In medicine there is a move away from specialist working to more generalist roles treating acutely ill patients.
This is the key finding of the latest census of consultant physicians in the UK, produced by the Royal College of Physicians (RCP).
The annual census measures the number of consultants in all medical specialties. Acute Medicine saw the largest increase, with a dramatic 33% expansion. The specialty remains relatively small in real terms, with just 393 practising physicians, but this has leapt from 295 the previous year.
The massive increase in demand exceeds supply of trained acute medicine specialists. 41% of advertised acute medicine posts could not be filled due to a lack of suitably trained applicants.
The largest medical specialty is geriatrics, with 1,252 consultant physicians across the UK, representing 10% of the workforce.
The nature of patients presenting at hospital is changing. 65% of people admitted to hospital are over 65 years old and many have multiple complex conditions. Such patients require more generalist care, as highlighted by the RCP’s Future Hospital Commission report.
It has also prompted the health secretary to call for the development of ‘Whole Stay Doctors‘, who can provide greater continuity of care to older patients.
There has been a marked increase in the provision of acute care by some specialties. Between 2011 and 2012, the number of renal medicine specialists contributing to acute care rose from 48% to 58% and the number of rheumatology specialists providing acute care shot up from 22% to 44%.
Specialities that have traditionally had a more acute care focus continue to have a large number of consultants providing acute care, such as respiratory medicine (79%), endocrinology and diabetes (82%) and geriatric medicine (83%).
Dr Harriet Gordon, director of the RCP’s Medical workforce Unit, said: “NHS trusts are looking for more generalists, and those acute medical posts may have a secondary focus on a particular specialty. However, it is clear that the demand for more generalist physicians is not being met, with only 59% of acute medicine posts being filled.
“As set out in the RCP’s Future Hospital Commission report, hospital care must change to better meet the needs of the large numbers of older patients presenting with multiple conditions. Key to this will be a more generalist workforce willing and able to treat acutely ill patients with complex needs that span traditional specialty boundaries.”
The latest Census highlights large geographic variation in NHS trusts’ ability to recruit consultant physicians. In London, 83% of advertised consultant posts were successfully filled, whilst in the North of England, only 51% of advertised consultant posts were filled.
Other key findings from the census include:
46% of consultant physicians aged under 40 are female, compared to just 14% of consultants aged over 60;
The consultant workforce has continued to become more part-time, with 17% of consultants physicians now working less than whole time;
79% of census respondents reported enjoying their jobs ‘always’ or ‘often’, but 75% felt ‘always’ or ‘often’ under pressure;
60% of consultants stated an intention to retire early
At the time the data was collected, there were a total of 12,221 consultant physicians working in the UK, an increase of 411 on the previous year. The expansion of hospital consultants has fallen considerably during the past three years from 10.2% in 2009 to 3.5% in 2012.
The census also collects data on how consultant physicians deploy their time at work. Direct clinical care, such as ward rounds, clinics and procedure lists, accounted for 71% of a consultant’s time, with 19% of time spent in supporting clinical activity, such as educational supervision, continuing professional development and quality-improvement activity. 6% of time was spent in research activity and 4% in other roles such as management.
Data for this latest Census of consultant physicians in the UK was collected in December 2012.