Medical registrars are the backbone of any hospital delivering patient care round the clock.
However, the heavy workload being placed on medical registrars, compounded by limited training opportunities and an unequal distribution of senior specialist doctors across the country, is posing a major threat to high quality hospital care, according a report from the Royal College of Physicians (RCP). Entitled ‘Hospital workforce: Fit for the future?’ the report findings have resulted in a call for urgent action to resolve these issues to prevent patient care being threatened. The report found that 37% of trainee physicians described the workload of the medical registrar as ‘unmanageable’ and 59% described it as ‘heavy’. This is compared to less than 5% of general practice registrars who believe their own workload is either heavy or unmanageable, resulting in a risk the best medical trainees will not choose a career that involves acute medical care. Training of registrars in ‘general medicine’ was found to be highly variable and is too often compromised by the heavy workload. The report says that that only 38% of registrars feel that their training in general medicine was good or excellent compared to 75% in their main specialty. Senior specialist skills were found to be unevenly distributed across the country. Patients in London have almost double the number of consultants per head of population compared to the East Midlands. There are big differences in provision across the 30 medical specialties in availability to patients. The amount of patients requiring general skills is increasing with the ageing population and frail elderly patients’ needs are best met by geriatric specialities but in 2011 it was not possible to fill 50% of consultant posts advertised in geriatric medicine. Teaching hospitals are often large enough to attract the best candidates for jobs and diversify training but these problems are compounded in district general hospitals (DGHs) To meet the challenges highlighted in the report, the RCP is calling for a greater proportion of doctors to be trained in the skills of emergency, general, acute and geriatric medicine; the hospital workforce needs to be reorganised to meet the need of frail elderly patients; the role of the medical registrar needs to be reassessed with their skills used more efficiently to better meet patients’ needs.
