our specialty still has some way to go around the tracks with quite different working patterns around the world and from hospital to hospital in the same country
here in Dunedin NZ we are just getting to 7 consultants and are just getting to 1:3 w/e ( have been on 1:2 then 2:5 w/e for past 12 years)
consultants on the floor 16 hours/day ( 2 x8 hour shifts)7 days week
31 clinical hours/week job sized at 45 hours. pay similar to UK
no clinics no special interests just general Emergency Medicine
will get to 1:4 w/e in a year or so I think
Best performing ED in New Zealand by a country mile and no difficulty recruiting now at any level
We all work very hard and shift work is not easy and very antisocial but out of hours is when 70% of our patients arrive be they minor or major, all have an acute need and benefit for specialist presence
This has taken years of hard work to achieve and still is not in everyone's comfort zone including mine
Specialist night shift will surely come in the next decade and is already happening around Australasia to some extent
but unlike 80 % of hospitals in the States we aim to have a quite robust junior staffing structure as well and I do not see this changing
it is now well recognised that our specialty has a very high profile in the hospital and one or more of our senior doctors are almost always there rostered and working and supervising the ED - and that we do a good job
I ( finally) do feel sort of lucky when reading postings and our overall staffing is almost decadent but our work and lifestyle are certainly not easy.
JohnC
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Dunn Matthew Dr. (RJC) A
& E - SwarkHosp-TR
Sent: Wednesday, October 19, 2005 8:39 PM
To: [log in to unmask]
Subject: Re: Consultant Rotas
I think the new contract guidance says most of it: most places are going to
a 1:4 (with cover for leave) or less frequent. Certainly anything more
frequent would deter applicants (even if you hardly ever get called in, the
restrictions on what you can do might not go down too well- particularly if
the applicant's partner works some weekends as well). As to out of hours
sessions, probably depends on how much call ins you get. We currently get 2
PAs for call ins (keep it low by not coming in for waiting times). I think
at that level, adding in regular unsocial hours sessions won't go down too
well with prospective applicants (or with family). Also if we were coming in
for waits instead of sick patients it would be a bit boring and I think we'd
need to cut the amount of call ins. Again, the 2 PAs worth of call ins is
the maximum recommended in the new contract.
Andy Webster's point about offering special interests is an important one.
Offer these sessions and you can get more free work out of the consultant
and make the job more attractive to the better applicants.
With regard to banding, there have been some strange interpretations. The
word in the contract is "typically". Some trusts have tried to interpret
this as "the majority" i.e. if you get one call on a typical night and come
in for that, it's Band A; if you get 10 calls and come in for 4 of them it's
Band B. Usually, though, if you need to come in at 20 minutes' notice (i.e.
if you're on call for sick patients not just for waits) with any degree of
frequency, it's Band A. Major Incidents were mentioned. They're specifically
covered: you can be on Band B even if you come in for them.
With a single consultant, I had a friend (in another speciality) who was in
this situation a few years back. The BMA advised him (and his trust accepted
this) that single handed consultants have a lot of admin work, so maximum 5
fixed sessions and no on call. Sadly this was slightly after my own spell of
being single handed.
Matt Dunn
Warwick
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