> Agreed, although I don't want to revisit the argument of
> "resident cover" versus "dashing in from home" styles of
> care; different styles will suit different departments. But
> as you suggest Matt, there are many consultants who provide
> "cover" from home after 5pm, but who never actually attend.
> Like you, I cannot see the point in this.
The interesting thing is that I've experimented with increased out of hours
consultant cover in the department. What I've found is that being in in the
evenings (whether needed or not) actually decreases your chances of being
called in when you are needed but at home. Personal feeling, no worthwhile
evidence. May vary between departments but worth trying out in your own one.
> I'm sure you're correct, but my feeling is that much of this
> expansion has not actually led to more out-of-hours care. I
> know of many departments where three or even four consultants
> all work from 9 to 5.
You may be right. My own feeling however (looking at departments around the
West Mids) is that on the whole there has been an expansion in the hours
during which a consultant is scheduled to be in the hospital (although it
would be interesting to see some accurate data on this). Has this led to an
increasing reluctance to call in consultants from home?
I am not questioning that there has been more A and E consultant involvement
in patients with primary care problems and self limiting minor injuries
(although possibly not in minor injuries as a whole- I've know a few
departments that have cut down on their care of minors- for example by
dropping extensor tendon repair and soft tissue clinics), just that this
appears to have led to consultants becoming less focussed with no increased
or even less consultant involvement in the areas where it is needed.
Again, leaving aside issues as to when a consultant's routine work should be
scheduled, is there and adequate answer to why increased consultant numbers
(can anyone give the actual national figures? Official figures from the 1998
statistical survey shows an increase of over 50% between 1994 and 1998 but
my gut feeling is that the rate of increase has been faster since then) have
not resulted in increased consultant involvement in the sickest patients?
> Basically I'm very happy to work until 10pm or beyond, I just
> don't believe we should get standard rates of pay for this.
> Speaking of pay, did anyone see BMJ news last week, where
> Thorpe quoted the standard week should be from 8am to 7pm?
> This seems a pretty poor place to start negotiations from
> doesn't it? I can understand how 9 to 5 can be stretched to 8
> to 6, but an 11 hour day seems ridiculous. Should doctors
> consider it standard to finish lists or clinics at 7pm?
I think you're right on that one. Regular evening work at standard rates as
an accepted part of the long term contract (as opposed to a temporary
voluntary measure) will make the departments (and indeed the specialities)
offering it unpopular.
Matt Dunn
Warwick
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