As new research on anaesthesia trainee morale is published, an impassioned plea is today being made in an open letter from the Association of Anaesthetists to the UK's four Health Secretaries: to urgently double the number of training posts for anaesthetists this summer and for subsequent years so that the UK can safely negotiate the current COVID-19 pandemic, any future pandemics, and deal with the huge backlog of surgical procedures that has built up during lockdown.
The Association has sent a separate letter to go to each Health Secretary - Matt Hancock MP in the UK Department of Health, Humza Yousaf MSP in Scotland, Baroness Eluned Morgan MS in Wales, and Robin Swann MLA in the Northern Ireland Assembly.
Association of Anaesthetists President Dr Mike Nathanson and Trainee Committee Chair Dr Roopa McCrossan explain that due a combination of a number of factors, this year there are many more applicants for specialist training in anaesthesia than in previous years. A recent estimate* found there are only around 350 jobs for approximately 1050 candidates, leaving up to 700 trainee anaesthetists without a suitable training post.
The increase in applicants this year results from a number of factors: the introduction of a new curriculum (mandated by the UK General Medical Council) which places an imperative on obtaining a training post before the regulations** change and the 'goal posts' move; the impact of the COVID-19 pandemic on the number of trainees who might otherwise have spent a year abroad to consolidate their learning but who are now unable to travel and wish to remain in the UK; the difficulty in achieving educational targets while re-deployed during pandemic surges; and a desire to complete training without any further interruptions after the unprecedented pressures and challenges of the last 14 months.
Dr Nathanson and Dr McCrossan add: "Providing these young doctors with training posts now will ensure we have a supply of trained senior staff in five years' time, and during their five-year training they will provide significant service, staff many out-of-hours rotas, and ensure the resilience we need for any further surges of the COVID-19 pandemic."
Recent research published in the Association's journal Anaesthesia revealed the pressure that hospitals in the UK have been under across the winter wave. Furthermore, the most recent census published by the Royal College of Anaesthetists has confirmed the findings of previous censuses that there is a very significant shortage of anaesthetists in the UK (over 1000, and almost certainly closer to 2000). The authors say: "At a time of a very significant shortage in the anaesthetic workforce, it is disappointing and surprising that, to date, there has been no increase in the number of training posts. As a result, the workforce gap will continue to grow. The impact of fatigue and stress, leading to more retirements or moves to part-time working, will only further increase the shortage."
Dr Nathanson and Dr McCrossan also point to the Association's own research*** (embargoed to the time above) that has shown a very significant degree of disillusionment in trainee anaesthetists. They say to the four Health Secretaries: "If you do not act, we believe there is a very real risk that many of these doctors in whom we have already invested time and money in training will be lost to the profession forever as they will seek alternative careers or move to work abroad once travel restrictions are lifted."
They suggest that the number of training posts (ST3) is doubled this year from approximately 350 to 700, and remains at that level for the subsequent two years. They explain that Health Trusts (and Boards) have money set aside for creating non-training 'locally employed doctor' (LED) posts this year as they recognise the need for more anaesthetists. The authors also suggest Health Education England already has money set aside to support the education of trainee anaesthetists. They say: "LED posts will not lead to training of qualified specialists, but if the funds we have identified and some additional new money was used to create training posts then there will be a long-lasting improvement in the anaesthetic workforce and the capability to provide more surgical services."
They conclude by giving an open invitation to the four Health Secretaries to discuss the matter further.
Dr Nathanson says: "There is very little time to act if we are to keep these doctors in the NHS. They have already committed to a career in anaesthesia and have spent at least two years training. We urgently need more anaesthetists; the backlog from the pandemic will take some years to clear, yet we risk losing the future workforce we clearly need. There has been a small increase in training posts in Wales. We need the other administrations to act now."
Dr McCrossan adds: "These highly skilled, dedicated anaesthetic trainees have worked tirelessly during the pandemic, providing the workforce needed to expand critical care. Nearly 700 of these trainees now have no job to go to from August 2021 and we risk losing them from our specialty. There is a documented shortage of consultant anaesthetists and nearly 700 doctors wanting to train in anaesthesia.
"By providing these much-needed training posts now, the four nation governments will resolve the anaesthetic workforce shortage, protecting the future surgical and intensive care capacity of the NHS. In short, it is a simple, cost effective, win-win for the governments involved and the NHS."