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Medical Manpower Planning in Nephrology Update 2010

Medical Manpower Planning in Nephrology Update 2010. Dr Phil Mason Oxford Kidney Unit CD Forum 12 th March 2010. JSC Workforce Group (2007). How many “consultants” do we need with the current and growing workload? How many trainees will complete training over the next 5-10yr.?

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Medical Manpower Planning in Nephrology Update 2010

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  1. Medical Manpower Planning in NephrologyUpdate 2010 Dr Phil Mason Oxford Kidney Unit CD Forum 12th March 2010

  2. JSC Workforce Group(2007) • How many “consultants” do we need with the current and growing workload? • How many trainees will complete training over the next 5-10yr.? • Review trends in consultant appointments • Consider how changes in working practices and the number of trainees may affect how specialists are deployed

  3. What I will cover today • Latest data on # trainees getting a CCT in next few years • Historical consultant expansion and projections based on CD survey • Evidence that supply will soon exceed likely vacancies • Efforts to reduce the trainee numbers…

  4. What I will not cover today • How many consultants/specialists we need over the next 10yr…certainly more! • Incr. RRT • Gender change • Incr. less than full time work • Involvement in AKI (NCEPOD) • Reduced job plans to 10 PAs • ?early retirements…

  5. Number of trainees… • Background

  6. BRS National Renal Workforce Planning Group (2002) • 1 physician:75 RRT patients  • 1 WTE nephrologist:100 RRT patients • 2001 establishment: 290 (203 wte) • Projected required by 2010: 803 (570 wte)

  7. Response to BRS document • DoH recognised need for urgent expansion of nephrology consultants • 200 extra training positions offered (50 pa x 4yr) • Not all were created because of funding • NB. Recommendation was that the number of training posts must reduce after sufficient trainees injected into system

  8. What actually happened? Shortfall D =362 D=237 D=302 D=188

  9. CCT awards 2009-2015 Data from JRCPTB 2009 † nos. unreliable because some of the ~80 trainees starting as ST3 in Aug 2009 (not registered at the time of the Table creation)

  10. CCT awards 2009-2015 Data from JRCPTB 2010 Data from JRCPTB 2009

  11. CCT awards in ‘steady state’ • ~420 trainees (currently ~5% flexible) • Estimate average 6yr training at ST3+ level • 3yr min. for renal only • 5yr min. for renal + GIM • Some will do research (trainee survey ~50%) • ~70 CCT pa = similar to JRCPTB projections over next 2-3 yr

  12. Possibly more CCT holders? • No restriction on EU applicants • Article 14 (CESR) applications-v.few…but • PMETB/JRCPTB minutes (Nov. 09): • Any Dr can now access Specialist Eportfolio (£125) & accumulate competencies and apply for SR (CESR)

  13. What happened to trainees awarded CCT 2008 & 2009? • NB data from CDs returns…not otherwise validated

  14. Consultant numbersPast, present & future • RCP data used most widely-but unreliable • because of job plan changes & poor RCP census returns • 2010 survey of all UK units

  15. Consultant numbersCD survey of all UK units, 2010 • RCP census 432….but includes many who no longer practice nephrology/retired • Survey of all 70 UK renal units (Jan-Feb 2010): • 501 physicians (110 female=22%) • 382 WTE

  16. Consultant Expansion/Replacement2005-2010 • Expansion: Based on RCP 2006 data & current Jan 2010 census = 139/4=av. 35 pa • Appointments (AAC-excl. Scotland): range 29-37, av. 32 pa • BMJ job adverts (2009): 32 • 5 locums, 27 substantive • 9 GIM component, 4 unclear, 18 renal only

  17. Consultant Expansion/Replacement ≥ 2010CD survey of all UK units, 2010 • Retirement/replacements 2010-2015: • 48 • Planned new posts 2010/11 • 36 • Wish list 2010-2015 (incl. planned 2010/11) • 91 • Wish list + replacements in 5yr • 48 + 91 = 139 ≅average 28 pa

  18. Consultant Expansion/Replacement2010 and beyond • Too conservative? • “growth” of 91 over 5 yr ≡ 3.5% growth pa • Less than predicted growth in RRT • 5-7% pa (UKRR) • No account of other needs, eg AKI (NCEPOD)…

  19. Part-time working • Increasing number of trainees plan to work part-time • BMA survey of 2006 graduates: 21% women anticipated p/t work for most of career 48% women & 15% men would prefer to train p/t 80% women & 50% men expected a career break

  20. Part-time workingNephrology trainees survey 2009 • NB only ~50% response rate • Likely to work less than full time (LTFT): • 41/217=19% • Preferred working pattern of those 41: • 6 50% WTE • 14 60% • 3 70% • 6 75% • 9 80%

  21. Current predictionsupply v. demand 2010-2015 • Expected CCT awards ~70 pa • Historical posts 2005-2009: • ~30-40 (av.32) pa (AAC data) • 32 posts advertised BMJ 2009 • CD survey 2010-2015 prediction: • Av. 28 pa • Conclusions: • Significant shortfall in jobs • Need to reduce trainee numbers

  22. How many trainees should we have? • RCP Workforce Group has predicted that in 10-15yr likely to be 25% of current trainee number • For nephrology? Too many unknown factors to model accurately!...but…

  23. How many trainees should we have? • Assumptions (optimistic?!): • Working life 28y (median age CCT 35y, but↓) • 7y training (R+GIM+2y OOPE; (NB currently <50% OOPE but LTFT training ↑) • ∴trained:trainee yrs=28:7 = 4:1 • If consultant stock would incr. from 501➙800 (job sharing/10PA jobs/↑RRT nos./AKI…) ⇒800/4 = 200 + some for drop out & career evolution out of nephrology service delivery…

  24. How many trainees should we have? • More sophisticated modeling needed…in progress • But we urgently need to begin the process of reduction without halting recruitment • This conclusion generally accepted by JSC and SAC • By autumn 2009 after much discussion JSC/SAC/Lead Dean/WRT/Donal O’Donoghue agreed to recommend a reduction in trainees by 13 from August 2010

  25. Efforts to reduce the trainee numbers… • Multiple bodies/committees seem to be involved in specifying training numbers (and keep changing!) • London already decided to reduce by 5 • No volunteers from other deaneries! • W Midlands PG Dean agreed to reduce by 2

  26. Efforts to reduce the trainee numbers…Scotland • Scotland decreed reduction from 37➙25 • Appealed…probably will be a 5-7 reduction phased from 2011 • …but Scotland have created an extra training slot for 2010!! (to deal with RRT)

  27. Mechanism of reduction-maintaining service provision • Ideally Trusts losing training posts should be able to use money to employ non-training doctors (Consultant, ‘Trust grade’, ‘Specialty’ (±CCT), post CCT Fellows) • …but 2/5 London and 2/2 W.Midlands posts are having funding withdrawn

  28. “Looking Forward” Feb. 2010 letter from Bill Burr to Chairs of SACs… • …we are heading for serious over-production of CCT-holders in many specialties compared with likely service requirement. • This will mean a reduction in trainee numbers, made more likely because of pressure on the MPET budget.

  29. Concerns • How will service provision be maintained as trainee numbers fall, esp. if money is withdrawn? • How will reductions be allocated?

  30. Thank you!

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