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Nephrology Manpower Planning: Challenges and Solutions

Explore the current and future needs for nephrology specialists, reviewing historical trends, trainee numbers, and consultant appointments. Understand the impact of changing practices on specialist deployment.

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Nephrology Manpower Planning: Challenges and Solutions

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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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