The American Society of Anesthesiologists Task Force on Chronic Pain Management has updated its chronic pain guidelines.
The new recommendations are designed to help clinicians who treat pain. The objectives are to optimise pain control, enhance physical and psychological well-being, and minimise adverse outcomes. Richard Rosenquist, from the University of Iowa Hospital, Iowa City, led the 12-member task force of anesthesiologists in both private and academic practice.
On the face of it, the staffing levels of medical clinical academics in medical schools have improved.
The annual staff survey published recently by the Medical Schools Council shows a 1% increase in the clinical academic staffing level over the 12 months to July 2008. The total of full time equivalents was 3,032 - the first time 3,000 has been topped in eight years.
However, a closer look at the data reveals that academic staffing is ageing, increasingly top heavy, male dominated and has been decimated in a number of specialties that were once academic strongholds.
Professors make up the greatest proportion of all medical clinical academics in post in medical schools, an increase in real terms of 27% since 2000. In contrast, the number of clinical lecturers in post has fallen by 386 – which represents 47% - for the same period.
Fortunately, there are some signs of a recovery in clinical lectureships with an increase in numbers of 6% for the second consecutive year.
The Medical Schools Council is particularly concerned that 58% of the clinical academic workforce is aged over 45. It fears that leadership skills and experience are being lost through retirement with insufficient recruitment in the lower grades.
A spokesperson said: “Existing schemes to support young researchers in accessing the clinical academic career pathway must continue to receive support.
“The Medical Schools Council is working with partner organisations to improve careers advice for students, to raise the profile of academia as a career pathway and to develop a tracking mechanism that will capture the pipeline of the future clinical academic workforce.”
Women continue to be under represented at senior clinical academic grades. Just 13% of clinical professors are female. The report calls for action to be taken to increase the attractiveness of an academic career for women, particularly with the increasing female intake into medical school.
On the positive side, the gender, ethnic and age diversity of staff is improving among younger members.
The survey shows that research in the specialties of pathology, paediatrics and child health, and anaesthesia is under threat. At lecturer grade, there has been a decline of more than 50% in staffing levels in eight specialties since 2000.
It’s worse in paediatrics, with a 60% reduction in the number of lecturers between 2000 and 2007.
Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health, said: “We exhort the government not to leave this to the free market and individual universities. Money must be ring-fenced for training posts for academic paediatricians.
“The terms and conditions should also be made more attractive and nationally uniform to address the fact that the majority of paediatric trainees are women and career breaks and maternity leave are major issues which deter them currently.”
Generally, the number of clinical academic consultants has remained relatively steady at around 2,300 full time equivalents, whereas the number of NHS consultants has increased by 40% since 2000 to a total of 39,3000 in 2007.
Professor Peter Furness, president of the Royal College of Pathologists, believes there are not enough opportunities to experience research in run through training.
He said: “We’ve had staff shortages in providing the services - so those entering training know they’ve got a consultant job at the end whether they’ve done research or not. Research just delays their appointment as a consultant which is a disincentive to doing it.”
The college is working to engage trainees in research but, for significant improvement, Furness believes national policy and funding have to change. For pathology, he hopes NICE’s stated intention to expand its remit to cover diagnostics could lead to a renaissance in research.
The Medical Schools Council warns that without new mechanisms to support training and research both the quality of patient care and our ability to educate the next generation of doctors will be severely compromised.
In the bigger picture, the UK’s position as a world leader in medical innovation and research is under real threat.
