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CONSULTANTS' WORK LOAD
1073 reiterate and perhaps enlarge from our own experience of the points Professor McLachlan made and ask what practical steps could be taken to ensure that a full-time academic career in Britain will attract and keep high-quality medlike
to
some
ical graduates. As professors in a large London teaching hospital our N.H.S. work involves responsibilities for the laboratory services in an 850 bed hospital and in smaller associated hospitals. Two of us (W.B. and A.V.H.) are heads of departments. Based on D.H.S.S. work-load figures, each of our departments has a deficit of staff. We all have clinical charge of patients and conduct ward-rounds and outpatient clinics each week. We all help with the care of private patients in the hospital; this provides our departments with some research money and excellent postgraduate and undergraduate teaching material, and no income from this work comes to us. Our academic work includes training of 100 medical students each year; acting as examiners in pathology; training junior postgraduate doctors and visiting fellows; research supported by grants for which we have applied to outside bodies (our departments have no established technicians, biochemists, or other non-medical personnel supported from university funds); writing of academic papers, reviews, chapters, books, giving internal and external lectures; arranging scientific meetings; membership of the editorial boards of journals; reviewing large numbers of papers and grant requests; attendance at appointment committees for both N.H.S. and university posts. Our administrative duties include those in our own departments, which have substantially increased with the reorganisation of the Health Service and include membership for each of us of not less than fifteen local hospital and medical-school committees and working-parties and of at least six university or regional committees. During our previous careers, like most present-day consultants, we received a pittance for being continually on call as house-officers, and low subsequent salaries as junior N.H.S. statt or as research-workers and subsequently as university employees, with no extra-duty payments, moving allowances, or other subsidies. Our present salaries are those of other fulltime consultants with one "C" merit award among the three of us. In all our departments junior doctors and technicians now earn extra-duty payments, for working considerably fewer hours than we do. We are taxed under the arrangements for full-time consultants which Sandison’ (presumably with no axe to grind) tells us result in a loss of about C2400 in gross income, compared with part-time consultants or general practitioners. The D.H.S.S. is not prepared to pay us, as university employees, for domiciliary visits. It is small wonder that many able and suitably qualified consultants now find that they cannot afford to become professors. Perhaps Professor Dudley could advise us in which area we clinical academics should put extra effort, or as he put it "pitch in", in order to ensure that the rewards of a clinical academic career in this country are more commensurate with the very many arduous duties involved. Unless radical changes are made there will soon be precious few true academics working in clinical academic posts in this countrv.
Departments of Microbiology, Hæmatology, and Chemical Pathology, Royal Free Hospital and School of Medicine, London NW3 2QG
W. BRUMFITT A. V. HOFFBRAND M. R. WILLS
CONSULTANTS’ WORK LOAD
SIR,—Dr Hopkins (May 1, p. 956) has bravely and honestly shed
light on a most forbidden topic, consultants’ work load. It is most extraordinary that in a National Health Service there are so few reliable data and statistics on what we are all doing, how we are doing it, and with what results. The Central Manpower Committee deliberates and makes recommenda1.
Sandison, C.
R.
Br. J. Hosp. Med. 1976, 15, 416
tions without
adequate facts,
as
do
regional,
area, and district
planners. analysed Department of Health and Office of Censuses and Surveys data and find that the apPopulation proximate outpatient consultations per week by a consultant and his (or her) junior staff and by a general practitioner are as shown in the table. It is likely that most of the new patients in 1974 were seen by the consultant and the old patients shared with one or more assistants. I have also
(1974) FOR CONSULTANT (AND TEAM) AND FOR AVERAGE GENERAL PRACTITIONER (1970-71)
WEEKLY OUTPATIENT CONSULTATIONS
Sources: Health and Personal Social Services: statistics for England, 1975. H.M. Stationery Office, 1976. Morbidity Statistics from General Practice; second national study 1970-1. H.M. Stationery Office, 1974.
Like Dr
Hopkins
I find that these numbers do
not seem
excessive, and he shows that the numbers have fallen in the past ten years. However, these figures mean little without other essential data and information that are not availablenamely, the time taken per consultation, the methods and techniques used, and the outcomes. Unless we have reliable information on all these factors we cannot produce any accurate predictive planning on manpower needs. What it does seem is that at present we have enough general practitioners and enough consultants, since they do not appear to be overloaded on the numbers of weekly consultations. In these circumstances it is questionable whether we need to raise the annual output of graduates from our medical schools from 2300 now to 4100 in 1980. 138
Croydon Road,
Beckenham, Kent BR3 4DG
JOHN FRY
CONSULTANT INVOLVEMENT IN PLANNING SUPER SPECIALTIES
SIR A series of communications, of which the latest was the "Oxford protest" (April 17, p. 858), has drawn attention to the difficulties experienced by regional specialties in gaining local recognition of their needs. I am personally acquainted with the background to the "Sheffield protest" (April 3, p.
739). It was perhaps to be expected that such difficulties would appear, or become worse, as a result of N.H.S. reorganisation. If indeed this is the case the situation must be corrected, but I would suggest that clinicians are clouding the issue by vaguely blaming the "system" or the "administration". Before reorganisation the power of hospital management committees, but not boards of governors, was limited by regional hospital boards which were able to arrange that regional specialties, and also unglamorous specialties such as geriatrics and mental illness, could be given necessary support. Under the new management system areas, especially teaching areas, have been offered, and have eagerly accepted, the opportunity to exercise a much larger measure of control over their own affairs. Furthermore clinical consultants are now themselves an important and powerful part of the administra-
to
some
ical graduates. As professors in a large London teaching hospital our N.H.S. work involves responsibilities for the laboratory services in an 850 bed hospital and in smaller associated hospitals. Two of us (W.B. and A.V.H.) are heads of departments. Based on D.H.S.S. work-load figures, each of our departments has a deficit of staff. We all have clinical charge of patients and conduct ward-rounds and outpatient clinics each week. We all help with the care of private patients in the hospital; this provides our departments with some research money and excellent postgraduate and undergraduate teaching material, and no income from this work comes to us. Our academic work includes training of 100 medical students each year; acting as examiners in pathology; training junior postgraduate doctors and visiting fellows; research supported by grants for which we have applied to outside bodies (our departments have no established technicians, biochemists, or other non-medical personnel supported from university funds); writing of academic papers, reviews, chapters, books, giving internal and external lectures; arranging scientific meetings; membership of the editorial boards of journals; reviewing large numbers of papers and grant requests; attendance at appointment committees for both N.H.S. and university posts. Our administrative duties include those in our own departments, which have substantially increased with the reorganisation of the Health Service and include membership for each of us of not less than fifteen local hospital and medical-school committees and working-parties and of at least six university or regional committees. During our previous careers, like most present-day consultants, we received a pittance for being continually on call as house-officers, and low subsequent salaries as junior N.H.S. statt or as research-workers and subsequently as university employees, with no extra-duty payments, moving allowances, or other subsidies. Our present salaries are those of other fulltime consultants with one "C" merit award among the three of us. In all our departments junior doctors and technicians now earn extra-duty payments, for working considerably fewer hours than we do. We are taxed under the arrangements for full-time consultants which Sandison’ (presumably with no axe to grind) tells us result in a loss of about C2400 in gross income, compared with part-time consultants or general practitioners. The D.H.S.S. is not prepared to pay us, as university employees, for domiciliary visits. It is small wonder that many able and suitably qualified consultants now find that they cannot afford to become professors. Perhaps Professor Dudley could advise us in which area we clinical academics should put extra effort, or as he put it "pitch in", in order to ensure that the rewards of a clinical academic career in this country are more commensurate with the very many arduous duties involved. Unless radical changes are made there will soon be precious few true academics working in clinical academic posts in this countrv.
Departments of Microbiology, Hæmatology, and Chemical Pathology, Royal Free Hospital and School of Medicine, London NW3 2QG
W. BRUMFITT A. V. HOFFBRAND M. R. WILLS
CONSULTANTS’ WORK LOAD
SIR,—Dr Hopkins (May 1, p. 956) has bravely and honestly shed
light on a most forbidden topic, consultants’ work load. It is most extraordinary that in a National Health Service there are so few reliable data and statistics on what we are all doing, how we are doing it, and with what results. The Central Manpower Committee deliberates and makes recommenda1.
Sandison, C.
R.
Br. J. Hosp. Med. 1976, 15, 416
tions without
adequate facts,
as
do
regional,
area, and district
planners. analysed Department of Health and Office of Censuses and Surveys data and find that the apPopulation proximate outpatient consultations per week by a consultant and his (or her) junior staff and by a general practitioner are as shown in the table. It is likely that most of the new patients in 1974 were seen by the consultant and the old patients shared with one or more assistants. I have also
(1974) FOR CONSULTANT (AND TEAM) AND FOR AVERAGE GENERAL PRACTITIONER (1970-71)
WEEKLY OUTPATIENT CONSULTATIONS
Sources: Health and Personal Social Services: statistics for England, 1975. H.M. Stationery Office, 1976. Morbidity Statistics from General Practice; second national study 1970-1. H.M. Stationery Office, 1974.
Like Dr
Hopkins
I find that these numbers do
not seem
excessive, and he shows that the numbers have fallen in the past ten years. However, these figures mean little without other essential data and information that are not availablenamely, the time taken per consultation, the methods and techniques used, and the outcomes. Unless we have reliable information on all these factors we cannot produce any accurate predictive planning on manpower needs. What it does seem is that at present we have enough general practitioners and enough consultants, since they do not appear to be overloaded on the numbers of weekly consultations. In these circumstances it is questionable whether we need to raise the annual output of graduates from our medical schools from 2300 now to 4100 in 1980. 138
Croydon Road,
Beckenham, Kent BR3 4DG
JOHN FRY
CONSULTANT INVOLVEMENT IN PLANNING SUPER SPECIALTIES
SIR A series of communications, of which the latest was the "Oxford protest" (April 17, p. 858), has drawn attention to the difficulties experienced by regional specialties in gaining local recognition of their needs. I am personally acquainted with the background to the "Sheffield protest" (April 3, p.
739). It was perhaps to be expected that such difficulties would appear, or become worse, as a result of N.H.S. reorganisation. If indeed this is the case the situation must be corrected, but I would suggest that clinicians are clouding the issue by vaguely blaming the "system" or the "administration". Before reorganisation the power of hospital management committees, but not boards of governors, was limited by regional hospital boards which were able to arrange that regional specialties, and also unglamorous specialties such as geriatrics and mental illness, could be given necessary support. Under the new management system areas, especially teaching areas, have been offered, and have eagerly accepted, the opportunity to exercise a much larger measure of control over their own affairs. Furthermore clinical consultants are now themselves an important and powerful part of the administra-