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Academics must protect their jobs from cuts

By Francesca Robinson - 28th January 2010 9:22 am

Medical academics are being advised to have proper job plans and regular appraisal in order to protect their jobs from funding cuts.

“We are anticipating a very tough time ahead for many medical schools and academics because of the current economic crisis,” warned the BMA’s medical academic staff committee co-chair Professor Michael Rees.

At the beginning of January Imperial College London made 21 medical academics redundant as part of a restructuring to tackle a £28m deficit.

Another 14 academics are currently facing redundancy at the Institute of Psychiatry at King’s College London, which has a £5m hole in its budget.

“There is certainly an increase in the generalised threat to academic employment. I can’t quantify the level of that threat but there certainly is a threat,” said Rees.

A three-pronged funding squeeze is putting a strain on medical school budgets. All university budgets will be affected by a £400m funding cut in 2010-11, announced by business, innovation and skills secretary Lord Mandelson in December. Some medical schools will also lose money because of a redistribution of funds following the Research Assessment Exercise (RAE) and a review of the Multi Professional Education and Training (MPET) levy currently being conducted by the Department of Health.

The MPET review is looking to more fairly distribute funds for clinical training. The MPET levy is likely to be replaced with a tariff-based system where the funding follows the student or the trainee.

The BMA fears that this will not equate to posts following the students and could result in academic jobs being axed. Traditional medical schools, particularly those in London, which employ more staff than the newer medical schools, are likely to suffer most from any reallocation of funds.

“The threatened redundancies at the Institute of Psychiatry at King’s are particularly unfortunate because it’s a high flying department, was shown to be a very productive department in the RAE and is an important site for academic training,” said Rees.

He added that the chances of academics finding work by either moving to other universities or NHS jobs were very slim in the current economic climate.

The BMA is publishing new job planning guidance for academics, which will advise them to ensure they have a job plan which clarifies the work they do. They should undergo regular appraisals and ensure they know exactly where the funding for their joint contracts between universities and the NHS is coming from. They are also being advised to avoid any dubious fixed term contracts and to carefully check terms and conditions before accepting any job.

A spokeswoman for Imperial College said they had now agreed a new structure for their Faculty of Medicine that would safeguard their internationally leading research and education activities, and address a significant projected deficit of 28.7m by 2013/14. The deficit was caused by rising salary costs, a cut in central funding and “the difficult economic climate that universities are now operating in”.

“Staff identified as holding posts that were at risk were fully consulted during the process, and every effort was made to avoid compulsory redundancies. In total, 21 academic members of staff and 27 support staff have regretfully been made redundant,” she said.

Read a blog on the future of medical research sector.

Tags: Academic posts, Research, Workforce
Posted in Hospital Dr News | 1 Comment »

A plan for rescuing the UK’s medical research sector

By Mike Broad - 17th January 2010 11:26 am

Academy of Medical Sciences (AMS) has contacted the major political parties ahead of the general election to outline its vision for UK medical science.

It claims that groundbreaking advances in medical science offer the next government an unprecedented opportunity to reinvigorate the economy, to enhance the productivity of the NHS and to make public services more cost-effective.

Professor Sir John Bell, president of the AMS, said: “We believe that making medical science a central pillar of government policy will produce a flourishing UK economy and alleviate the burden of ill health on patients and public services.”

The UK has historically supported vibrant research-intensive medical science industries and internationally renowned academic medical research centres as part of its knowledge economy. It generates over 10% of the world’s clinical science and health research outputs and has created nearly a quarter of the world’s top 100 medicines.

Historically, both larger pharmaceutical and smaller biotechnology companies have flourished in the UK, where the availability of skilled researchers and a unified health system present a significant advantage for both basic and clinical research.

However, the report warns that the future of commercial medical research in the UK is under serious threat and much activity has already moved abroad. It says that between 2000 and 2006, the proportion of the world’s clinical trials conducted in the UK fell from 6% to 2%, in part because of more attractive regulation and incentives elsewhere.

“The UK’s competitors, including the USA, China, Canada and Singapore, have begun to realise the huge potential of medical research to both their economies and public services, and are implementing robust policies to grow this crucial sector. Decisive action is needed now to attract and anchor increasingly mobile medical researchers and life science industries in the UK,” it urges.

The report sets out seven important challenges that must be tackled to reap the rewards from recent investment in medical science:

1. To benefit patients the NHS must become a willing participant in health research

A unified health system offers a unique advantage as a resource for medical research and innovation. High-quality research should be an integral component of the next NHS Operating

Framework; it should be an outcome on which the performance of NHS trusts is measured; and should be a central goal of any system for electronic health records.

2. The regulatory environment is driving medical science abroad

The combined regulatory requirements of the EU Clinical Trials Directive, European Medicines Agency, Medicine and Healthcare products Regulatory Agency, NHS ethics committees, R&D offices in NHS trusts, the National Information Governance Board and other agencies are stifling R&D in both the private and public sector.

Regulation must be proportionate to the risks involved. We should lead the world in creating a proportionate, risk-based regulatory framework for medical research involving patients, which is fit for purpose and informed by an independent review of existing regulations.

3. Innovative incentives must firmly root the medical science industries in the UK

Investment in novel therapeutics, diagnostics and devices, should be encouraged through flexible pricing, public procurement strategies, tax incentives and new pathways to support uptake and access to medicines. Alliances should also be encouraged between the NHS, universities and industry to share the risks and rewards of new products.

4. Publicly funded health research needs further coordination

Maintaining a ring fence around the budgets held by the Medical Research Council and the National Institute for Health Research would help, as would better coordination of their work.

5. Public health challenges must become cross-departmental priorities

Effective public health research and delivery can provide enormous economic and health benefits to the UK, but are hindered by under-investment and fragmented responsibility and oversight. The UK lacks the necessary co-ordination to tackle health inequalities and major public health challenges such as obesity, infectious pandemics, ageing, alcohol and climate change.

Budgets and strategies need to be established for specific public health priorities that fund research and service delivery across government departments.

6. Health research should be used as a driver of foreign policy and international development

Medical science can underpin cost effective international development measures that enable poorer countries to address their health needs and help to reduce health and security threats to the UK.

Greater efforts are made by the government to support indigenous research capacity in resource-poor countries.

7. We must grow and sustain its world-class biomedical workforce

There needs to be better coordination of efforts to build biomedical research capacity, focusing on developing interdisciplinary researchers and workers in key areas of current and future need. Biomedical research training for doctors needs to be supported and the mobility of researchers across academic, industry and healthcare sectors incentivised.

The report provides a much needed rallying cry for academic medicine during a challenging time. The big medical research centres are under pressure to make cuts, and both Kings College and Imperial have made researchers redundant recently.

Earlier this year a study revealed that, while overall staff numbers have stabilised, the workforce profile is ageing, top heavy and male dominated. Certain specialties that were previous academic strongholds have also been decimated.

Sir John said: “A government that unites researchers from across academia, the NHS, industry and the charitable sector, and engages with patients and the public, can make significant progress towards addressing these challenges within five years.

“Bold leadership is needed to ensure that the UK can continue to generate world class medical science that is translated into health and wealth benefits. Generous donations to medical research charities and enthusiastic backing of the NHS indicate strong UK public support for medical science. The next government must respond to this chorus of public approval by placing medical science at the heart of its agenda.”

Read an article on how to get into medical research.

Tags: Academic posts, Research
Posted in Features | No Comments »

Jerry survives vaccination only to find the world a colder place

By Jerry Nelson - 7th December 2009 10:19 am

Sorry for my - what’s the term? - ‘light blogging’ lately. Been off work for a bit. Had a flu jab a couple of weeks ago, and felt a bit feverish and achey for a while and then the next thing I know I’m sectioned under the Mental Health Act and detained in a secure unit for the irretrievably autistic. Bloody vaccinations.

Anyway, I’m a bit blown away by all this Climategate stuff. It looks like a bit of a blow for those fascists who want to stop us travelling by plane and enjoying 24-hour flloodlit, patiowarmer golf.

For those of you who don’t know what I’m talking about because you get your news from the BBC, a massive file full of emails and other data from climate scientists (who work at the ‘University of East Anglia’ - bwahahahaha polypolypolypoly) was hacked/leaked/left lying around, and has now appeared on the interweb.

The upshot of it all appears to be that scientists fudge data when it doesn’t fit the theory, collude and gang up on anyone who doesn’t agree, and all they care about is chasing kudos and research funding.

I’m like: and?

What do you expect? They’re scientists. It’s what they do - they’re a bunch of shysters.

There is this foolish image of scientists being sweet-natured boffins who only care about the truth. Well, it’s a load of arse! The typical research department is a pit of vipers full of the sort of characters who make Scarface’s Tony Montana look like Bungle off Rainbow.

Take our own world-renowned research institute, presided over by the Headmaster, The Middle Bit of England Centre for Anorectal Diseases. I happen to know that when they couldn’t get some paper into the journal Arse, they had two of the editors killed. And the HM actually sold his own grandmother on e-bay to get a letter in the BMJ. And one of their seminal papers on the precise clock positions of haemorrhoids was based on a single patient, which was the Headmaster examining himself.

The thing is, once they get in too deep, and they’re all being invited to join the UN Intergovernmental Panel on Haemorrhoids and fly off to exotic conferences, and they get all the praise and fame and money and chicks (well, probably not the chicks) it’s too late. They have to keep the lie going at all costs.

No-one’s going to be interested in a paper showing that - sorry to bother you - but the classic haemorrhoid positions of 3, 7 and 11 o’clock were right all along. Are they?

Tags: Humour, Research
Posted in Nelson's Column, Bolg, Blog, whatever... | 1 Comment »

How to move into medical research - guidance for doctors

By Mike Broad - 24th November 2009 11:09 am

There are various reasons why doctors consider carrying out a research project: to learn new things; to improve career progression; for a change in life style and to try out a life in academia while still paying a mortgage.

There are also many benefits to doctors of undertaking an academic position including getting research published, understanding statistics and IT, attending conferences (some abroad), improving presentational skills and making new contacts.

Choosing a supervisor

The first step for a doctor is to choose a supervisor. Your choice of supervisor is intimately linked with your project - their interests will soon be your interests. If you pick a clinician, they may be around a lot less due to their clinical priorities, but they may understand you better and will be essential if your project is clinically based. If you choose a scientist, they are likely to be around more and will probably supervise you more directly. Things to consider include: what is the set up, location and size of the lab, will you and your project fit in with others? Is there a track record of medics in the lab?

Choosing a project

When deciding on the type of project you want to carry out, it’s a good idea to approach established labs or groups who you have a link with. If you don’t have a link already, manufacture one by asking for introductions through colleagues. Discuss your interests with theirs and see if you can come up with something suitable. Often, supervisors have several projects in mind that they’ve been looking for someone to carry out, but they’ve not found a home for yet. The important thing is to make sure you are actually interested in the project enough to spend a few years of your life on it. Other points to consider include:

1. Implications for the rest of your career.

2. Will it involve whole animal work?

3. What are your priorities?

4. Is it relevant to your clinical interests?

5. Will it lead to publications and conference presentations?

6. Do you want to do a PhD or an MD?

Clinical projects

Doctors should be aware that clinical projects tend to take a long time to get going. There can also be lots of hanging around waiting for ethics approval and the recruitment of patients. However, the results can be easier to get published (though may not be as well respected).

Basic science projects

There are advantages. As soon as you start, you start. There is a lot of opportunity to learn new techniques and skills and become immersed in science. Your research may be more widely respected, and mini clinical projects can be pursued at the same time. However, a doctor going into a science project will have to be more self-reliant.

Sorting out the ethics of a medical research project

All research ethics is now done centrally via the National Research Ethics Service.

Filling in ethics forms can be a long-winded process, but is also an essential one. You will need one for anything involving patients, or their tissues, or their genetic material. This is a legal requirement and cannot be dodged or applied for retrospectively. You also need to state it in all publications.

Finding funding for medical research

In the first instance, ask your supervisor what’s suitable and available. Use search engines, such as Google, and check as many websites as possible. Academic Clinical Fellowships and Academic National Training Numbers are a great spring board to a Clinical Research Fellowship.

Otherwise, it’s worth considering local sources: “soft” or “funny” money. These may be specific to the lab, department or your current institution. They may also be specific to your original medical school. Doctors should hunt their websites, ask experienced supervisors and the research grants department or librarian for tips.

The next step is to contact organisations specific to your subject such as societies and medical charities. The big players include the British Heart Foundation, Cancer Research UK, and Diabetes UK.

Alternatively, doctors should contact general medical research bodies such as NIHR, MRC, Health Foundation and The Wellcome Trust.

Early career grants, essay prizes and travel grants may be available. Doctor’s should check their specialty websites.

Finally, it is worth checking the BMJ careers section. Within this lies the university research and fellowships section. This may carry adverts for: clinical PhD studentships, clinical research fellows, clinical teaching fellowships, research and teaching registrars and others, any of which may be enough to start you off.

Eligibility to do medical research

Generally speaking, there are no specific skill requirements. Fellowships often require a degree such as an intercalated BSc. They are also usually aimed specifically at either medically qualified or non-clinical graduates. Remember, a ‘clinical’ research fellowship does not necessarily mean the research is clinical.

Practicalities of funding applications

Read the small print. The main submission is usually huge and requires detailed costings and timings. You will need several people’s help with different sections so start well in advance, for example with finance. Your project may also impact other departments, such as biochemistry and histopathology, so get approval.

Writing a grant proposal

Have a go; it is your project and should be your work. But be prepared for it to be significantly changed. Ask your supervisor for comments and read someone else’s successful submission as a guide. A good tip is to tailor your project proposal for different funding bodies - just as you would change your CV for different jobs. Remember the grants panel is made up of lay members who are not experts. You will also need to fill in a ‘Public understanding of science’ section. Get help if English isn’t your first language or, indeed, if IT isn’t your first language either.

Always ask a non scientist to read through your application and, once it’s nearly ready, ask a neutral expert or successful candidate to read it too. With no experience of writing or researching, don’t expect to get everything first time. If you don’t get it first time, discuss it with your supervisor, and try again.

The medical research interview

After short-listing, again read as much as you can and discuss it as much as possible with colleagues. Talk to people who have been through this interview, even if unsuccessfully, and it’s a good idea to arrange mock interviews with as many nasty and experienced people as you can persuade to help. Finally practise in the mirror, wear the right clothes (conventional suit will always go down well) and be early.

Academic redundancies weaken profession

By Francesca Robinson - 13th August 2009 12:32 pm

Financial problems at one of the UK’s top medical schools will set back recent gains in clinical academic staffing levels, warn leading academics.

There are also fears that academic job cuts will impact on teaching and training and deter new recruits from developing research careers.

This year a Medical Schools Council survey revealed that the number of academic staff had risen above 3,000 for the first time since 2000.

But it has emerged that Imperial College London is consulting on proposals to tackle a projected deficit of £28m in the next five years which is putting 80 of its 500 staff at risk of redundancy.

“This will send a negative signal to prospective trainees who might want to engage in a career in academic medicine at a time when we need to be attracting new talent into the sector,” said Geraint Rees, Professor of Cognitive Neurology at University College London, and a member of the BMA’s Medical Academic Staff Committee (MASC).

“My heart sinks when you read stories like this because academic medicine is already an uncertain career marked by competition and insecurity about where grant funding is coming from. Seeing people being made redundant from a medical school can only make people less interested in an academic career.”

Dr Peter Dangerfield chair of MASC said: “I do worry what effect this is going to have on both undergraduate and postgraduate education programmes because if you lose key players from the education process how on earth is education going to be taken forward?

“We have seen a massive increase in students matched by a massive decrease in academic doctors. What this means is increasing reliance on NHS staff to fulfil undergraduate teaching and whether that is appropriate or not is open to question. If we have no figure heads and respected practitioners at the top pinnacle of research, teaching and education then that is not very desirable from the profession’s point of view.”

Prof Rees said in the current bleak financial outlook it was a worry that other academic medical institutions may also be struggling financially. There was further uncertainty pending the outcome of the current government review of university funding. He said they would be raising their concerns about the future of academic medicine with ministers.

The BMA is representing individuals at Imperial who have been threatened with redundancy. It is also concerned that the job losses may create extra work for NHS colleagues, who may have to pick up the service work carried out by academics.

Prof Rees said: “This issue of redundancies is significant not just because it is the first announcement of possible large scale redundancies at a medical school but also for the future employment of these individuals in the current economic climate.”

A spokeswoman for Imperial College denied that the proposed redundancies would affect teaching and training. She said: “The College is making every effort to avoid compulsory redundancies. It is hoped that taking this painful step now will create a financially sustainable structure within which outstanding staff can be supported and nurtured over the long-term.”

Tags: Research, Teaching
Posted in Hospital Dr News | No Comments »

Research being wrapped up in red tape

By Mike Broad - 4th August 2009 2:56 pm

British academics are warning that the ability to undertake clinical research is being stifled by red tape.

They say the implementation of the European Clinical Trials Directive (ECTD), in 2004, has created too much bureaucracy and is compromising medical research in the UK.

Under the UK’s interpretation of ECTD rules, a detailed protocol - which might reach 100 pages in length - has to be produced and over 40 questions have to be answered on a 28-page form.

University College researcher Michele Saunders says in The Lancet Oncology report that she has been trying for over two years to start a trial already well-established at another major hospital, but has been unsuccessful to date with no end in sight.

She said: “All was well before the European directive came into action. The regulations are law in some cases and this has made those with responsibility nervous, there’s so much documentation for everything. The culture of blame in this society does not help.”

The report concludes: “Clearly, approval authorities and researchers are only trying to do their jobs - some on a volunteer basis. But if clinical research is being delayed and there is a real danger of its future being compromised, then researchers, approval bodies, and policymakers need to foster better partnerships to develop more effective and efficient integrated solutions as soon as possible.”

However, Ken Woods, chief executive of the Medicines and Healthcare Products Regulatory Agency, said that the UK’s interpretation of the ECTD did “not add” to its bureaucracy. “UK researchers already faced an increasing administrative burden due to the NHS research governance framework launched in 2001,” he said.

A new body called Sensible Guidelines for Clinical Trials Working Group is due to hold its second meeting in September, in Oxford, to discuss how to get randomised trials off the ground.

Read the full report.

Tags: Research
Posted in Hospital Dr News | No Comments »

How are we going to educate tomorrow’s doctors?

Dr Peter Dangerfield, co-chair of the BMA's medical academic and staff committee - 28th July 2009 1:49 pm

Anyone reading the recent Medical School Council’s report on the academic workforce will be struck by the depressingly familiar trinity of contradiction, complacency and confusion that seems to seep into every aspect of workforce planning towards academic medicine.

Whereas medical student numbers have increased from 30,600 in 2004 to 39,000 today, the number of clinical academic consultants (needed to train this rightly expanding cohort of future doctors) has stayed static since the turn of the decade at around 2,900. The position of academic trainees at lecturer level is even worse: they now represent fewer than 15% of the clinical academic workforce whereas they made up 24% in 2000. Grimly, the report states that the number of clinical academics in the 26-35 age range is insufficient to replace the number of clinical academics approaching retirement.

The conclusion is clear: soon there will be insufficient staff to educate and train the UK’s aspiring doctors. If this happens then not only do we face the possibility of falling training standards, as our workforce becomes increasingly over stretched, but the UK’s clinical research will also continue to slide as the number of top clinical researchers recedes.

However, taking pot shots from the side lines is always an easy pass time: what are the solutions to these problems?

There are some crumbs of comfort from the MSC report. The growing number of academic clinical fellows, currently employed by the NHS, are expected to move into lecturer positions, easing some of the pressure - although feedback to the BMA from these fellows suggests a certain amount of disillusionment at the lack of support from both the NHS and university employers.

This is why we are calling on both employers and employees to work with the BMA to produce clear guidance on what academic trainees should expect from their employers and, indeed, what is expected from them, with the aim of ultimately agreeing model honorary contracts.

Further, immediate work is required, and ultimately employers need to protect and enhance the terms and conditions of trainee academics. The funding regime also needs to ensure that this already diminished group is not further reduced through the effects of the forthcoming Research Excellence Framework, which will look at university funding.

We are entering austere times as the country and the world reels from a deep recession. But patients deserve a highly trained workforce and a field of homegrown clinical researchers who can meet the challenges of the coming decades.

Tags: Research
Posted in BMA | 6 Comments »

UK’s reputation for research and innovation under threat

By Mike Broad - 24th June 2009 1:59 pm

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.

Tags: Anaesthesia, Paediatrics, Pathology, Research
Posted in Features | No Comments »

Research funding cuts as charities tighten belts

By Mike Broad - 1st June 2009 8:08 am

Medical research is being cut because of the recession, a survey of charities reveals.

The survey by the Association of Medical Research Charities (AMRC) shows that over three quarters of the charities are being affected by the downturn.

More than a quarter intend to cut their research expenditure by up to 40% over the coming year.

In 2008/2009, AMRC members spent over £900m on medical and health research. It is predicted to drop significantly over the next two years. Many are exploring co-funding opportunities to mitigate the impact of the downturn.

The AMRC is calling on public and corporate donors and the government to support medical research charities.

Norman Barrett, of the Association for International Cancer Research, said: “The cost of funding a research grant to try to improve the prevention, detection and treatment of cancer has gone up by 20% over the last three years, while legacies and regular donations have fallen by 5%.

“We are very concerned about the impact of the economic climate on our ability to make progress against cancer.”

Read more on the economic benefits of medical research.