Published: 03/11/2005 Volume 115 No. 5980 Page 34

The pressure of providing emergency on-call services could drive many consultants to early retirement. Alexis Nolan sees what is being done to pre-empt the exodus

The NHS must change the working environment for consultant physicians or face an exodus of early retirements, according to research from the Royal College of Physicians.

Its 2004 census of more than 5,000 consultant physicians shows that a 'startling' 78 per cent intend to retire early. The RCP says that if all these physicians retired three years early, at the age of 62, it would represent a total loss of 6,189 years of experienced work to the NHS, the equivalent of two physicians from every large hospital.

Almost one in four consultants is above the age of 55.

The RCP says the heavy burden of emergency on-call work for consultants nearing the end of their careers can persuade many to take early retirement.

'The time has come to take a long hard look at the way consultants work as they progress through their careers, ' says RCP medical workforce unit director Dr Alistair McIntyre. 'We need to change the working environment and workload to encourage this experienced and committed workforce to stay in the NHS.' The RCP says consultant physicians nearing the end of their careers are keen to stay on to do specialty work, management and postgraduate education. It says that by allowing consultants to concentrate on these areas, the NHS could retain their experience and improve the training of junior doctors.

The census shows that physicians are still working long hours - 41.8 per cent work more than 60 hours a week, and 23.3 per cent over 50 hours a week.

The average working week for those with an NHS component to their contract, including part-time doctors, averaged 59.3 hours - over 11 hours more than allowed by the European working-time directive.

The RCP says the NHS would require a 28.2 per cent expansion in whole-time equivalent consultant physicians to meet the European requirement without loss of service quality.

But there are some positive trends. The census showed the number of consultant physicians in the UK rose by 5.4 per cent in 2004. Numbers rose fastest in England, by 6.5 per cent. But nearly half of advisory appointment committees failed to appoint to consultant physician posts.

'Although this failure to fill 284 posts represents only 4.4 per cent of the consultant workforce, it will impact on the quality of care, ' says Alistair.

The proportion of women consultants continues to rise, although they appear to be less attracted to acute specialties.

Women now represent 23 per cent of consultant physicians and 42 per cent of specialist medical registrars in the UK.

-www. rcplondon. ac. uk