GASTROENTEROLOGY WORKFORCE REPORT, DEC 2010,
Harriet Gordon, Chris Romaya
Key points

There are 1113 gastroenterologists across the UK, a 6.9% expansion on
last year.

It is predicted that we need 6.1 full-time consultants per 250,000
population, a total of 1980, or 867 more. This is achievable over the next
8 years at 7% expansion, the trainees are planned for.

For the next 4 years there are a potential 100 CCT holders in excess of
predicted retirements.

It is appropriate not to increase the total number of training posts now to
avoid a further increase in trainees above this who would gain CCTs
around 2018.

National requirements in the future, e.g. screening programmes, 24 hour
7 day working, may alter the number of gastroenterologists needed.
Consultant gastroenterologists
There are currently (at 30.9.10) 1113 gastroenterology consultants, an
increase of 6.9% from last year. Of these consultants 86% are male, and
14% female, unchanged from last year. Across all medical specialties 27%
consultants are female.
Table 1: Number of consultants in different parts of the UK
30/9/01 30/9/02 30/9/03 30/9/04 30/9/05 30/9/06 30/9/07 30/9/08 30/9/09 30/9/10
England
552
600
643
688
737
752
780
824
866
926
Wales
30
32
34
37
40
43
45
48
49
48
Scotland
67
69
71
76
81
82
86
89
96
108
Northern
Ireland
20
21
23
25
25
26
27
29
30
31
Total
669
722
771
826
883
903
938
990
1041
1113
Although there was a drop in Wales of one consultant at 30.9.10, three further
appointments were made in early October.
Consultant expansion
Table 2: Annual expansion (%) of consultants in different parts of the UK
by year
30/9/01 30/9/02 30/9/03 30/9/04 30/9/05 30/9/06 30/9/07 30/9/08 30/9/09 30/9/10
England
5.7
8.0
7.2
6.5
7.0
2.0
3.7
5.6
5.1
6.9
Wales
20.0
6.7
6.3
8.1
8.1
7.5
4.7
6.7
2.1
-2
Scotland
8.1
3.0
2.9
6.6
6.6
1.2
4.8
3.4
7.9
12.5
Northern
Ireland
5.3
5.0
9.5
8.0
0
4.0
3.8
6.9
3.4
3.3
Total
6.4
7.9
6.8
7.1
6.9
2.3
3.9
5.5
5.2
6.9
It is estimated that we need approximately 6.1 full-time gastroenterology
consultants per 250,000 population. Assuming a population of 60,819,200 in
the UK, this requires 1484 consultants. The full-time:part-time ratio is around
1.3, therefore this equates to 1929, and including 50 new posts for BCSP, a
total of 1979 consultants required. Therefore we need approximately 867
more new consultants over and above retirement replacements. This would
be achievable over the next 8 years if expansion is maintained at 7%. There
are already approximately 800 SpRs in training, and if the average training
time continues at 7 years, then there are sufficient trainees already in place to
meet this target.
However expansion, which was running at 6-7% until 2005, dropped to 2-3 %
in 2006 and 2007. It has increased to 6.9% in the last year, attributable to
recruitment driven by financed national bowel cancer screening and other
political requirements from targets e.g. the '18 week pathway'. This may drop
off in the next few years as NHS resources have been reduced.
Retirements
The current average retirement age is 62.7 (range 55-66), unchanged from
previous years.
Of the current consultant body, an average of 20 state that they intend to
retire each year over the next 7 years, or around 139 retirements.
Table 3: Number of consultant reaching retirement age in the next 10
years
Numbers at 30/09/10
Scotland N Ireland
England
Wales
Totals
>60 years
88
3
8
1
100
Reaching 60 or more
in the next 10 years
274
13
31
9
327
There are 327 consultants reaching the age of 60 over the next 10 years,
averaging 33 retirements per year
Age of consultants
The majority of the consultants are within the 40-50 age group, so that there is
likely to be 20-30 retirements per year over the next 10 years, increasing
thereafter.
Fig 1: Age distribution of consultants
350
Number of consultants
300
250
200
150
100
50
0
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-68
Age
Part-time appointments
62 consultants described themselves as part-time. Of all those who gave
details of their PAs, 93 receive <10 in total (12% of respondents for this
question), and of those who described themselves as part time, 14 received
>10 Pas. Of all the part-timers, 68% were female.
Acute medicine/gastroenterology: 29 consultants were working within acute
medicine and gastroenterology, with 2-9 PAs of a total 7-12 PAs as
gastroenterology.
174 of consultants no longer take part in a GIM on call (19% of those giving
information).
Academic
104 consultants described themselves as academic.
36 were full time
academics. 15 (14%) were female.
PAs
Fig 2: Distribution of PAs and SPA paid
Number of consultants
300
250
200
150
100
50
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19
Number of consultants
PAs paid
200
150
100
50
0
0-1
1-1.9
2-2.9
SPA paid
3-3.1
4
The majority of consultants are paid 11.1-12.9 PAs. Those paid >10 PAs
reported working 1-5 PAs more in reality.
Of the PAs paid, the majority of consultants receive >2 SPAs.
Distribution of gastroenterologists nationally
Table 4: Distribution of gastroenterology consultants by SHA
Strategic Health
Authority
Pop (1,000s) for
2008
Total no
consultants
North East
2,559.5
69
Population
served by 1
consultant
37,094
London
7,562.5
184
41,100
Scotland
5,168.5
108
47,856
Average population served by 1 consultant 54,644
West Midlands
5,374.3
97
55,405
Northern Ireland
1,788.9
31
57,706
North West
6,893.5
123
58,045
Yorkshire & the
Humber
South West
5,166.6
89
58,052
5,128.9
87
58,953
East Midlands
4,327.6
71
60,952
East of England
5,608.5
92
60,962
Wales
2,993.4
49
61,090
South East Coast
4,246.8
61
69,620
South Central
4,000.2
52
76,927
60,819.2
1113
Total
Population statistics 2008: DOH for England, General Register Office for Scotland,
Statistics for Wales, NISRA for Northern Ireland
The population statistics for England came from the Department of Health,
from GP registrations in 2008, and therefore may under-represent, missing
those not registered. The Wales, Scotland and Northern Ireland statistics
come from their 2008 national census.
The average population in the UK served by one consultant is 54,644. In
England the average is 54,993, varying from around 40,000 in London and
the NE to double this, around 80,000 on the South Coast/South central.
In Wales there is one consultant per 61,090 population, in Northern Ireland
one per 57,706 population and in Scotland one per 47,856.
Thus there continues to be significant variation across the UK, South Central
having among the highest populations per gastroenterologist, and London and
the North East the lowest.
Single handed gastroenterologists
There are 13 consultants working alone, 10 of these have consultants from
nearby hospitals carrying out 1 or 2 days per week, 3 are working alone on
Islands.
Non-consultant career grades
There are 330 in total:
●
82 associate specialists,
●
58 staff grades
●
50 clinical assistants
●
30 consultants from other specialties (care of the elderly, radiology)
contributing to gastroenterology
●
18 trust doctors
●
92 hospital practitioners/GPs, majority working one session per week
These numbers are similar to last year.
Nurses in gastroenterology
There are currently 756 nurses working in clinical gastroenterology within the
UK, an increase of 33 (5%) over the last 12 months.
●
353 Nurse endoscopists/specialist nurses performing > 1 session
endoscopy / week
●
144 Clinical nurse specialists (including IBD, hepatitis, nutrition, alcohol
liaison)
●
235 Nurse practitioners, increased from 183 last year.
●
24 Nurse Consultants, increased from 13 last year.
The 353 performing regular endoscopy (1-10 sessions stated in the survey,
median 2 per week), is the same as last year.
Surgeons in gastroenterology
490 perform 0.25-3 sessions (median 1) per week of OGD, and 667 perform
0.2-4 (median 1) sessions per week of lower GI endoscopy
Trainees in gastroenterology
There are currently 790 trainees in the UK, approximately the same as last
year. Within the trainee population there are:
●
493 trainees in hospital posts (increased by 5% from last year)
●
159 trainees taking time out for a period of formal research or OOPE, a
stable number
●
41 VTNs (23% decrease on last year)
●
59 LATs, same as the previous year
●
40 acting as locum consultants, 21% increase on last year
●
4 post CCT fellows, new posts since last year
●
35 ACFs, an increase of 12.
●
45 less than full time trainees, 38 in hospital posts, 4 in research, 4
doing locum consultant posts
The mean training time remains at 7 years.
Table 5: Distribution of grade of those in Registrar posts (30/09/09)
England
Wales
Scotland
N Ireland
UK
Specialist Registrar
(Clinical)
Research
Registrar/OOPE
LAT
423
16
39
15
493
139
6
12
2
159
56
1
1
1
59
Locum Consultant
35
3
2
0
40
ACF
32
2
1
0
35
Post CCT fellows
4
0
0
0
4
Total trainees for
each country
Visiting Registrar
689
28
55
18
790
38
1
1
1
41
Less than full-time
trainee
38
3
4
0
45
There would appear to be as small increase in clinical posts, 22 more than
last year, despite a national freeze on posts.
There are currently 11 in specialised hepatology posts, although there are 16
posts available nationally. This is the same situation as at 2009. Trainees
have been reluctant to move out of region for a 12 month post, and also do
not want to designate themselves 'hepatologists' and potentially reduce their
job opportunities in the future, despite a drive to increase the number of
hepatologists nationally.
Gender
The trainee population is now 34% female, the same as last year. Within the
Royal College of Physicians the average for all medical specialties is 47%.
There are 45 less than full time trainees, 4 more than last year, representing
6% of the total trainees.
trainees.
42 of these are female, or 20% of the female
25% of less than full time trainees are female in all medical
specialties.
Trainee expansion
Since 2003 there has been an increase from 430 trainees to 790, or an 85%
increase. This has been driven initially by the EWTD and then by a desire to
replace posts vacated for OOPE by NTNs rather than LATs. In the last year
there has been a freeze on total posts, as requested by the BSG.
Table 6: Number of trainees in different parts of the UK by year
2003
2004
2005
2006
2007
2008
2009
2010
England
430
478
542
586
602
661
696
689
Wales
20
26
25
25
25
25
25
28
Scotland
27
34
39
40
44
53
56
55
Northern
Ireland
13
12
13
16
15
19
18
18
Total
490
550
619
667
686
759
795
790
%
expansion
+12.2% +12.5% +7.7%
+2.8% +10.6% +4.7%
-0.06%
Outcome of trainees >6 months post CCT
66 trainees are more than 6 months post CCT and unappointed to a
consultant post, a 35% increase on last year. Of these:
●
26 in locum consultant posts,
●
4 in post CCT fellowships
●
6 research experience
●
22 are working within the NHS in clinical other posts
●
7 VTNs
●
1 unknown
Predicted CCT dates
Fig 3: Graph of predicted CCT dates
120
CCTs predicted
100
80
England
Wales
60
Scotland
Northern Ireland
40
20
0
2011
2012
2013
2014
2015
Year
There are a stable number of retirements expected over the next 5 years of
around 15-25 per year. These leaves around 100 predicted CCT holders in
excess of retirements, per year.
consultant posts next year.
7% expansion would require 78 new
Fig 4: Planned retirements and CCT dates
140
Number consultants planning to retire
SpR CCT dates
120
100
80
60
40
20
0
2011
2012
2013
2014
2015
2016
Year
Consultant expansion
Fig 5: Graph of expansion at 3%, 5% and 7%
2000
Predicted number of consultants
1900
1800
1700
1600
7% expansion
1500
5% expansion
3% expansion
1400
1300
1200
1100
1000
2010
2011
2012
2013
2014
2015
2016
2017
2018
Year
The Royal College of Physicians 'Working for Patients' estimates that a
population of around 250,00 requires 65-75 gastroenterology PAs per week,
or 6 full-timers working 10-12 Pas.
On this basis we need 867 more
gastroenterologists, or 1980 in total.
With consultant expansion at 7% this would take 8 years to achieve. There
are predicted to be around 100 CCT holders with a CCT in excess of
retirements over the next few years, so a rate of 7% expansion has the
required CCT holders available, with 790 NTNs are already enrolled.
Career aims of trainees
Of those who expressed a preference:
●
169 (44%) teaching hospital, 216 (56%) in a DGH
●
128 (16%) hepatology post
●
64 (8%) academic post (gastroenterology or hepatology)
●
23 (3%) work less than full time
●
7 (0.01%) solely accrediting in gastroenterology
●
98% VTNs would opt to remain in the UK
Consultant appointments in the last year
There have been 96 appointments in the last year:

69 GIM and gastroenterology

13 in hepatology

4 gastroenterology/nutrition

1 gastroenterology/IBD

2 gastroenterology/interventional endoscopy

1 gastroenterology/motility

6 into acute medicine/gastroenterology
Relationship of trainees to population
There is a variation across the UK for the number of trainees per population.
As with consultants, there is a higher density of trainees to population in
London (1: 36,890) than for other regions, with the lowest density in South
East Coast (1:124,906) or South West (1:125,095).
Fig 6: Population served by 1 trainee
140000
Population for 1 trainee
120000
100000
Average UK population /
trainee
80000
60000
40000
20000
W
al
No
es
rth
er
n
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la
nd
Sc
ot
la
nd
be
r
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e
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s
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rk
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es
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es
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h
es
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rth
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on
No
rth
Ea
st
M
id
la
nd
Ea
s
st
of
En
gl
an
d
0
Strategic Health Authority
Fig 7: Total number of consultants and trainees in each SHA
Total no
gastroenterologists
200
150
Trainee numbers
100
50
W
No
al
es
rth
er
n
Ire
la
nd
id
la
Ea
nd
st
s
of
En
gl
an
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on
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rth
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es
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nt
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es
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e
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be
r
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ot
la
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0
Ea
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M
Number trainees/consultants
250
Strategic health authority
Future changes in consultant numbers
Increased need for gastroenterologists:
●
National screening programmes.
Bowel cancer needs have been
included in these figures. There is very likely to be a national flexible
sigmoidoscopy screening programme for the population at age 55,
requiring 105 individuals, not necessarily doctors. For this reason this
requirement has not been included in these figures.
●
Increased hepatology requirements from a change in population
behaviour, i.e. increase in obesity, alcohol misuse. The National Liver
Plan asks for a trained Hepatologist in every hospital.
●
Increasing requirement for 7 day, 24 hour working week
●
Drive for political targets e.g. '18 week pathway'
●
Increase in the number of consultants working less than full time.
Reduced need for gastroenterologists:
●
If gastroenterologists withdraw from GIM rotas, currently 174 no longer
participate.
●
If others take on traditional gastroenterology roles, e.g. radiology
replaces endoscopy
There has been a predicted excess of CCT holders over consultant jobs
recently. CCT holders have taken jobs in acute medicine/gastroenterology (6
appointed in the last year). However there are now acute medicine trainees
gaining specialist CCTs and it is likely that they will access these jobs in the
future.
Surrogate markers for pressure on jobs:
●
There are 3 posts unfilled nationally, fewer than last year.
●
The average number of jobs that a CCT holder applies for is 4
●
The average success rate per job application is 18%, one of the lowest
rates for all medical specialties
The deanery budgets are being reduced and there may well be a reduction in
trainee numbers. There is already national variation in trainee numbers in
relation to both population and consultant numbers.
Conclusions
As with all the large medical specialties gastroenterology is predicted to train
an excess of CCT holders over jobs available in the next few years, around
100 per year over predicted retirements.
7% consultant expansion over the next 8 years would achieve the 1980
gastroenterologists it is estimated that the UK requires, however expansion
has fallen to below this in recent years. Even at 5% expansion there would be
a predicted 268 CCT holders without a consultant job over the next 8 years.
It would seem appropriate to freeze the total number of trainee posts now,
and there may be a post reduction in the future.