|Training in uncertain times|
|Tuesday, 11 January 2011|
Following predictions of reduced consultant numbers in the years ahead, Matthew Cartwright-Terry and David Machin ask, ‘Will there be any jobs when I qualify?’
There have been several reports published recently highlighting potential problems in the future job market for trainees. The first was a reference to Core Trainees in the article ‘The New Lost Tribe’ (Oxtoby; BMJ Careers; October 2009). Currently, there are more Core Trainees competing for Specialty Training numbers than are available. Reductions have recently been made in the number of Specialty Trainees and further reductions are expected across all surgical specialties. The result is far greater competition across the ‘SHO’ Grades. However, even those in a Specialty Training post are by no means guaranteed a consultant post.
"The future for current trainees is more uncertain than it has been for a long time but there are still some reasons to remain optimistic"
This article examines the possible impact of Recommendations for Trauma and Orthopaedic Surgery from the Centre for Workforce Intelligence (CfWI) and the government’s recent White Paper Equality and Excellence: Liberating the NHS, published in July 2010.
Projecting healthcare provision and its requirements is a difficult task but the CfWI has made an attempt. Over the last decade or so, the number of orthopaedic consultants has increased massively (including by 23% in the last five years) to accommodate the ability of the specialty to treat a greater number of conditions and to meet society’s increased expectations. This expansion has far exceeded population growth, which has run consistently at around 2% per annum for the over 60 years population (the main age group for which orthopaedic surgeons provide care). The CfWI report takes this into account.
In order to maintain the status quo there needs to be a reduction in recruitment from 2014 to prevent a bulge of CCT holders, but this may result in a large number of highly trained professionals with no prospect of consultant or equivalent post. The decrease in training numbers is proposed to be 16 posts, specifically nine in London, five in South Central and two in the North East due over capacity in these regions.
Currently there is predicted to be approximately one full-time equivalent (FTE) orthopaedic consultant per 25,000 head of population in England by 2012 (Developing a Modern Surgical Workforce, RCSEng 2005), although the regional spread is uneven. This ratio was also supported, until recently, by the BOA, who now recommend that there should be a gradual increase in the number of consultant orthopaedic surgeons so that there is a ratio of one per 15,000 head of population.
This new ratio would mean there needs to be 3,400 FTE consultants instead of 2,040. This recommendation is based on the changing population profile of the Western world where there is a well-documented increase in life expectancy.
This is leading to a massive increase in the demand for orthopaedic services as osteoarthritis and osteoporosis cause distress and suffering to evermore elderly people. This trend will continue for the foreseeable future. The population is becoming more obese, causing multiple medical problems including early onset osteoarthritis leading to an increased demand for orthopaedic services for younger people as well as for the elderly.
On the other side, current surgeons are likely to continue to be healthy for longer than in the past. This, as well as pension reforms, may force those currently in consultant posts to retire much later. In production of the CfWI report it has been necessary to make a large number of assumptions many of which could prove inaccurate. These are stated clearly within the document including issues such as immigration/emigration and trainees completing the CCT.
Conspicuous by its absence in the Government’s White Paper is any reference to workforce planning or training numbers. Commissioning is due to change dramatically, allowing foundation trusts or private suppliers of healthcare to tender for service provision. It remains unclear what the impact of these reforms will have on consultant numbers. One certainty is that, with the predicted budget cuts, hospitals are unlikely to recruit consultants in large numbers. There may be a drive by commissioners to continue to extend the roles of allied health services, such as physiotherapy, podiatry, and nursing, in an attempt to drive down costs.
Trainees looking to specialise in spinal surgery have more reason to be optimistic. There are currently just enough trainees getting the CCT to maintain the current numbers. It has been stated that there is already a shortfall is the number of spinal surgeons and that an expansion is required. The future for current trainees is more uncertain than it has been for a long time but there are still some reasons to remain optimistic. Advice for trainees will remain that they must have a portfolio and CV of the highest standard to give them the best chance of getting a consultant post.
Matthew Cartwright-Terry, ST6 Trauma and Orthopaedic Surgery, Mersey Deanery
David Machin, ST6 Trauma and Orthopaedic Surgery, Mersey Deanery