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Consultant Census Reveals Workforce Pressures Impacted Patient Care

Consultant physicians responding to an annual survey have revealed that the majority believed widespread vacancies were "significantly impacting patient care", whilst nearly 1 in 5 (18%) said they "almost never" felt in control of their workload.

The newly published report of the 2022 census by the Medical Workforce Unit of the Royal College of Physicians (RCP) showed that 58% of consultant physicians reported consultant vacancies in their departments last year, a proportion the report authors described as "staggering".

The Annual consultant physician census was carried out on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE), and the Royal College of Physicians and Surgeons of Glasgow (RCPSG), between them representing over 50,000 physicians globally. The survey was sent to nearly 20,000 consultant physicians, with a 27% response rate, the majority from practising NHS consultants.

The "widespread gaps in the medical workforce" their members reported "laid bare" the pressure on doctors and the impact on patients, a press release issued on behalf of the Royal Colleges said.

Widespread Staff Shortages Challenging

More than two-thirds (69%) of consultant physicians were also aware of gaps in trainee rotas either daily or weekly. Seven in 10 (73%) said rota gaps had impacted patient care, particularly on access to outpatient care (25.8%), the length of hospital stays (23.4%), and out-of-hours inpatient care (23.3%).

"Widespread staff shortages make it increasingly challenging to meet rising demand," the release said. "Despite over 2 million diagnostic checks and tests being delivered by NHS staff in April 2023, there were still over 1.5 million patients waiting for 1 of 15 key checks at the end of that month, with 430,800 patients waiting 6 weeks or more for a test or scan from referral."

The strain felt by UK consultants trying to keep pace with ever-growing patient need was highlighted by figures showing that 44% reported having "an excessive workload almost always or most of the time", 41% said they worked excessive hours, 18% said they "almost never feel in control" of their workload, with only a third (34%) saying they felt in control of their workload "most of the time or almost always".

1 in 5 Physicians at Risk of Burnout

The survey showed that based on those reporting three or more high scores on the Maslach burnout inventory, 19% of consultant physicians were at risk of burnout. Some 42% did not take all their annual leave, with reported reasons being mainly that they were unable to find or were too busy to arrange cover. 

However the 2022 survey also showed that almost a third (30%) of consultant physicians worked either flexibly or less than full time – 45% of female consultants and 18% of male consultants, with the proportions similar until age 35, then diverging so that by age 35-44 this was true of 10% of male consultants but almost half of female consultants. 

Women made up 41% of the consultant physician workforce in 2022 (compared with 23% in 2004) and were projected to comprise 46% by 2027.

Half of consultants had taken sick leave in 2022 and 80% continuing professional development leave. Most (84%) did some work remotely.

Workforce Wellbeing 'Very Fragile'

Mike McKirdy, president of the RCPSG, commented that the report showed that the wellbeing of the medical workforce was "currently very fragile". He said: "This year's physician census once again demonstrates the challenge of delivering good medical care when there are so many consultant vacancies, and gaps in the rotas of doctors providing emergency care, right across the United Kingdom." 

Dr Sarah Clarke, president of the RCP, said: "It is alarming that so many of our dedicated doctors feel that their workload is out of control. Large-scale staff shortages see patients in need facing further delays to care, which in many cases negatively affects their treatment. Doctors are feeling intense strain and responsibility for making up for these shortcomings, when they have been trained to do the best for their patients."

Professor Andrew Elder, president of the RCPE, said: "Year on year, the census data demonstrate increasing risk to the safe provision of patient care, with an alarming and rising proportion of unfilled consultant posts and consultants approaching retirement. In order to address these challenges, an effective recruitment and retention strategy is required for doctors across each of the four nations of the UK."