thus leading to less training time for juniors and forcing some to work beyond their competence.
This was, of course, strenuously denied by the last administration. But because it can now all be laid at their door, everyone can now criticise the 48-hour week for juniors.
Health secretary Andrew Lansley was first in, saying he’d re-negotiate an opt-out.
Now it’s the GMC’s turn. Apparently, they’ll be getting tough on those units and specialties that aren’t enabling juniors to train properly or making them do work beyond their skills (but admit none of these problems get reported). And they also want an opt-out.
It raises questions in my mind about the competence of the profession’s workforce planners and so-called leaders. Remedy have already pursued this thought with MMC and revealed a group of ‘untouchables‘.
But there’s an even more obvious question at the front of the queue: why on earth would you embark on a career in surgery?
The GMC review confirms that it’s surgeons and the more acute medical specialties that have been worst affected by the working time regulations.
So, for surgeons, this appears to be problem number one. Problem number two is that even if they are getting decent training, chances are they’re going to struggle to progress.
An investigation by BMJ Careers suggests that in certain areas of the country there are very few roles available for those trying to move from core training into specialist training. Most will be thwarted, many will be delayed. This is despite it having cost the taxpayer £250,000 to train them.
Problem number three for wannabe surgeons is that because of the WTD they’re probably going to have to do an extra year of training. The RCS is currently campaigning on the issue.
To cap it all off (“If only they would,” the Lib Dems groan), medical graduates embarking on this uncertain and prolonged career are going to be carrying more debt than ever with tuition fees set to rocket. There’s some evidence to suggest that foundation year doctors might already be considering other careers altogether, let alone surgery, as a significant proportion haven’t moved on to specialist training.
No wonder a recent Lancet editorial described surgery as a ‘profession adrift’.
General Practice anyone?
Read the president of the Royal College of Surgeons response.
and your solution is?….
56-hour week for trainees in craft and acute specialties. Workforce planning based around 3:1 ratios for specialist training in surgery, not 14:1 as is being seen in some areas. Colleges and unions ensure that non-training and specialty roles are genuinely flexible and allow for movement back into training. Easier recruitment from the sub-continent. Realistic career advice earlier for medical graduates.
And, oh yes, if we have to get rid of some people from the NHS let’s make sure it’s the crap planners and leaders…
Double the length of core training. 4 years, with a broad spread of surgical specialties, including A&E. Double the years means we can staff departments with half as many total CT’s. This would reduce the competition to 6:1 at a stroke. It would increase competition to get into core training, restricting entry into surgery, rather than allowing people to waste 5 or more years of their lives in a futile race for jobs that don’t exist in their early 30’s.
16 years ago, as a senior registrar, my junior colleagues and I wrote to the BMA News Review deprecating the ‘long hours bad, short hours good’ mantra. The letter was gutted before publication because it did not toe the line. Nothing has changed. If we need more juniors to cover on-call rotas, then inevitably there will be an excess of supply over demand for training grades.
I would not wish a 1:2 or 1:3 on any of my juniors, however I do not think that a night a week and a weekend a month is excessive for our trainees. There is now much greater provision of operating time for trauma and emergencies during the working day, and there is less likelihood of anyone needing to operate all night other than in dire emergencies.
We should also be flexible enough to recognise that different specialties make different demands on their staff, and rotas/on-call can be adjusted accordingly. Our (often appalling) negotiators especially need to accept that a ‘one size fits all’ policy is inappropriate and that each specialty should be allowed to come up with its own plan. Again different hospitals should also be allowed a degree of flexibility when rotas are being worked out.
Will this happen? I doubt it. There are those who do, and those who want to control those of us who do.
orthopod is right. the only thing that need to be re-considered is the 13hour shift limit. but the 48 hour a week limit is absolutely doable. a one in six rota with a few days off here and there can achieve the 48 hour average. the fact that nobody from the ruling mafia argues in this direction but all they want to do is abolish the 48 hour AVERAGE prooves that they are only interested in one thing: the availability of cheap labour in the name of “training”. that so many surgical trainees do not spot this prooves that the cliches about surgeons have more truth to them than the surgeons think …
The 48 hour average is a misnomer in itself. Many of us are continuing to work weeks of 13 hour night shifts. Add this to the daily commute, necessitated by the huge distance some of our training regions cover and the lack of any rest facilities in the hospital, and you will find worn out, tired and demoralised doctors. Who are these doctors looking after, yep you guessed it the acute admissions and sickest patients overnight. This is because whilst my average hours are less than 48 per week in the 2 weeks that I am oncall (doing a long day shift or a night shift) I regularly work in excess of 90 hours. Has the EWTD helped, clearly not.
the new work pattern are worse because the hospitals are deliberately creating this situation - they do not want to make to ewtd work and creating these unhealthy shift patterns is their way of sabotaging it. their goal is to make trainees want the old system back so they the hospitals have unlimited amounts of cheap labour at their fingertips. nowhere in the ewtd legislation is stated that rest areas are to be dissolved, nowhere does it say that full shift patterns have to be implemented. an end to the 80 hour weekends (from friday 09.00 to monday 17.00) and serial on-calls — THAT is what the ewtd was created for. the aim has always been to create a work pattern monday to friday 09.00 to 17.00 with smthg like a one in six on-call and proper pay for the hours performed. the hospitals would have none of it and set out to pervert the aims of the ewtd the best they could in order to avoid creating jobs and having to pay the doctors. it is all about the money they rather spend on quangos, bureaucrats, managers and the creation of nurses who do not do any nursing. that so many doctors fall for this charade is frustrating.
The EWTD (or EWTR as they have now become) has only highlighted a problem that has existed for a long time; it is not entirely the CAUSE of the problem. The profession itself (and the most senior members of it, in particular) is reponsible for organising rotas. The real solutuion lies in the separation of providing the ’service’ (which includes the provison of 24 hr cover for emergencies) from the ‘training’ of the future generation of doctors. Of course trainees need to have some ‘experience’ of dealing with emergencies ‘out of hours’; but they should not be relied upon to provide this as their prime function! Once ‘cover’ is provided by ‘trained doctors’; then it should be possible to arrange a suitable timetable for the proper training (including proper supervision) of trainees - though, in my opinion, like others training for any other profession, they will need to ‘work’ for more than 48 hrs per week to achieve their ambition.
reading up, studying and auditing is work in the sense of “training relevant work”. i agree that this type of work should not be included in the 48hr limit - but 48 hours per week as an average on the shop floor plus some 10 to 20 hours of the aforementioned work is plenty. the idiotic bureaucracy junior doctors have to battle with these days alone, already ensures that even those on a 48hour per week average rota perform a lot more hours. what is needed is an effort to make sure trainees do relevant work - and yes, this will mean to push the tarted up nurses who occupy training opportunities these days on their way to do e.g. endoscopy lists, back into place.
Why a Career in surgery? Good question…as trainees we wonder where is our “training” gone between the EWTD and the “service provision” side of our job…the truth is most of us stay out of hours to achieve some of the required skills, and to think that we have been labelled as not willing to work as hard as “the old generation” used to by some consultant really makes us angry…a solution to our training? It’s to increase the size of the current consultants’ cojones and get them to bloody train us like they should. Allocated theatres time for every CT, clinic time and regular feed back (no pseudo assessments filled by mates) - make sure the trainee reaches an allocated number of each procedure under consultant supervision, and if it means doing one less case on the list then so be it…