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BMJ. 2007 September 22; 335(7620): 583.
PMCID: PMC1988965

Growth in number of UK consultant physicians is lowest in 15 years

The number of consultant physicians in the United Kingdom showed the smallest increase for 15 years from 2005 to 2006, shows a survey published this week, and numbers of consultants in some major specialties fell.

The survey, carried out by the Royal College of Physicians, showed that the number of consultant physicians increased by only 1.8% from September 2005 to September 2006. This was the smallest increase recorded by the annual census since it began in 1991. Over this period the number of consultants grew by an average of 6.5% each year.

The annual increase in the number of consultant physicians in the UK has been shrinking for the past couple of years. In 2004-5 the number increased by 3.2% from the previous year, and the increase in 2003-4 was 5.4%.

The latest figures showed that the number of consultants fell in some smaller specialties, including clinical pharmacology and immunology, as well as in some of the larger ones, such as dermatology and rheumatology. The overall slowing in the expansion of the number of consultant posts was due to fewer posts being advertised rather than a lack of suitable applicants, the survey showed.

Alistair McIntyre, director of the Royal College of Physicians' medical workforce unit and a consultant gastroenterologist at Buckinghamshire Hospitals NHS Trust, said: “Consultant physicians are needed to lead the delivery of high quality care to patients and to contribute to the development of the NHS.

“The lack of expansion in consultant numbers is likely to be detrimental to patient care. The UK has the lowest number of trained doctors—at consultant level—in the developed world.”

He added that the slowing in the numbers of consultants was a major concern for doctors now in training. “There is an increasing number of junior doctors coming through. If there is very limited expansion in consultant posts, the only new jobs will open up when people retire.” He said he hoped that the problem is a short term one, reflecting the shift to care in the community making primary care trusts unwilling to fund new consultant posts.

Other results from the survey showed great variation across the UK in the number of physicians working in the larger medical specialties. Almost all the figures were lower than those recommended by the colleges and specialist societies. The populations served by physicians working in cardiology and diabetes varied by a factor of 1.9 in different strategic health authorities in England. The variations were even greater for medical oncology (which had a nearly sixfold variation) and neurology (a more than fourfold variation).

The census, which is carried out in the autumn each year, collated workforce data from 4966 returns from a total of 8712 consultant physicians who were surveyed. It showed that most consultants were still working beyond their contracted hours. The average consultant physician worked 12 programmed activities (equivalent to four hours of daytime work or three hours of work done out of hours) each week, totalling approximately 48 hours. However, they are contracted for an average of 10.9 programmed activities or approximately 43.5 hours.

One in 12 consultant physicians who responded said that they were finding it difficult to find time outside their work for their trust for national or deanery roles or for training and lecturing.

Dr McIntyre said, “It's concerning that physicians are finding it difficult to be released for this type of work, because it benefits the wider NHS and patient care, as it allows doctors to contribute towards activities such as education, standard setting, or national guideline development.” He said that the situation needed to be monitored to ensure that such time is protected in future.

The number of women consultants increased by 6.4% from last year, with women now representing 24.5% of the consultant physician workforce. The college predicted that this number would continue to rise in all specialties because of the number of women progressing through training. The number of part time appointments also continued to increase, with part time workers occupying more than 13% of posts.

Notes

The census is available at www.rcplondon.ac.uk/college/mwu/.


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