More consultants attracted to acute medicine

CENSUS figures for UK consultants suggest a move away from specialist working to more generalist roles treating acutely ill patients.

The latest Census of consultant physicians in the UK, produced by the Royal College of Physicians, found a 33 per cent expansion in consultants working in acute medicine. This is the largest increase reported in the survey which was conducted in December 2012 and measures the number of consultants in all posts.

Acute medicine remains a relatively small specialty in real terms with just 393 practising UK physicians in 2012 but up from 295 the previous year. Demand for consultants in acute medicine remains high despite the increase, with 41 per cent of advertised posts unfilled due to a lack of suitably trained applicants.

The RCP believes the need for more generalist care can only increase as the nature of patients presenting at hospital changes – with 65 per cent of admitted patients over age 65 and many with multiple complex conditions.

The census showed a marked increase in the provision of acute care by some specialties. Between 2011and 2012, the number of renal medicine specialists contributing to acute care rose from 48 per cent to 58 per cent and the number of rheumatology specialists providing acute care rose from 22 per cent to 44 pre cent.

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 per cent), endocrinology and diabetes (82 per cent) and geriatric medicine (83 per cent). Geriatrics was found to be the largest specialty, with 1,252 consultant physicians working across the UK in 2012, representing 10 per cent of the 12,221 consultant workforce.

The census also reported that 46 per cent of consultant physicians aged under 40 are female, compared to just 14 per cent of consultants aged over 60. The consultant workforce has also become more part-time, with 17 per cent working less than whole time.

Job satisfaction was found to be reasonably high with 79 per cent of consultants saying they enjoyed their jobs ‘always’ or ‘often’, but 75 per cent also felt ‘always’ or ‘often’ under pressure and 60 per cent stated an intention to retire early.

Commenting on the data, 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 per cent 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."