sUrGical worKforce 2011 · sUrGical worKforce 2011. contribUtors The Association of Surgeons of...

A report from The Royal College of Surgeons of England in collaboration with the surgical specialty associations

sUrGical worKforce 2011

contribUtorsThe Association of Surgeons of Great Britain and IrelandThe British Association of Paediatric SurgeonsThe British Association of Plastic, Reconstructive and Aesthetic SurgeonsThe British Association of Oral and Maxillofacial SurgeonsThe British Association of OtorhinolaryngologistsThe British Association of Urological SurgeonsThe British Orthopaedic AssociationThe Society of British Neurological SurgeonsThe Society for Cardiothoracic Surgery in Great Britain and Ireland

fUrtHer informationwww.rcseng.ac.uk/surgeons/working/clinical-policy/[email protected]

3

preliminariesForeword 2Introduction and key messages 3Notes on methodology 6

overviewShape of the surgical workforce 7Profile of workload 10

by specialtyCardiothoracic surgery 15General surgery 19Neurosurgery 23Oral and maxillofacial surgery 27Otorhinolaryngology 31Paediatric surgery 35Plastic surgery 39Trauma and orthopaedic surgery 43Urology 47

surgical workforce report 2011

Contents

1

I am pleased to present the College’s second annual workforce census of all surgical specialties at a Consultant level. The first census conducted in 2010 was met with considerable success and allowed the College to make evidence-based contributions to national workforce planning. The 2011 census brings with it the promise of even better contributions, as it saw a remarkable rise in the participation of individual surgeons by more than 10%.

The College’s mission statement commits us to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. This requires consistent and appropriate staffing levels for all surgical services and can only be achieved by rigorous workforce planning. The College’s dedication to collecting information directly from the profession ensures that we can produce relevant and accurate data to support commissioners and service planners in developing high quality surgical services. It is important therefore that this project continues to grow from strength to strength.

I am thankful to the many surgeons who contributed to this census and hope that this publication shows what value we gain from their direct involvement. I hope that we can continue to benefit from increasing support from the profession.

I would like particularly to acknowledge the work of Bob Greatorex, former Council Lead for workforce for his dedication to this project, and of the nine surgical specialty associations for their continued collaboration and expert contribution to this project.

Professor Norman Williamspresidentroyal college of surgeons

preliminaries

Foreword

2

preliminaries

Introduction and key messages

The Royal College of Surgeons is committed to collecting accurate and reliable data on the surgical workforce in England, Wales and Northern Ireland. Such information is crucial for delivering safe and effective services, high quality patient care and for ensuring that workforce planning is robust and flexible enough to respond to the ever-changing landscape of the NHS and technological developments. As part of this commitment, we have established an annual, professionally led census of individual consultant surgeons employed in England, Wales and Northern Ireland, which is just about to enter its third year. This report reflects the results of the second annual census, which ran in 2011, and marked an improvement in accuracy, relevance and return rates from the first census in 2010: it achieved a response rate of over 70%, compared with 60% in 2010. This increase in participation has allowed us to give a more in-depth picture of the consultant surgical workforce across English regions as well as additional data on the consultant workload.

The first part of the report provides an overview of the surgical workforce in England, Wales and Northern Ireland. There is a breakdown of the total response rate and response rate by surgical specialty, followed by an analysis of all respondents, which is broken down by number, gender, age and region. We have profiled workload patterns and intentions, such as the rate of on-call commitments, contract type and retirement plans. We have also provided a breakdown of programmed activities in a working week.

The second part of the report provides workforce information that is specific to each of the nine surgical specialties.1 It includes comments and recommendations for the consultant workforce from the specialty associations. These recommendations can be interpreted against the backdrop of the UK population and national population projection statistics from the Office for National Statistics (Table 1).

Some of the most notable trends from the 2011 data include a significantly low number of female consultants, representing just over 8.5% of the total workforce. While this marks an increase of almost 1% from 2010’s results, female participation in the surgical workforce lies well behind other professions.

1 at the time of writing, vascular surgery had been acknowledged as a separate surgical specialty. However, at the time that the census closed, vascular surgery was still part of general surgery and that is how it has been reflected in this report. future censuses will reflect the transition of vascular surgery as a separate surgical specialty.

3

Another notable trend that will be of significance for those in the front line of surgical services is the consistent tendency of consultant surgeons to work more than the 10 programmed activities (PAs) that NHS Employers recommend and more than the 12 PAs that the European Working Time Regulations recommend. It is interesting to note that in 2010 less than 10% of surgeons who responded to the census worked more than 12 PAs a week. This year that figure has risen to 13%. The current climate of financial strain combined with major changes to the NHS is placing significant pressure on the surgical workforce.

Based on the census results, most of this additional working time is spent on direct clinical care with the vast majority of surgeons spending an average of 1.6 PAs per week on supporting professional activities (SPAs). The College recommends that new consultant posts should typically include 2.5 SPAs in a 10 PA contract at appointment but this provision should be subject to annual appraisal and job planning. SPAs are essential not only for the development of the individual surgeon but also of the NHS more broadly. With the revalidation implementation approaching at the end of the year, it is likely that the demand on surgeons’ SPA time will only increase in the coming years.

Finally, a consistent trend which reappears in this year’s census is the large percentage of surgeons (over 30%) who express the desire to work part time at some point in their career. Although currently less than 10% of the surgical workforce is employed on a part-time basis, it is likely that future years will see a shift towards surgeons wishing to achieve more work–life balance, which could potentially have significant implications for workforce planning.

We hope that by highlighting these issues using reliable data from surgeons themselves we can support policy development and workforce planning such that it can adapt and address major workforce problems in the future. In particular, we hope that it will assist those responsible for the development of surgical services, the Department of Health, the Centre for Workforce Intelligence, Health Education England, the NHS Commissioning Board, the local education and training boards, the Human Resources Directorate

preliminaries: introduction and key messages

4

2011 (000s)

2021 (000s)

2031 (000s)

2035 (000s)

United Kingdom 62,735 67,636 71,766 73,208england 52,655 57,020 60,751 62,078wales 3,018 3,187 3,326 3,369scotland 5,251 5,509 5,701 5,755northern ireland 1,811 1,919 1,987 2,005

of the Welsh Assembly Government, the Department of Health, Social Services and Public Safety of Northern Ireland and all those concerned with the training, development and employment of surgeons.

We would also like to acknowledge the support provided to the surgical service across the UK by Staff and Associate Specialist Surgeons (SAS). Although the College’s workforce census is publicised and disseminated to all non-training grade surgeons, data for SAS surgeons have so far been scarce and not sufficiently reliable for publication. In order to capture a complete picture of the surgical workforce it is essential to account for this group of surgeons. We are therefore in the process of launching a separate, dedicated workforce initiative that will hopefully allow us to identify their location and contact details in the next year.

Table 1

uk population projection from the office of national statistics.

preliminaries: introduction and key messages

5

This report provides data on consultant surgeons practising in England, Wales and Northern Ireland. Surgeons classified as retired, temporarily not in practice, surgeons in training and non-consultant grades are not included in this report. For further information on collecting data on specialty doctors, associated specialists and staff grades, please see the note in the introduction.

The Royal College of Surgeons ran an online census from March 2011 to October 2011. A personalised link to the online census was emailed to all surgeons on the College’s database2 and was followed up by email reminders. For those surgeons without email addresses, hard copies of the census were sent by post.

The results were anonymised by the College data team and then shared with the nine surgical specialty associations as defined by the specialist advisory committees. The specialty associations provided, where possible, additional workforce information and recommendations for their own field.

The census achieved a 70.41% response rate and collected data on the surgical workforce and information on consultant surgeons’ working practices. This year we also introduced analysis-based data on the 10 strategic health authorities as defined by the Department of Health. All information in this year’s census refers to England, Wales and Northern Ireland unless stated otherwise. The source of the information presented in this report is indicated throughout. The primary data sources for this report include:• consultantresponsestothecensusofTheRoyalCollegeofSurgeonsof

England• thesurgicaldatabaseofTheRoyalCollegeofSurgeonsofEngland• datafromtheninesurgicalspecialtyassociations.

The numbers presented may vary at times from other reports. This is to be expected, as those reports may use different categories and selection criteria. Please pay close attention to the notes included in this report before making direct comparisons to other data.

preliminaries

Notes on methodology

2 the college database includes information not only on rcs fellows and members but also on consultants who practice in england, wales and northern ireland and are involved in the activities of the college.

6

Specialty England Wales Northern Ireland TOTAL

cardiothoracic surgery 322 13 9 344

General surgery 2052 133 88 2273

neurosurgery 246 11 8 265

oral and maxillofacial surgery 336 31 9 376

otorhinolaryngology 583 44 31 658

paediatric surgery 146 6 6 158

plastic surgery 357 14 10 381

trauma and orthopaedic surgery 2089 142 55 2286

Urology 733 44 22 799

All Specialties 6864 438 238 7540

0 500 1000 1500 2000 2500

Uro

TrOS

PlaS

PaeS

ORL

OMFS

NS

GS

CTS 301

2273

265

376

658

158

381

2286

799

oVerView

Shape of the surgical workforce

Number of consultant surgeons by surgical specialty

Data refer to consultant surgeons who practice in England, Wales and Northern Ireland as of October 2011.

Surgeons classified as retired, temporarily not in practice, surgeons in training and non-consultant surgeons are not included.

Source: RCS Surgical Database, RCS Census October 2011 and surgical specialty associations.

Total number of consultant surgeons by surgical specialty

Data based on the total number of consultant surgeons who practice in England, Wales and Northern Ireland as of October 2011.



7

SpecialtyNorth East

North West

Yorkshire & Humber

East Midlands

West Midlands

East of England London

South East Coast

South Central

South West

TOTAL

cardiothoracic surgery 23 51 32 26 33 27 78 6 22 24 322

General surgery 133 289 226 144 224 194 343 162 134 203 2052

neurosurgery 18 33 24 13 27 13 70 6 20 22 246

oral and maxillofacial surgery 18 42 36 28 32 26 61 37 24 32 336

otorhinolaryngology 33 85 51 41 70 52 102 44 42 63 583

paediatric surgery 8 22 17 12 10 11 39 6 15 6 146

plastic surgery 26 37 38 19 43 38 86 15 22 33 357

trauma and orthopaedic surgery 130 290 206 163 261 207 319 152 144 217 2089

Urology 40 105 77 45 65 86 136 59 48 72 733

Total 429 954 707 491 765 654 1234 487 471 672 6864

Highest numbers

lowest numbers

Total number of consultant surgeons in each of the ten regions in England

Data based on consultant surgeons who practise in England as of October 2011.



OVERVIEW sHape of tHe surgical workforce

8

0 500 1000 1500 2000

>60

56-60

51-55

46-50

41-45

36-40

30-35 0.6%

11.3%

25.2%

24.6%

18.3%

11.8%

8.2%

Age profile (in years) of consultant surgeons in all surgical specialties

Data based on consultant surgeons of all surgical specialties who practise in England, Wales and Northern Ireland as of October 2011.

The percentages are based on the number of surgeons whose age was known. Age was unknown for 202 practising surgeons.

Source: RCS Surgical Database, RCS census October 2011.

0 500 1000 1500 2000 2500

Uro

TrOS

PlaS

PaeS

ORL

OMFS

NS

GS

CTS 4%

11.1%

5.3%

10.1%

10.9%

21.5%

18.9%

4.2%

6.4%

Number of female surgeons by surgical specialty

Data based on consultant surgeons who practise in England, Wales and Northern Ireland as of October 2011.


The percentages are based on the number of surgeons whose gender was known. Gender was unknown for 247 practising surgeons.

Source: RCS Surgical Database, RCS Census October 2011.

OVERVIEW sHape of tHe surgical workforce

9

Mixed practice

Independent practice only

NHS practice only

32.4%

5%

62.6%

Combined

Academic

Clinical

93.4%

3.5%3.1%

Part time

Full time

90.5%

9.5%

Consultant surgeons working in the NHS or independent practice

The majority of consultant surgeons (62.6%) identify themselves as having a mixed NHS and independent practice.

Source: RCS census, October 2011

Consultant surgeons in clinical or academic practice

The vast majority of surgeons (93.4%) work in direct clinical care with 6.6% maintaining an academic element to their work.


Consultant surgeons working part time

Less than 10% of consultant surgeons identified themselves as working part time.

The census classified a workload of less than 10 programmed activities (PAs) per week as part time.


oVerView

Profile of workload

10

0 500 1000 1500 2000

>15

15

14

13

12

11

10

9

8

7

6

5

4

3

2

≤1 0.4%

0.3%

0.4%

0.4%

1.2%

2%

2%

2.1%

2.6%

17.6%

22.1%

35.7%

8.5%

3.4%

0.9%

0.3%

Number of PAs worked within a week by consultant surgeons

NHS Employers recommends that a job plan for a full-time consultant surgeon should consist of 10 PAs per week. Over two-thirds of respondents (70.9%) indicated that they work longer hours.

Data based on the mean programmed activities contracted per week on a 10 PA-contract for all surgical specialties.

One PA equals approximately four hours.


8.1 PAsDirect clinical care

1.6 PAssupporting professional activity

0.3 PAsadditional professional activity (includ-ing academic)

Mean PAs contracted per week on a 10 PA contract for all surgical specialties

The distribution of mean programmed activities on a 10 PA contract comprises 1.6 PAs for supporting professional activities.

The RCS recommends approximately 2.5 PAs for supporting professional activities on a 10 PA contract.


OVERVIEW profile of workload

11

No

Yes

16%

84%

0 200 400 600 800 1000

≥12

11

10

9

8

7

6

5

4

3

1 in 2

≥

1.2%

4%

11%

11.6%

14.9%

12.3%

21%

5.8%

6.2%

10%

2.1%

No

Yes

95.3%

4.7%

Consultant surgeons with on-call commitments

The great majority of consultant surgeons (84%) indicated that on-call commitments are part of their contracted workload.


Frequency of consultant surgeons’ on-call commitments

Nearly half of consultant surgeons (48.2%) reported the frequency of their on call commitment to be between 1 in 6 and 1 in 8.

Approximately 5.2% of respondents indicated that they are working on-call rotas of greater intensity than 1 in 4.

Data based on consultant surgeons with on-call duties.


Consultant surgeons who are resident while on call

A small percentage of consultant surgeons (4.7%) reported that they are resident while on-call. Surgeons who are resident while on-call are classified as working even when at rest, which needs to be taken into account when considering working patterns that comply with EWTR.

Data based on consultant surgeons with on-call duties.



12

No

Yes34.5%

65.5%

Not specified

No

Yes

60.3%

35.9%

3.8%

0 500 1000 1500 2000

URO

TrOS

PlaS

PaeS

ORL

OMFS

NS

GS

CTS 75.7%

64.2%

80.7%

65.6%

14.7%

67%

68.6%

41.2%

75%

Consultant surgeons who are free from elective duties while on call

Just over a third (34.5%) of respondents indicated that they are free from elective duties while on-call.

As part of its policy for separating emergency and elective work streams to maintain high standards of practice, the RCS recommends that surgeons in specialties with high emergency workloads are free from elective duties while on call.


Consultant surgeons involved in trauma care

Almost two-thirds of consultant surgeons (60.3%) have indicated that they are involved in trauma care within their usual working hours.

The RCS recommends treatment in a small number of specialised trauma centres.


Consultant surgeons involved in trauma care by surgical specialty

The highest number of consultant surgeons involved in trauma care come from both general surgery and trauma and orthopaedic surgery.

As a proportion of their specialty workforce, consultant neurosurgeons and cardiothoracic surgeons have the highest involvement in trauma care.



13

11–20

>20

Not specified

5–10

<540.7%

32.5%

11.1%

12.4%

3.2%

34.5%

65.5%Don’t know

No

Yes35.4%

23.7%

40.9%

In next 3–5 years

Don’t know

In next 2 years

In next year

3.6%4%

12.7%

79.7%

Frequency of consultant surgeons’ involvement in trauma care (by number of incidents per year)

The majority of consultant surgeons (73.2%) are involved in less than ten trauma incidents per year.


Consultant surgeons intending to work part time at some point in their career

More than a third of consultant surgeons indicated that they would like to work part time at some point in their career. Based on census data, currently less than 10% of consutlant surgeons work part time.

Data based on consultant surgeons who currently work full time.


Consultant surgeons’ intentions for their retirement

An accurate account of retirement intentions is crucial for effective workforce planning. Potential trends for earlier retirement among consultant surgeons may have a profound effect on workforce numbers, particularly for smaller surgical specialties.



14

0 20 40 60 80 100 120

Thoracic

Congenital

Adult cardiac

32.5%

9%

58.5%

0 10 20 30 40 50

>60

56–60

51–55

46–50

41–45

36–40

30–35 1.1%

7%

25.8%

22%

19.4%

17.2%

7.5%

by specialty

Cardiothoracic surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe society for cardiothoracic surgery in Great britain and ireland (scts) recommend a total of 330 consultant cardiothoracic surgeons in england. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. scts estimate that the current numbers of trainees are sufficient to meet this demand. scts maintain specialty-specific data for consultant cardiothoracic surgeons across the UK. more information can be found by contacting scts through its website at http://www.scts.org.

Percentage of consultant surgeons working in areas of special interest

Data refer to the responses from consultant cardiothoracic surgeons who practise in England, Wales and Northern Ireland as of October 2011.

Respondents were able to select more than one area of special interest so the total number of responses across all areas of special interest may be higher than the total number of respondents.


Age profile of consultant surgeons

Approximately two thirds of consultant cardiothoracic surgeons (67.2%) are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 13 practising cardiothoracic surgeons.


15

40.3%

1.1%

58.6%

Mixed practice


NHS practice only

94.6%

2.2% 3.2%

Combined

Academic

Clinical

95.2%

4.8%

Part time

Full time


The majority of consultant cardiothoracic surgeons (58.6%) identify themselves as having a mixed NHS and independent practice.



Approximately 5.4% of respondents maintain an academic element to their work.



4.8% of respondents identified themselves as working part time, lower than the total surgical average (9.45%).

The census classified a workload of less than 10 PAs per week as part time.


by SPEcIAlTy cardiotHoracic surgery

16

No

Yes

2.7%

97.3%

0 10 20 30 40 50

≥12

11

10

9

8

7

6

5

4

3

1 in 2 5%

15.5%

19.9%

19.3%

24.3%

5%

5.5%

0.6%

0.6%

3.9%

0.6%

No

Yes

97.2%

2.8%


The great majority of consultant cardiothoracic surgeons (97.3%) indicated that on-call commitments are part of their contracted workload.


Frequency of on-call commitments

The majority of respondents (84%) are on call at a frequency of 1 in 2 to 1 in 6, a more intense frequency than the total surgical average.

Data based on consultant cardiothoracic surgeons with on-call duties.



A small percentage of consultant cardiothoracic surgeons (2.8%) indeicated that they are resident while on call.

Data based on consultant cardiothoracic surgeons with on-call duties.



17

No

Yes

3.3%

96.7%

Don’t know

No

Yes

39.8%

31.2% 29%

In next 3–5 years

Don’t know

In next 2 years

In next year

3.2%3.2%

11.9%

81.7%


Only 3.3% of respondents indicated that they are free from elective duties while on call, much lower than the total surgical average (34.5%).

The RCS recommends that surgeons are free from elective duties while on call.



Almost one third (29%) of respondents indicated that they would like to work part time, compared with 4.8% of the cardiothoracic surgical workforce who actually do.

Data based on consultant cardiothoracic surgeons who currently work full time.



Less than a fifth (18.3%) of consultant cardiothoracic surgeons indicated that they wish to retire within the next one to five years.



18

585

0 100 200 300 400 500 600

Vascular

Upper gastrointestinal

Transplant (abdominal)

Specialty hepatobiliary

Specialist oesophageal/gastric

Non-specialist elective

General paediatric

Endocrine

Emergency general

Colorectal

Breast

Bariatric 3.5%

17.3%

24.6%

6.6%

5.5%

2.7%

4.7%

2%

2.5%

2.9%

12.3%

15.4%

0 100 200 300 400 500

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.6%

8.8%

21.3%

26.4%

18.8%

14.3%

9.6%

by specialty

General surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDin 2010 the association of surgeons of Great britain and ireland (asGbi) recommended a consultant workforce ratio of 1:25,000 population and an overall maintenance of consultant surgeon numbers. these recommendations will vary depending on each sub-specialty.


Data refer to the responses from consultant general surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Two thirds (66.6%) of consultant general surgeons are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 56 practising general surgeons.


19

35.8%

3.8%

60.4%

Mixed practice


NHS practice only

91%

4% 5%

Combined

Academic

Clinical

87.5%

12.5%

Part time

Full time


The majority of consultant general surgeons (60.4%) identify themselves as having a mixed NHS and independent practice.



Approximately 9% of consultant general surgeons maintain an academic element to their work.



12.5% of respondents identified themselves as working part time, slightly higher than the total surgical average (9.45%).



by SPEcIAlTy general surgery

20

No

Yes

18.3%

81.7%

0 50 100 150 200 250 300 350 400

≥12

11

10

9

8

7

6

5

4

3

1 in 2 0.7%

2.2%

8.9%

12.3%

15.9%

14.6%

25.6%

6.5%

6.3%

5.3%

1.8%

No

Yes

92.1%

7.9%


The great majority of consultant general surgeons (81.7%) indicated that on-call commitments are part of their contracted workload.



Over half of respondents (56.1%) are on call at a frequency of 1 in 6 to 1 in 8.

11.8% are working on-call rotas of 1 in 4 intensity or greater.

Data based on consultant general surgeons with on-call duties.



Approximately 7.9% of respondents indicated that they are resident while on call.

Data based on consultant general surgeons with on-call duties.



21

No

Yes55.2%44.8%

Don’t know

No

Yes

31.5%

30.2%38.3%

In next 3–5 years

Don’t know

In next 2 years

In next year

5.3%6%

13.4%

75.3%


Over half (55.2%) of respondents indicated that they are free from elective duties while on call, much lower than the total surgical average (34.5%).




More than one third (38.3%) of respondents indicated that they would like to work part time at some point in their career, compared with 4.8% of the general surgical workforce who actually do.

Data based on consultant general surgeons who currently work full time.



Approximately a quarter (24.7%) of consultant general surgeons indicated that they wish to retire within the next one to five years.



22

0 20 40 60 80 100

Spinal

Skull base

Paediatric

Neurovascular

Neuro-oncology

Functional

Core neuro 14.6%

7.1%

16.1%

11.3%

11.9%

12.5%

26.5%

0 10 20 30 40 50

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.5%

12.8%

26.2%

23.5%

9.1%

18.2%

9.6%

by specialty

Neurosurgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe society of british neurological surgeons (sbns) recommend a consultant workforce ratio of 1:200,000 population. they note, however, that this figure does not take into account workforce requirements related to nHs targets, trauma centres, sub-specialty rotas, an ageing population, increasing time requirements for delivering and supervising training and for preparing for revalidation. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. they estimate that the current training numbers are enough to meet this demand. sbns maintain specialty-specific data for neurological surgeons across the UK. more information can be found by contacting sbns through its website at www.sbns.org.uk


Data refer to the responses from consultant neurosurgeons who practise in England, Wales and Northern Ireland as of October 2011.




Just over two thirds (67.91%) of consultant neurosurgeons are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 7 practising neurosurgeons.


23

36.4%

3.2%

60.4%

Mixed practice


NHS practice only

89.3%

6.4%

4.3%

Combined

Academic

Clinical

88.8%

11.2%

Part time

Full time


The majority of consultant neurosurgeons (60.4%) identify themselves as having a mixed NHS and independent practice.



Approximately 10.7% of consultant neurosurgeons maintain an academic element to their work.






by SPEcIAlTy neurosurgery

24

No

Yes

8.6%

91.4%

0 5 10 15 20 25 30 35 40

≥12

11

10

9

8

7

6

5

4

3

1 in 2 0%

1.8%

7.6%

13.5%

5.8%

18.1%

22.2%

9.9%

8.8%

9.4%

2.9%

No

Yes

97.7%

2.3%


The great majority of consultant neurosurgeons (91.4%) indicated that on-call commitments are part of their contracted workload.



Nearly half of respondents (46.1%) are on call at a frequency of 1 in 6 to 1 in 8.

9.4% are working on-call rotas of 1 in 4 intensity or greater.

Data based on consultant neurosurgeons with on-call duties.



Approximately 2.3% of respondents are resident while on-call.

Data based on consultant neurosurgeons with on-call duties.



25

No

Yes

15.8%

84.2%

Don’t know

No

Yes

25.7%

33.7%40.6%

In next 3–5 years

Don’t know

In next 2 years

In next year

1%2.7%

14.4%

81.9%






More than 40% of respondents indicated that they would like to work part time at some point in their career, compared with 11.2% of the neurosurgical workforce who actually do.

Data based on consultant neurosurgeons who currently work full time.



Less than a fifth (18.1%) of consultant neurosurgeons indicated that they wish to retire within the next one to five years.



26

0 20 40 60 80 100 120

Trauma

Thyroid

TMJ disorders

Skull base

Skin surgery

Salivary diseases

Pre-prosthetic/Implantology

Paediatric

Oral medicine

Head and neck

Facial deformity

Dental alveolar/Oral surgery

Craniofacial

Cleft lip and palate

Aesthetics 3.7%

1.8%

1.9%

13.9%

11.2%

9.4%

7.3%

4.6%

4.6%

10.8%

10.8%

11.5%

1.7%

5.8%

0.9%

0 10 20 30 40 50 60

>60

56–60

51–55

46–50

41–45

36–40

30–35 3.2%

7.2%

20.4%

24.9%

15.4%

20.4%

8.6%

by specialty

Oral and maxillofacial surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe british association of oral and maxillofacial surgeons (baoms) recommend a consultant workforce ratio of 1:150,000 population. in order to achieve this target an expansion of the size of the consultant workforce is recommended. they estimate that the current training numbers are not yet enough to meet this demand. they note that a move to 24/7 direct supervision of all emergency care may affect the ability to meet their target with the current training numbers. baoms maintain specialty-specific data for oral and maxillofacial surgeons across the UK. baoms can be contacted through its website at www.baoms.org.uk.


Data refer to the responses from consultant oral and maxillofacial surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Almost two thirds (65.7%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 2 practising oral and maxillofacial surgeons.


27

29%

5.4%

65.6%

Mixed practice


NHS practice only

89.6%

5.4%

5%

Combined

Academic

Clinical

84.2%

15.8%

Part time

Full time


The majority of consultant oral and maxillofacial surgeons (65.6%) identify themselves as having a mixed NHS and independent practice.



Approximately 10.4% of consultant oral and maxillofacial surgeons maintain an academic element to their work. .






by SPEcIAlTy oral and maxillofacial surgery

28

No

Yes

21.3%

78.7%

0 10 20 30 40 50 60

≥12

11

10

9

8

7

6

5

4

3

1 in 2 4%

5.7%

30.5%

21.3%

17.8%

5.2%

9.8%

3.4%

0%

0.6%

1.7%

No

Yes

98.3%

1.7%


The great majority of consultant oral and maxillofacial surgeons (78.7%) indicated that on-call commitments are part of their contracted workload.



Over two thirds of respondents (69.6%) are on call at a frequency of 1 in 4 to 1 in 6, a greater intensity that the total surgical workforce average.

Data based on consultant oral and maxillofacial surgeons with on-call duties.



Approximately 1.7% of respondents are resident while on-call.

Data based on consultant oral and maxillofacial surgeons with on-call duties.



29

No

Yes

10.9%

89.1%

Don’t know

No

Yes

18.1%

35.7%

46.2%

In next 3–5 years

Don’t know

In next 2 years

In next year

5%3.6%

14.5%

76.9%






Almost half (46.2%) of respondents indicated that they would like to work part time, compared with 15.8% of the oral and maxillofacial surgical workforce who actually do.

Data based on consultant oral and maxillofacial surgeons who currently work full time.



Approximately a quarter (23.1%) of consultant oral and maxillofacial surgeons indicated that they wish to retire within the next one to five years.



30

0.3%

0.8%

0 50 100 150 200

Skull base surgery

Rhinology

Phoniatrics

Paediatric laryngology

Paediatric ENT

Otology

Neuro-otology

Neuro-laryngology

Head and neck

General ENT

Facial plastics


6.4%

18.9%

12.9%

5%

14.7%

15.3%

1.7%

4.7%

15%

4.4%

0 20 40 60 80 100 120

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.6%

12.2%

19.1%

25%

14.1%

17.4%

11.6%

by specialty

Otorhinolaryngology

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe british association of otorhinolaryngologists (ent UK) recommend a consultant workforce ratio of 1:50,000 population. they estimate that current numbers are closer to 1:86,000. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. they estimate that the current training numbers are enough to meet this demand. ent UK maintain specialty-specific data for otorhinolaryngologists across the UK. more information can be found by contacting ent UK through its website at www.entuk.org.


Data refer to the responses from consultant otorhinolaryngologists who practise in England, Wales and Northern Ireland as of October 2011.




Almost two thirds (61.5%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 22 practising otorhinolaryngologists.


31

29%

5.4%

65.6%

Mixed practice


NHS practice only

91.2%

1.9%6.9%

Combined

Academic

Clinical

83.6%

16.4%

Part time

Full time


The majority of consultant otorhinolaryngologists (65.6%) identify themselves as having a mixed NHS and independent practice.



Approximately 8.8% of consultant otorhinolaryngologists maintain an academic element to their work.



16.4% of respondents identified themselves as working part time, higher than the total surgical average (9.45%).



by SPEcIAlTy otorHinolaryngology

32

No

Yes

9.4%

90.6%

0 20 40 60 80 100

≥12

11

10

9

8

7

6

5

4

3

1 in 2 0.2%

5.3%

20%

12.5%

15.5%

14.6%

16%

4.2%

3.7%

6.5%

1.4%

No

Yes

96%

4%


The great majority of consultant otorhinolaryngologists (90.6%) indicated that on-call commitments are part of their contracted workload.



The majority of respondents (78.6%) are on call at a frequency of 1 in 4 to 1 in 8, a greater intensity that the total surgical workforce average.

Data based on consultant otorhinolaryngologists with on-call duties.



Approximately 4% of respondents are resident while on-call.

Data based on consultant otorhinolaryngologists with on-call duties.



33

No

Yes

6%

94%

Don’t know

No

Yes

22.5%

35.1%

42.4%

In next 3–5 years

Don’t know

In next 2 years

In next year

6.7%7.1%

14.5%

71.7%


Only 6% of respondents indicated that they are free from elective duties while on call, much lower than the total surgical average (34.5%).




Over 40% indicated that they would like to work part time at some point in their careers, compared with 16.4% of the otorhinolaryngological workforce who actually do.

Data based on consultant otorhinolaryngologists who currently work full time.



More than a quarter (28.3%) of consultant otorhinolaryngologists indicated that they wish to retire within the next one to five years.



34

0 10 20 30 40 50 60 70 80

Thoracic

Paediatric urology

Paediatric oncology

Neonatal

Hepatobiliary

Gastrointestinal surgery

General surgery of childhood 3 25.5%

18.3%

1262.7%

22.4%

8.7%

12.9%

9.5%

0 5 10 15 20 25 30 35 40

>60

56–60

51–55

46–50

41–45

36–40

30–35 0%

10.4%

16.8%

30.4%

15.2%

18.4%

8.8%

by specialty

Paediatric surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe british association of paediatric surgeons (baps) recommend a consultant workforce ratio of 1:250,000 population. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. baps estimate that the current training numbers are enough to meet this demand. baps maintain specialty-specific data for paediatric surgeons across the UK. baps can be contacted through its website at www.baps.org.uk.


Data refer to the responses from consultant paediatric surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Approximately two thirds (65.6%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 6 practising consultant paediatric surgeons.


35

53.6%

2.4%

44%

Mixed practice


NHS practice only

93.6%

4.8% 1.6%

Combined

Academic

Clinical

95.2%

4.8%

Part time

Full time


Over half of consultant paediatric surgeons (53.6%) identify themselves as being in NHS practice only.



Approximately 6.4% of consultant paediatric surgeons maintain an academic element to their work.



4.8% of respondents identified themselves as working part time, lower than the total surgical average (9.45%).



by SPEcIAlTy paediatric surgery

36

No

Yes

4.8%

95.2%

0 5 10 15 20 25 30 35

≥12

11

10

9

8

7

6

5

4

3

1 in 2 3.4%

8.4%

15.1%

21.8%

18.6%

12.6%

6.7%

0.8%

0.08%

1.7%

0%

No

Yes

100%

0%


The great majority of consultant paediatric surgeons (95.2%) indicated that on-call commitments are part of their contracted workload.



Almost two thirds (65.5%) of respondents are on call at a frequency of 1 in 4 to 1 in 6, a greater intensity that the total surgical workforce average.

Data based on consultant paediatric surgeons with on-call duties.



There are no consultant paediatric surgeons who are resident while on-call.

Data based on consultant paediatric surgeons with on-call duties.



37

No

Yes44.5%55.5%

Don’t know

No

Yes

32.8%

28.8%

38.4%

In next 3–5 years

Don’t know

In next 2 years

In next year

2.4%

6.4%

13.6%

77.6%


Under half (44.5%) of respondents indicated that they are free from elective duties while on call, higher than the total surgical average (34.5%).




More than a third (38.4%) of respondents indicated that they would like to work part time at some point in their careers, compared with 4.8% of the paediatric surgical workforce who actually do.

Data based on consultant paediatric surgeons who currently work full time.



Less than a quarter (22.4%) of consultant paediatric surgeons indicated that they wish to retire within the next one to five years.



38

0 30 60 90 120 150

Upper limb

Skin cancer

Lower limb

Head and neck

Craniofacial


Burns

Breast reconstruction

Aesthetic plastics 20.9%

7.6%

2.5%

1.8%

6.9%

9.7%

20.7%

14.5%

0 10 20 30 40 50 60 70 80

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.7%

9.8%

24.6%

27.5%

10.1%

17.8%

9.4%

by specialty

Plastic surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe british association of plastic, reconstructive and aesthetic surgeons (bapras) recommend a consultant workforce ratio of 1:100,000 population. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. they estimate that the current training numbers are enough to meet this demand. bapras is conducting a specialty-specific census of plastic surgeons across the UK. more information can be found through the bapras website at www.bapras.org.uk


Data refer to the responses from consultant plastic surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Just over two thirds (69.9%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 24 practising consultant plastic surgeons.


39

23.6%

10.5%65.9%

Mixed practice


NHS practice only

94.9%

0% 5.1%

Combined

Academic

Clinical

84.1%

15.9%

Part time

Full time


Almost two thirds of consultant plastic surgeons (65.9%) identify themselves as being in mixed NHS and independent practice.



Approximately 5% of consultant plastic surgeons maintain an academic element to their work.



15.9% of respondents identified themselves as working part time, higher than the total surgical average (9.45%).



by SPEcIAlTy plastic surgery

40

No

Yes

17.4%

82.6%

0 5 10 15 20 25 30 35

≥12

11

10

9

8

7

6

5

4

3

1 in 2 1.3%

3.5%

10.1%

12.7%

12.3%

13.2%

14%

6.6%

8.8%

12.7%

4.8%

No

Yes

97.8%

2.2%


The great majority of consultant plastic surgeons (82.6%) indicated that on-call commitments are part of their contracted workload.



Almost two thirds (62.8%) of respondents are on call at a frequency of 1 in 4 to 1 in 8, a greater intensity that the total surgical workforce average.

A high percentage (10%) have an on-call frequency of only 1 in ≥12.

Data based on consultant plastic surgeons with on-call duties.



Approximately 2.2% of respondents indicated that they are resident while one call.

Data based on consultant plastic surgeons with on-call duties.



41

No

Yes

18.4%

81.6%

Don’t know

No

Yes

19.9%

34.8%

45.3%

In next 3–5 years

Don’t know

In next 2 years

In next year

6.5%

6.9%

9.8%

76.8%






Nearly half (45.3%) of respondents indicated that they would like to work part time at some point in their careers, compared with 15.9% of the plastic surgical workforce who actually do.

Data based on consultant plastic surgeons who currently work full time.



Approximately a quarter (23.2%) of consultant plastic surgeons indicated that they wish to retire within the next one to five years.



42

0.6%

0 100 200 300 400 500 600 700 800

Trauma

Spinal

Shoulder and elbow

Paediatric

Orthopaedic oncology

Limb reconstruction

Knee

Hip

Hand / Wrist

Foot and ankle 11.7%

7.6%

18.7%

22.4%

3.6%

4.2%

9.1%

4.7%

17.4%

0 100 200 300 400 500

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.5%

13.7%

26.8%

21.4%

9.6%

19.1%

8.9%

by specialty

Trauma and orthopaedic surgery

specialty recommenDations for enGlanD, wales anD nortHern irelanDin 2010 the british orthopaedic association (boa) recommended a consultant workforce ratio of 1:15,000 population, to be achieved ideally by 2020, with an interim target of 1:20,000 by 2015. these figures match european mean workforce figures for orthopaedic surgery. in order to achieve this target an expansion of the size of the consultant workforce is recommended. the boa has for many years maintained and analysed details of the trauma and orthopaedic workforce. it is conducting a specialty-specific census of trauma and orthopaedic surgeons across the UK. more information can be found through the boa website at www.boa.ac.uk


Data refer to the responses from consultant trauma and orthopaedic surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Just over two thirds (67.3%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 89 practising consultant trauma and orthopaedic surgeons.


43

27.4%

5.9%66.7%

Mixed practice


NHS practice only

94.4%

1.6%4%

Combined

Academic

Clinical

86.8%

13.2%

Part time

Full time


The majority of consultant trauma and orthopaedic surgeons (66.7%) identify themselves as being in mixed NHS and independent practice.



Approximately 5.6% of consultant trauma and orthopaedic surgeons maintain an academic element to their work.






by SPEcIAlTy trauma and ortHopaedic surgery

44

No

Yes

20.8%

79.2%

0 50 100 150 200 250 300 350

≥12

11

10

9

8

7

6

5

4

3

1 in 2 0.6%

1.2%

2.9%

5.4%

10.8%

12.4%

28.2%

5.9%

7.6%

21.4%

3.8%

No

Yes

95.3%

4.7%


The great majority of consultant trauma and orthopaedic surgeons (79.2%) indicated that on-call commitments are part of their contracted workload.



Over half (51.4%) of respondents are on call at a frequency of 1 in 6 to 1 in 8, a greater intensity that the total surgical workforce average.

A high percentage (21.4%) have an on-call frequency of only 1 in ≥12.

Data based on consultant trauma and orthopaedic surgeons with on-call duties.



Approximately 4.7% of consultant trauma and orthopaedic surgeons indicated that they are resident whileon-call.

Data based on consultant trauma and orthopaedic surgeons with on-call duties.



45

No

Yes41%59%

Don’t know

No

Yes

23%

32.7%

44.3%

In next 3–5 years

Don’t know

In next 2 years

In next year

3.8%4.7%

12.6%

78.9%


41% of respondents indicated that they are free from elective duties while on call, much higher than the total surgical average (34.5%).




Almost half (44.3%) of respondents indicated that they would like to work part time at some point in their careers, compared with 13.2% of the plastic surgical workforce who actually do.

Data based on consultant trauma and orthopaedic surgeons who currently work full time.



Under a quarter (21.1%) of consultant trauma and orthopaedic surgeons indicated that they wish to retire within the next one to five years.



46

0 50 100 150 200 250 300

Oncology – Upper tract

Oncology – Pelvic

General urology

General paediatric urology

Female and reconstructive

Endourology

Andrology 3 9.1%

17.8%

10%

4.6%

29.7%

15.2%

13.4%

0 20 40 60 80 100 120

>60

56–60

51–55

46–50

41–45

36–40

30–35 0.6%

11.4%

22.7%

20.6%

13.7%

20.8%

10.1%

by specialty

Urology

specialty recommenDations for enGlanD, wales anD nortHern irelanDthe british association of Urological surgeons (baUs) recommend a consultant workforce ratio of 1:60,000 population. in order to achieve this target, an expansion of the size of the consultant workforce is recommended. they estimate that the current training numbers are enough to meet this demand. baUs is conducting a specialty-specific census of urological surgeons across the UK. more information can be found through the baUs website at http://www.baus.org.uk.


Data refer to the responses from consultant urological surgeons who practise in England, Wales and Northern Ireland as of October 2011.




Approximately two thirds (64.2%) of respondents are between 41 and 55 years old, a trend reflected in all specialties.

Data based on the number of surgeons whose age was known. Age was unknown for 23 practising consultant urological surgeons.


47

29.9%

3.2%

66.9%

Mixed practice


NHS practice only

93.7%

3.8% 2.5%

Combined

Academic

Clinical

90.1%

9.9%

Part time

Full time


The majority of consultant urological surgeons (66.9%) identify themselves as being in mixed NHS and independent practice.



Approximately 6.3% of consultant urological surgeons maintain an academic element to their work.



9.9% of respondents identified themselves as working part time, which is close to the total surgical average (9.45%).



by SPEcIAlTy urology

48

No

Yes

11.4%

88.6%

0 20 40 60 80 100

≥12

11

10

9

8

7

6

5

4

3

1 in 2 2.6%

11.9%

22.1%

17.8%

17.3%

9.5%

6.9%

2.9%

3.6%

5%

0.5%

No

Yes

98.3%

1.7%


The great majority of consultant urological surgeons (88.6%) indicated that on-call commitments are part of their contracted workload.



Over half of respondents (57.2%) are on call at a frequency of 1 in 4 to 1 in 6, a greater intensity that the total surgical workforce average.

Data based on consultant urological surgeons with on-call duties.



Approximately 1.7% of respondents indicated that they are resident while on call.

Data based on consultant urological surgeons with on-call duties.



49

No

Yes

8.3%

91.7%

Don’t know

No

Yes

20.8%

33.9%

45.3%

In next 3–5 years

Don’t know

In next 2 years

In next year

5.3%

6.1%

13.1%

75.6%






Nearly half (45.3%) of respondents indicated that they would like to work part time at some point in their careers, compared with 9.9% of the urological surgery workforce who actually do.

Data based on consultant urological surgeons who currently work full time.



Approximately a quarter (24.5%) of consultant urological surgeons indicated that they wish to retire within the next one to five years.



50

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the royal college of surgeons of england35–43 lincoln’s inn fieldslondonwc2a 3pe

the royal college of surgeons of england © 2012registered charity number 212808

all rights reserved. no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the royal college of surgeons of england.

while every effort has been made to ensure the accuracy of the information contained in this publication, no guarantee can be given that all errors and omissions have been excluded. no responsibility for loss occasioned to any person acting or refraining from action as a result of the material in this publication can be accepted by the royal college of surgeons of england and the contributors.

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