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Dear esteemed colleagues Over many months I have read all the messages from this mailbase. I do find it very disturbing to read comments that both demean SHOs and recently the SpRs. One may be tempted to ignore that the present set of SpRs contain a cohort of experienced doctors (as opposed to the green ones who took the shortest quickest route to a SpR programme within a couple of years of leaving medical school). I am aware and do acknowledge Danny McGeehan’s comments on the subset of doctors within the grade but we appointed them so we have the responsibility to train them or kick them out. It is arguably easier to train so we must get on with it. In the 5 years that a SpR trains to become a consultant he must change from an experienced SHO to a consultant. The idea being that at the end of 5 years when he/she takes up post as a consultant there is also the experience at sitting in the office not contributing to the queue busting that the SpRs are expected to do. -Yes, consultants sit in the office doing nothing useful to help the poor nurses and SHOs keep the waiting times down. They also do not see enough patients to make mistakes and have complaints made against them. They pontificate when their juniors make errors resulting in complaints and/or litigation. Consultants should do 56 hours of shift work and then do the paper work (audit/research/management & meetings etc) on their own time. I of course do not believe this! But if a consultant starts to criticise his juniors for being in the office attempting to practice critical appraisal, working on audits, writing up clinical topic reviews, working on a research project etc (which he/she is also doing on his/her own time at home as is part of the expected training), then he will lose the trainees support. I think, and only time may tell, that if we move (as is the government's agenda) to cheap consultant based posts (Senior casualty officer role), it would kill off the present consultant cohort within 5 years. I was at a BAEM conference in Cardiff a few years ago and Kenneth Calman indicated in a round about way (for anyone paying attention at the time) that we would move to a consultant provided service. He said in response to a question on who will be treating the public. " I know who I would want treating me". So before anyone trains SpRs to become super SHOs (senior casualty officers) and ignores the aspects of training that helps them to pass the FFAEM (as opposed to repeating the work that got them their FRCSEd (A&E) equivalent)- think very carefully. SpRs need to feel respected for the hard work it takes to become one. They should contribute to the quality of service to a greater extent than the quantity. Their training needs should be given equal priority to the service needs of the department. It may require set service and management shifts etc to achieve this. If you are not prepared to address equity of training and service needs (Nick Jenkins!) then have a staff grade because you are choosing an SpR to make up for not being able to get another SHO, which is dishonest to the SpR and yourself. Look at your trainee, not only at the RITA and decide does he/she need more shop-floor experience or other experience to complete his/her training and help them through the FFAEM? If you don’t know then you should not be a trainer As for the future, who knows? I am quite willing to be part of a consultant provided ( also called 'based') service for 3 times the present salary and a retirement at 55yrs on full pension. Look at the burn out rates in the U.S. and ask if you want that. I would prefer to have a consultant led service with it's diversity of shop floor work, management, audit, research, prehospital work etc. These are only some of the reasons that make it at present the most exciting speciality to be in. We need to have strong people representing us and take a solid stance against external forces (yes, mainly the government) from pushing us in directions we do not wish to go. We need individuals with the testicular fortitude (A role for Danny McGeehan I feel!) to draw a line in the sand and in good management terms learn to say No! John Chambers refers to it being incorrect to use the term inappropriate attendees. There are inappropriate attendees if your service is set up to deal with Accidents and Emergencies especially if there is a perfectly good primary care (GP) service available 24hrs a day. Please do not say my GP colleagues are deficient because if they were they would recognise it and correct that...not expect A&E to fill in for them. Duplication of service is wasteful (and dangerous from a communications aspect). I do respect that these patients are not inappropriate in their own minds and do not condemn them for attending, but a 'spade is a spade'. I am not G.P. trained but if we are to take on this role and deny inappropriateness then I think I feel a year in General practice is mandatory. Will this additional training be part of the 5 years or extra? The one reassuring thing is that the militant cohort of junior doctors who have improved juniors work conditions (and you better believe it, if you have not grown up through all the changes) will be consultants soon and they are unlikely to take any rubbish. On a personal I have never been allowed to pick and choose and I see well in excess of BAEM recommendations for a SpR training post but guess who vetted my posts from the JCHTA&E Carlos?? Derek Keith Sage SpR A&E Presently Public health fellow Cambridgeshire Health Authority Peterborough [log in to unmask] [log in to unmask]