Working in Accident and emergency!?

The question I'm interested in is, will training in A&E be fixed by the time I have to make specialty applications in 3 years? One of my obs and gynae consultants was quite adamant that things are going to improve markedly in the next few years because they HAVE to get more juniors to choose it, and lose fewer of their ACCS trainees to anaesthetics. Otherwise it all goes tits up, and I doubt there are enough adrenaline junkies willing to do crap jobs for the thrill of it to staff the whole country.

So what are the solutions? How do they turn emergency medicine into a specialty that people still want to do after they've tried it?

To get more people into it, I think you need more people there in the first place so understaffed/overworked isn't the norm. Increase the number of FY posts there? Make it a compulsory rotation of GPVTS? Hell, make it a compulsory rotation of any specialty that can refer/accept patients to/from it...

Reply 21

Egypt

9

Trouble is shortage of SHOs isn't the problem, it's middle grades. From a personal point of view I really enjoyed A&E and have had 3 A&E jobs over the years. In fact, if I hadn't got in to GP training I would have chose A&E as a career.

In my humble opinion the real problem is increased patient demand and. Population who are not prepared to wait and cannot manage simple illnesses. Until you address that problem A&E demand will go up and up no matter how good other services are.

Reply 22

Brachioradialis

18

We got an email at work yesterday RE: the A&E missing Q3 targets, and essentially forcing a reallocation of staff from wards to A&E, as well as cancelling a bunch of elective surgeries. We're also a major A&E trust so I wonder how some of the less funded ones are doing...

I shan't mention names :P

Reply 23

moonkatt

19

Original post by MJK91

We got an email at work yesterday RE: the A&E missing Q3 targets, and essentially forcing a reallocation of staff from wards to A&E, as well as cancelling a bunch of elective surgeries. We're also a major A&E trust so I wonder how some of the less funded ones are doing...

I shan't mention names :P

They were saying on the news that the issue of missing targets was more with the big emergency departments rather than the smaller DGH based ones. I think a lot of people are bypassing their local A&E's to go to the larger places and MTC's as they assume their treatment will be better thus causing backlogs in A&E.

Reply 24

Zafda

8

Original post by Fission_Mailed

The question I'm interested in is, will training in A&E be fixed by the time I have to make specialty applications in 3 years? One of my obs and gynae consultants was quite adamant that things are going to improve markedly in the next few years because they HAVE to get more juniors to choose it, and lose fewer of their ACCS trainees to anaesthetics. Otherwise it all goes tits up, and I doubt there are enough adrenaline junkies willing to do crap jobs for the thrill of it to staff the whole country.

So what are the solutions? How do they turn emergency medicine into a specialty that people still want to do after they've tried it?

I think there are already ACCS EM run through tracks for training? I'm pretty sure there is actually, 2 of my friends are in the midst of applying...

Reply 25

Brachioradialis

18

Original post by moonkatt

They were saying on the news that the issue of missing targets was more with the big emergency departments rather than the smaller DGH based ones. I think a lot of people are bypassing their local A&E's to go to the larger places and MTC's as they assume their treatment will be better thus causing backlogs in A&E.

This also raises the problem of the current performance-based structure of the NHS. By that, I mean the emphasis by major trusts on improving their hospital's imagine within the rankings. By doing so, you clearly improve patient care but there's the catch-22 of increasing population draw to that hospital.

E.g. when patient opinion suffered at one of the local A&Es, my workplace's A&E was inundated with patients from that catchment area who had travelled to ours seeking better quality treatment.

That clearly increases waiting times and the burden of that A&E, and puts pressure on the quality of care.

TL;DR: Letting patient's decide which A&E is best is a terrible idea.

Reply 26

moonkatt

19

Original post by MJK91

This also raises the problem of the current performance-based structure of the NHS. By that, I mean the emphasis by major trusts on improving their hospital's imagine within the rankings. By doing so, you clearly improve patient care but there's the catch-22 of increasing population draw to that hospital.

E.g. when patient opinion suffered at one of the local A&Es, my workplace's A&E was inundated with patients from that catchment area who had travelled to ours seeking better quality treatment.

That clearly increases waiting times and the burden of that A&E, and puts pressure on the quality of care.

TL;DR: Letting patient's decide which A&E is best is a terrible idea.

Indeed and it's further complicated by the MTC network, with people gravitating towards them as they're seen as the place to go if you need care for your injuries from a major trauma, leads to the thinking they will be better at sorting an ingrown toenail/twisted ankle/other minor ailment

Reply 27

nexttime

22

Original post by MJK91

This also raises the problem of the current performance-based structure of the NHS. By that, I mean the emphasis by major trusts on improving their hospital's imagine within the rankings. By doing so, you clearly improve patient care but there's the catch-22 of increasing population draw to that hospital.

E.g. when patient opinion suffered at one of the local A&Es, my workplace's A&E was inundated with patients from that catchment area who had travelled to ours seeking better quality treatment.

That clearly increases waiting times and the burden of that A&E, and puts pressure on the quality of care.

TL;DR: Letting patient's decide which A&E is best is a terrible idea.

Original post by moonkatt

They were saying on the news that the issue of missing targets was more with the big emergency departments rather than the smaller DGH based ones. I think a lot of people are bypassing their local A&E's to go to the larger places and MTC's as they assume their treatment will be better thus causing backlogs in A&E.

There are the official structures as well though. Its only in the last 20 years that every STEMI goes for PCI, every CVA goes to the stroke centre, every trauma goes to the trauma centre, etc. All of which tend to be the same (big) hospitals.

I'm not necessarily sure patients acting on choice will have changed much over the years, although it would be interesting to see some current figures.

Reply 28

Brachioradialis

18

Original post by nexttime

There are the official structures as well though. Its only in the last 20 years that every STEMI goes for PCI, every CVA goes to the stroke centre, every trauma goes to the trauma centre, etc. All of which tend to be the same (big) hospitals.

I'm not necessarily sure patients acting on choice will have changed much over the years, although it would be interesting to see some current figures.

I might have been slightly overzealous in my analysis given that my trust's problems originated after the closure of a local A&E, not before. But I'll do some more digging :smile:

Reply 29

Beska

21

Original post by Egypt

Trouble is shortage of SHOs isn't the problem, it's middle grades. From a personal point of view I really enjoyed A&E and have had 3 A&E jobs over the years. In fact, if I hadn't got in to GP training I would have chose A&E as a career.

In my humble opinion the real problem is increased patient demand and. Population who are not prepared to wait and cannot manage simple illnesses. Until you address that problem A&E demand will go up and up no matter how good other services are.

It's a vicious circle. The SHOs see that there are no middle grades so are stressed about having no seniors, the juniors are seeing the SHOs are stressed so are avoiding the speciality so they won't be in the same position in a few years. Then there's loads of middle grades, with no junior grades, and the cycle must continue like that. The most important thing is retaining the SHOs and making sure that F1s/F2s etc are not put off from it as a career...

Reply 30

shiggydiggy

12

Original post by Pittawithcheese

Kinda defeats the object though...

Posted from TSR Mobile

I'm pretty sure it was a joke..

Reply 31

Helenia

20

Original post by Zafda

I think there are already ACCS EM run through tracks for training? I'm pretty sure there is actually, 2 of my friends are in the midst of applying...

There is an ACCS EM programme, has been for years, but you still have to reapply at ST4 for higher training, I don't think it's completely run-through. And I don't think that the major problem is that it's not run-through, it's that they haemorrhage trainees to anaesthetics (plus a few other specialties) after CT2, with very few moving the other way.

The two major downsides of EM for me were 1)the rota, which destroys your natural circadian rhythm and any attempt at a social/personal life, and 2) the constant pressure to get everything done in 4 hours, even if it means making a poor referral or even admitting someone unnecessarily. Neither of these are about to change any time soon, I think.

Reply 32

Fission_Mailed

15

Original post by Helenia

There is an ACCS EM programme, has been for years, but you still have to reapply at ST4 for higher training, I don't think it's completely run-through. And I don't think that the major problem is that it's not run-through, it's that they haemorrhage trainees to anaesthetics (plus a few other specialties) after CT2, with very few moving the other way.

The two major downsides of EM for me were 1)the rota, which destroys your natural circadian rhythm and any attempt at a social/personal life, and 2) the constant pressure to get everything done in 4 hours, even if it means making a poor referral or even admitting someone unnecessarily. Neither of these are about to change any time soon, I think.

So how do they fix this? How do you break the vicious circle?

Reply 33

Brachioradialis

18

Moar doctorz.

You obviously need more staff in order to vary the shifts more, but to get more staff you'd probably have to incentivise it somehow. Perhaps similar to the supplement system already in place for >40 hours, but in terms of 'unsociable hours'?

Ahh I don't know. I'm not paid enough to think of solutions on a Band 3...

Reply 34

nexttime

22

The same way they solve no one wanting to do psych - massively overstaffing it!

Reply 35

moonkatt

19

Original post by MJK91

Moar doctorz.

You obviously need more staff in order to vary the shifts more, but to get more staff you'd probably have to incentivise it somehow. Perhaps similar to the supplement system already in place for >40 hours, but in terms of 'unsociable hours'?

Ahh I don't know. I'm not paid enough to think of solutions on a Band 3...

And moar beds. and then more staff for the beds.

A lot of hospitals are running at capacity. Both I've worked in have been nightmares to get people transferred to a bed a large percentage of the time. (I could go on at length about this but won't because it'll just turn into a protracted moan about it all).

Reply 36

Sarky

18

They are piloting run through EM training this year. I know a few people applying.

Reply 37

Helenia

20

Original post by MedicineFanaTic

Ohh wow thanks for ur help, much appreciated... Where do u currently work if u don't mind. Me asking?
I was thinking of going into obstetrics... What is ur opinion on it? Thanks

Obstetrics and gynaecology is combined in this country. It is possible to specialise just in obstetrics once you're a consultant but you'd still have to go through a lot of gynae in training.

It's a nice mix of medicine and surgery, and quite often very satisfying (everyone loves babies!) The downside is that it can be very emotionally charged, and it's a very high litigation risk so your insurance premiums will be huge.