> Emergency medicine and
> "elective" work are
> incompatible, well, at least they're very uncomfortable
> bed-partners.
Not sure I agree here: Are there certain skills in emergency medicine that
are useful in elective work? I'd say yes (unless you pass on all your
extensor tendons and facial lacerations you should have some skills in
operating and tissue handling; you should have some experience of regional
anaesthesia; you should have some skill in musculoskeletal medicine); some
elective work can provide useful training for your trainees (musculoskeletal
medicine, minor ops etc.). Certainly, with appropriate staffing, I don't see
doing some elective work as causing a problem- and of course it gives you
the opportunity to have a lower proportion of your work done at unsocial
hours (allows you to have 24/7 senior cover on more acceptable rotas).
Remember, taking on elective work does not use up your existing staff.
Rather, it is a way of getting new staff funded (clearly, otherwise don't do
it). It also gives you a useful tool against some management manoeuvres
(extra workload without extra resources; or reduction in staffing means
cutting elective work).
>> No, the way we cope with changeover is by having sufficient senior and
> middle grade staff available; no distractions and no leave
> for the first
> week or two. There are many other non-core activities that can be
> rescheduled this week to make room for the juniors, including most
> administration and most types of teaching etc.
Teaching? Much of our teaching load (both formal an on the job) is in the
induction period and the first few weeks until the new SHOs bed down. Much
of the administrative work is day to day stuff that can't wait, and there is
an increase in administrative work when you have new SHOs. Medical schools
keep their own terms and while they are quite happy with having no teaching
around the Christmas period, over the summer and in April; they aren't too
happy with a couple of weeks of suspension mid term. I accept that may be
appropriate to drop SpR and staff grade teaching over this period, but
that's a fairly low part of our teaching workload.
> And anyway, how come it's not such a good idea to be
> unavailable doing minor
> ops this week, but OK for the rest of the year?
A 3 or 4 week wait for minor ops is not a major deal (better than you'll get
when general surgeons do them). Offering elective stuff year round apart
from at predictable periods of high demand of emergencies or low staffing
levels gives a better deal than offering a reduced service to emergencies at
these periods; is cheaper than staffing year round for the short periods of
highest demand; and is often more acceptable to staff than annualisation of
hours. I'd reckon it would also suit those areas with big fluctuations in
seasonal demand.
Matt Dunn
Warwick
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