NHS must make emergency medicine more attractive to doctors
An article published in The Guardian on 27/12/13. Written by Dr Cliff Mann president of the College of Emergency Medicine.
It is clear from the dropout rate in emergency medicine that too many young doctors would not recommend it as a career.
The challenge for all concerned with the future of emergency medicine in the UK is to make a career in it a credible option when compared with the many other medical specialties that doctors could choose instead. We do not need to compete with Australia, where terms and conditions are vastly better. We simply need to ensure that people who enter emergency medicine in this country are embarking on a sustainable career.
Emergency medicine doctors are a resilient breed; they thrive in situations that others find difficult. However, they are not indestructible and the current ratio of doctors to patients in the UK means that too often workloads are not just intense, they are overwhelming. Young doctors in training observe this state of affairs and choose accordingly. Far too often I hear comments and feedback that can be paraphrased as: "Great job – but couldn't possibly last more than six months."
The NHS in England has recently introduced a friends and family test – a questionnaire given to each patient when they leave a ward, clinic or emergency department. The response to the question "would you recommend this ward/department to your friends and family?" is used as a barometer of patient satisfaction. It is clear from the dropout rate in emergency medicine that too many young doctors would not recommend it as a career to their friends or family.
It is not only trainees who vote with their feet – many consultants have also emigrated. For those who remain, stress levels are crippling many. Emergency medicine consultants in London have the highest rate of referrals for counselling and psychological support.
At the heart of the problem lies a key comparison. Doctors are paid the same amount of money to work 1am to 4am on Christmas Eve morning as they are to work 1pm to 5pm on a Wednesday afternoon in October. The current contract was designed based on a five-day-week, 10-hours-a-day model of service delivery and is completely unfit for purpose. Only by recognising the need to ensure the contractual offer to both groups restores a degree of equity can we break out of a vicious circle in which recruitment and retention problems further burden those who remain, thus exacerbating the root cause.
No one in emergency medicine expects not to work a significant amount of time in the evenings and at weekends. However, this time away from their families and friends needs to be recognised and compensated for. This is more about differential leave allowances than it is about money.
This opinion is not predicated on a need to spend more money – quite the reverse. The NHS spent more than £100m last year on locum doctors in emergency departments alone. Failure to invest in emergency medicine will ensure that we continue to spend extravagantly, a state of affairs that makes no economic sense and cannot be allowed to continue.
The solution is evident, and both the manpower and financial arguments are aligned and compelling. The current contract negotiations between NHS employers and the British Medical Association represent an ideal opportunity to address these issues to ensure the UK continues to attract high-calibre emergency physicians and so deliver world-class care to patients attending our departments.
Dr Cliff Mann is president of the College of Emergency Medicine and a senior A&E consultant in Taunton, Somerset.
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