I understand that with current numbers of A&E trainees and expected
retirements, BAEM's recommendation of around 800 consultants will become a
reality around the middle of the next decade. In order to prevent the
bottleneck disaster that befell O&G specialists, consideration has to be
given to a dramatic reduction in A&E training posts, which may result in
perhaps just teaching hospitals having SpRs in A&E.
This gives me the willies. Without SpRs, who will provide middle grade cover
in most DGHs? As far as my limited imagination sees it the options are:
Hire non consultant career grades - but where will they come from? The good
ones in my region are like gold dust.
'Import' foreign doctors
Get the Consultants to do the 'middle grade' cover - is that realistic in a
3 or 4 consultant department?
Not have middle grade cover - just SHOs with consultants on call from home,
like the 'good old days'
Whichever way I look at this I can't help thinking either the specialty is
put back at least ten years or consultants are going to get shafted. Either
way the quality of emergency care for patients is not going to benefit. Is
it time we push for a consultant-based service so that adequate consultant
and trainee numbers are provided for, or do we stick with the consultant-led
principle, with its associated catch-22 situation? Am I overestimating the
contribution made by SpRs to quality A&E service delivery?
I would value the opinions of both my senior colleagues and fellow trainees
on this. At a time when the development and credibility of the specialty
seem to be gaining momentum, this news has shaken my optimism somewhat.
Cliff Reid
SpR in (Accident &) Emergency Medicine
North Hampshire Hospital
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