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In the United Kingdom, trainee vacancies hit 40%
In the United States, there has been a decrease in the number of fellows applying for residency slots in nephrology. There is a similar problem in the United Kingdom’s National Health Service. The shortage of higher specialty trainees is reflected in the poor recruitment and retention of senior doctors/consultants in nephrology. This problem applies across all medical specialties in the United Kingdom to varying degrees.
The Royal College of Physicians of London conducts a yearly census of the medical workforce. The 2017-2018 report showed 45% of available consultant posts across the medical specialties were not appointed. The shortage of higher specialty trainees is causing great concern, with the vacancy rate for trainee posts in nephrology being as high as 40% in different regions in the United Kingdom. London has the best fill rate. The east of England, just 2 hours driving time from London, has the poorest success rate.
Career aspirations
The way medicine is practiced – and the career aspirations of higher specialty trainees – have changed dramatically in recent years. There is more emphasis on pursuing a desirable work-life balance. Medicine is now regarded more as a job than a vocation, with less than full-time working becoming more common. The number of less than full-time consultants has increased to 23%. The number of trainees working less than full-time has increased to 15%, according to the Royal College of Physicians of London report.
Although work in primary care has become more strenuous, it has traditionally offered the best work-life balance. The report shows 63% of entrants to medical school are women; while there are now more female consultants than in the past, their numbers fall sharply after 40 years old. Male consultant numbers fall at 50 years old. While these demographics are still evolving, the figures would suggest consultants working beyond 60 years old are not blocking the career progression of young colleagues. It looks as if colleagues working beyond the U.K. retirement age of 65 years, and more are doing so, may be one of the solutions, not an impediment for the workforce issue.
Serious gaps
The shortage of higher specialty trainees leads to serious gaps in rounds for covering our hospitals. It is worrying that, across the medical specialties, 46% of on-call shifts have a junior doctor absent due to sickness. In a typical NHS hospital, the general internal medicine intake is covered daily by specialists in acute medicine and also by consultant physicians who are specialists in their own areas but who spend a significant amount of time in general internal medicine. Most trainees destined to become consultants go through general internal medicine training. There seems to be widespread disenchantment with general internal medicine; 59% of higher specialty trainees state they would not train in general internal medicine if the clock could be turned back. General internal medicine has probably become intellectually less challenging. Few current higher specialty trainees would have ever seen an acute ST elevation cardiac event; these cases now pass directly from paramedics into cardiology intervention. It is similar for stroke.
Practical interventional skills have emerged in many specialties which can easily be practiced outside the NHS. While the specialties used to be concentrated in large metropolitan hospitals, these are now more diffusely spread with the general physician working in district general hospitals having been replaced by the specialist.
Solutions are not easy to come by. While there have been restrictions on the numbers of consultants and trainees which can be recruited from overseas, the rules are being slackened for a number of specialties. Not a great state of affairs, but that is the reality.
- Reference:
- www.rcplondon.ac.uk/census
- For more information:
- Roger Greenwood, MSc, MD, FRCP, is a consultant nephrologist in the medical division of East and North Herts NHS Trust (Lister Hospital) in London. Suresh Mathavakkannan, MRCP, PhD, is the clinical director of nephrology and chair of the medical division at Lister Hospital. Sivakumar Sridharan, MBBS, MRCP, MRCP (Nephrology), PhD, is a consultant nephrologist at Lister.
Disclosures: The authors report no relevant financial disclosures.