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Medical registrars’ increasing workload threatens training quality and patient care

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Source: BMJ Careers

Authors: Caroline White 

Publication date:  05 Mar 2013

Medical registrars are struggling to cope with “unmanageable” workloads, jeopardising the safety of patients and the quality of hospital care and compromising training, the Royal College of Physicians has warned.[1]

Hospitals cannot afford to let the situation deteriorate any further, concludes a report from the college on the future of the hospital workforce. The report draws on evidence gathered in 2011-12 from online surveys and face to face interviews with 2800 medical registrars (doctors in the later stages of training to become consultants and who specialise in hospital medicine rather than general practice or surgery) in England.

Hospitals are too reliant on medical registrars to provide the bulk of hospital services, particularly at night, the report says. More than one in three (37%) trainee doctors described the medical registrar workload as “unmanageable,” and more than half (59%) said it was “heavy.” Just one in 20 GP registrars thought this way about their workload.

This situation threatens patient safety and heightens the risk that the most able junior doctors will be put off pursuing a career in acute hospital medicine, the college suggests.

Its report calls on hospitals to review the workload of medical registrars and their associated teams as a matter of urgency. Hospitals should adjust rotas and redistribute basic clinical and administrative tasks to other staff, it says. Additional resources should be provided when the workload puts patient safety at risk, it adds.

Hospitals also need to change as a result of the increasing number of female trainee doctors in the workforce, the report says. It recommends that local education and training boards promote flexible training posts for medical registrars to ensure that women don’t desert medical specialties.

The report also argues that the quality of training provided is too variable and that training is further compromised by registrars’ heavy workload. Only 38% of registrars thought that their training in general medicine was “good” or “excellent,” compared with 75% in their main specialty.

Medical registrars and other trainees should routinely attend post-take reviews of all patients they have dealt with, including ward referral patients, the report suggests. Hospitals should also ensure that medical registrars can maintain their practical skills, including specialty skills required of them.

The report calls on the Department of Health to reassess the value of the second year of foundation training for those wishing to specialise in hospital medicine and to explore the benefits of extending core medical training.

The uneven distribution of consultants around the country serves to compound problems in the medical registrar workforce, it says. Patients in London have almost double the number of consultants per head of the population as those in the East Midlands, it points out.

Andrew Goddard, director of the Medical Workforce Unit at the Royal College of Physicians, said that medical registrars were the “unsung heroes of hospital care.” He said, “Their skills are not being used to best meet patients’ needs. The NHS will soon struggle to provide the best care for patients if this situation is not urgently reviewed.”

The data on the availability of consultants across the country reflected poor workforce planning, he added. “National and local education and training structures must get to grips with this straight away,” he urged.

Ben Molyneux, chairman of the BMA’s Junior Doctors Committee, said that medical registrars’ excessive workload was bad for training and for patient care. He called for hospital services to be redesigned.

“If we don’t do this we risk the next generation of consultants avoiding careers in acute medical specialties,” he said. “All junior doctors should get decent training and be properly supported if we are to deliver the highest standards of care for our patients.”


  1. Royal College of Physicians. Hospital workforce: fit for the future? Mar

Caroline White freelance journalist, BMJ


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