Part-time training:Experience in the Northern region

Publ. Hlth, Lond. (1984) 98, 134-138

Part-time Training" Experience in the Northern Region Edmund G. Jessop M.A., B,M.

Senior Registrar in Community Medicine Michael O'Brien F,F.C,M

Specialist in Community Medicine, Northern Regional/-/ea/th Authority. Benfie/d Road, Newcastle upon Tyne NE6 4PY and James Parkhouse F.F.A.R.C.S,

Regional Postgraduate Dean, Regional Postgraduate Institute; 1 1 Fram/ington Place, Newcastle upon Tyne NE2 4AB

This paper presents information and opinion on the characteristics of part-time trainees and the working of the scheme over the past 11 years, Data have been of variable quality and it is perhaps too early to assess properly the outcome of part-time training schemes. Nevertheless such evaluation is necessary and will only be possible if suitable data are collected systematically and thoroughly, starting now.

Introduction

Fourteen years ago the departmental circular PM(69)6 entitled "Re-employment of Women Doctors ''1 asked hospital authorities to encourage those with domestic commitments to return to practice by creating part-time posts. Ten years later, in PM(79)3, 2 the scheme was redefined; in particular it was made clear that doctors of either sex were eligible. At Senior Registrar level applicants now face two hurdles. First they must obtain manpower approval from the D.H.S.S. : if the number of applicants exceeds the quota for the specialty competitive interviews are held. Secondly they must satisfy the criteria of a Senior Registrar Appointment Committee 3 in their own Region. Manpower approval lapses unless the candidate obtains an appointment within 9 months (although the D.H.S.S. can be persuaded to grant extensions), If a doctor holding manpower approval moves, the approval (but not, unfortunately, the funding) moves too, enabling a part-time Senior Registrar who starts training in a personal post in one Region to finish in another. A further modification was introduced in 1982 when it was accepted that a Regional Health Authority could establish a personal part-time Senior Registrar post under the terms of PM(79)3 at any time of the year (i.e. without awaiting the national advertisement) for a doctor who had previously held a substantive Senior Registrar post, either whole-time or part-time, in the same specialty. 0033-3506/84/030134+ 05 $02.00/0

© 1984 The Society of Community Medicine

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Registrar and S.H.O. applications are considered at regional level and procedure is less formal. In the Northern Region interviews have recently been introduced for applicants at these levels. Also, Regional Advisers for the relevant specialties are consulted about the acceptability of the proposed part-time training, although the advisers are not always clear about their role in this respect. Colleges vary widely; some require all personal part-time posts to be included in their lists of approved posts while others have no record at all of their part-time training posts. The progress of all doctors occupying part-time training posts in the Northern Region is now reviewed annually by the Educational Committee which reviews the full-time occupants of established posts. The scheme has been in operation for 14 years. Recently some anxieties have been felt in the Northern Region about the way that the scheme has developed. These have stemmed from variations in the attitudes of different specialties to the value of part-time training, from difficulties in defining what the phrase "domestic c o m m i t m e n t " encompasses, from doubts about the quality of some training programmes, and from an apparently ever increasing number of applications which threatened to upset efforts to reshape the career structure. 4 It is understood that similar anxieties have been expressed elsewhere in the country, particularly as it becomes more difficult to set aside money for part-time posts. It was decided to examine the performance of the scheme in the Northern Region. Method The main source of information was the personnel files of the Northern Regional Health Authority, supplemented in some cases by personal knowledge of the trainees. The files extended back to 1971 ; 30 October 1982 was taken as the cut-off date for analysis. Data were extracted manually and processed by Computer using the Statistical Package for the Social Sciences. ~ Results Partial or complete information was obtained on all 124 holders of part-time training posts identified in the records. O f these 118 were female, two were male, and in four cases the sex was not clear from the records. Age at first appointment is shown in Table 1, and specialty in Table 2, which also displays the proportion by specialty in two other analyses of part-time training, n,7 Overall 39% of the part-time posts have been held in the one Teaching District of the Region. Of the 124 doctors identified, 63 still held their posts at 30 October 1982. There was disappointingly little information about the 61 leavers. F o r 34 not even the date of resignation was readily available. Seven are known to have obtained Consultant posts (five in psychiatry, one in medical microbiology and one in paediatrics). F o u r of them are part-time Consultants. One became a principal in General Practice. Six are known to have moved out of the Region. A cross-sectional analysis of current trainees on 30 October 1982 showed that 17 were Senior Registrars, 42 Registrars and five Senior House Officers; most of these (75%) were committed to five, six or seven standard units of medical time (U'sMT) per week. Their distribution by specialty was similar to the cumulative distribution shown in Table 2. In no specialty was the ratio of part-time to full-time trainees greater than 1 : 10. The growth in number of part-time trainees over the past 10 years is shown in Table 3 : no reliable data for the number before 1976 are available.

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E. G. Jessop et al. TABLE 1. Age at first appointment Age

Number

(%)

30 or less 31-35 36-55 Not known

27 23 15 59

42 35 23 --

Total

124

--

TABLE2. Specialization by region

Specialty Medicine Paediatrics Surgery Obstetrics/gynaecology Psychiatry Pathology Radiology Anaesthetics

Northern reNon (n = 124) (%)

Oxford (1975) ( n = 98) (%)

17 8 6 l1 25 8 2 22

26 12 1 2 31 8 2 7

National (SR only) (n = 229) (%) 10 8 -0.5 31 15 7 23

TABLE 3. Growth in number of part-time trainees over the past 10 years.

Year 1976 1977 1978 1979 1980 198l 1982 (Jan.-Oct.)

Part-time trainees in post during year (prevalence)

New appointments during year (incidence)

9 14 23 42 54 60 63

4 8 12 21 16 14 10

I n a d d i t i o n to t h e 124 a n a l y s e d t h e r e w e r e s e v e r a l d o c t o r s w h o s e a p p l i c a t i o n s for p a r t - t i m e t r a i n i n g w e r e o u t s t a n d i n g at 30 O c t o b e r 1982.

Discussion I n f o r m a t i o n o n m e d i c a l p e r s o n n e l m a t t e r s is n o t o r i o u s l y difficult to o b t a i n s,9 a n d t h e r e c o r d s a v a i l a b l e to us w e r e n o t suited to this t y p e o f r e v i e w . It was, h o w e v e r , d i s a p p o i n t i n g t o find so little i n f o r m a t i o n o n w h e t h e r the s y s t e m o f p a r t - t i m e t r a i n i n g is fulfilling its m a i n o b j e c t i v e : t o t r a i n d o c t o r s f o r c a r e e r posts. T h e p r e s e n t s c h e m e for p a r t - t i m e t r a i n i n g is r e g a r d e d b y t h e D . H . S . S . as e x p e r i m e n t a l ( a l t h o u g h n o a r r a n g e m e n t s w e r e m a d e to e v a l u a t e t h e results o f t h e e x p e r i m e n t a n d n o c r i t e r i a o f success o r f a i l u r e w e r e e s t a b l i s h e d ) . I n o r d e r

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to evaluate the scheme properly, information is needed on leavers; where they are going and why. Had the importance of such information been realized at the outset, it could have been collected as each person left the scheme. Because no mechanism of review was envisaged when the scheme was started the information is all but lost. It is clear that there was a great increase in the number of part-time trainees during the latter half of the 1970s, although this rise appears to have reached a plateau. The upsurge led to the suspicion that some junior doctors were using part-time posts to escape the rigour of open competition for full-time posts, as they applied for part-time posts shortly after failing to obtain full-time posts. Conversely some part-time trainees have moved quickly into full-time posts, apparently overwhelming domestic commitments having faded with remarkable speed. Another suspicion was that part-time juniors were being used to avoid the freeze on junior staff establishment. In our survey only a small proportion of all juniors were part-time, and many of those were in the shortage specialties of anaesthetics and psychiatry, but anything which unbalances the career structure still further is undesirable. The number of part-timers in a given specialty is governed by two factors: the readiness of local Consultants to accept part-time junior staff, and the acceptability to the Royal College or Faculty of part-time training. The first factor is illustrated by the high number of part-time trainees in obstetrics in the Northern Region (Table 3) attributable to the readiness of some local Consultants to have part-time junior staff. In principle all Royal Colleges and Faculties accept that part-time training should be available. In practice not all Specialist Advisory Committees feel committed to this philosophy. For example, "surgery is not regarded as a discipline that lends itself to learning on a part-time basis" although exceptions can be made. 1° Further difficulties occur when doctors are limited by domestic commitments to working in a particular geographical area which may not contain any posts recognised for training by the Royal College. In such circumstances there may be genuine doubts about the quality of training available to doctors who cannot travel. In addition the total number of part-timers is limited by the willingness of the Regional Health Authorities to pay them (or strictly speaking, to reimburse the Districts which employ them). All supernumerary part-time posts are funded by Regional Health Authorities. In the Northern Region the money is "top-sliced, before the general allocation of budgets to Districts. In other Regions it is understood that the money is distributed with an earmark (albeit an insufficiently indelible one in some cases). The sum to be set aside for part-time training must be gauged against other demands on the allocation for medical staff and postgraduate medical education. Part-time posts are supposed to be neither easier nor more difficult to obtain than equivalent full-time posts, but it is impossible to judge the likely success in open competition of a candidate who by definition does not have to compete (except perhaps against a small field for manpower approval). The scheme is designed to permit those who can only train part-time to achieve career posts. However there seem to be several categories of applicant: first there are doctors requiring a period of part-time training because of commitments to young children, during the course of a full preparation for a Consultant career. Next there are doctors who are able to work full-time but who are tied by domestic commitments to a specific town or city (supernumerary full-time posts are not available under PM(79)3 arrangements). Then there are overseas doctors who seek additional experience or wish to complete higher qualifications before returning to their country of origin.

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Finally there are doctors who apply for a personal part-time post after failing to obtain an established post. These categories are not mutually exclusive (nor exhaustive). Applicants in the second are not eligible under present arrangements but probably should be. Applicants in categories three and four are not the intended beneficiaries of the scheme. Doctors in category four are trying to use the scheme as an easy route into a specialty. To encourage anyone in this direction is to do them a disservice by fostering career expectations which are unlikely to be fulfilled in the long term. Doctors with disabilities and ill health do apply, but in such small numbers that they do not warrant aggregation into a major "category". It might be more appropriate, following Scottish precedent, to abolish personal part-time posts and simply increase establishment in the training grades by say 10~o so as to accommodate those needing part-time training in earmarked established posts through a competitive field. Such posts should provide as many opportunities for career development (including practice and research) as full-time posts. The precise increase in establishment would differ by specialty; for example psychiatry and anaesthetics attract more part-time trainees than general surgery. Such normalization of part-time posts into establishment might dispel the lingering stigma of part-time training, and the scepticism of those who regard the present system merely as a sop to the feminists. Conclusion Examination of available data about part-time training has failed to support subjective anxieties about the numerical performance of the scheme. They suggest that a steady state might have been reached, but conceptual and educational difficulties remain. It is suggested that regardless of how the scheme may develop, those enjoying part-time training need to be monitored in detail. References 1. NationalHealth Service (1969). Re-employment of women doctors, HM(69)6. London: D.H.S.S. 2. Department of Health and Social Security (1979). Opportunities for part-time training in the NHS for doctors and dentists with Domestic Commitments, Disability or Ill-health, PM(79)3. London: D.H.S.S. 3. Department of Health and Social Security: Health Services Management (1982). The Appointment of Consultants and Senior Registrars, HC(82)10. London: D.H.S.S. 4. Department of Health and Social Security Health Services Management (1982). Hospital Medical Staff: Career Structure and Training, HC(82)4. London: D.H.S.S. 5. University of Michigan (1981). The Statistical Package for the Social Services, 2nd Edit., Version 9. New York: McGraw-Hill. 6. Rue, R. (1975). Organisation and services problems. In Women in Medicine. London: D.H.S.S. 7. Medical Manpower Division (1981). Medical and dental staffing prospects in the NHS in England and Wales 1981. Health Trends 14, 28-33. 8. Viner, R. S., Lees, W. & Dick, G. W. A. (1982). A regional medical manpower and training information system. Community Medicine 4, 108-112. 9. Vickers, M. D. (1983). Letters to a young doctor. British Medical Journal 286, 53-54. 10. Anon. (1980). Acceptability of part-time training. British Medical Journal 281, 1582-1583.