When a leading Northern Ireland anaesthetist claimed at an international conference last week that the specialty faced a recruitment crisis, he provoked incredulity among his senior colleagues.
Dr Joseph Gaston, director of anaesthetics and intensive care at Belfast's Royal Hospitals trust, told the conference that the UK and Ireland 'face a particular challenge in recruiting enough anaesthetists'.
He is adamant that there is a real and continuing problem, and estimates that he needs 10 to 15 per cent more anaesthetists. Later, he told HSJ: 'The 17 acute trusts in Northern Ireland all need consultant anaesthetists.
'We cross-cover in various ways but we still end up with around 50-100 operating lists, some 5-10 per cent of all lists, cancelled every month because of a lack of anaesthetists, and this is replicated in all the trusts,' he says.
Many of Dr Gaston's peers disagree. They argue that the crisis in anaesthetics recruitment is over. Indeed, they say, the profession could be heading for a glut of anaesthetists.
Dr William MacRae, vice-president of the Royal College of Anaesthetists, says he 'doesn't know where Dr Gaston gets (his calculation) from'.
He adds: 'I understand Northern Ireland produces more anaesthetists than it needs.'
UK-wide there is 'no difficulty in recruitment at all', says Dr MacRae. 'In a recent study carried out by the royal college, 1,560 senior house officers were interviewed, of whom 70 per cent wished to continue in the specialty. If this is the case we will be pushed to accommodate them all.'
Staff planning is an art, not a science, says Dr MacRae, and estimates could be way out. Last year, he says, there was an 8 per cent increase in the number of trainees coming out of the system.
'Fortunately, a series of cock-ups we hadn't thought about cancelled each other out and everyone got jobs.'
No one denies there was a severe recruitment crisis in the mid-1990s. 'Things got way out of kilter,' says Peter Wallace, secretary of the Association of Anaesthetists of Great Britain and Ireland.
By next year there will be enough anaesthetists to fill all posts, Dr Wallace says. 'If we weren't extending the training period we would end up with overproduction.'
The recruitment situation was still difficult when the Audit Commission produced its 1997 report Anaesthesia under Examination. Recommendations included considering the use of nurse anaesthetists, which is common in the US and parts of Europe.
Richard Waite of the Audit Commission was at the Northern Ireland conference and believes that the arguments put forward then 'are still as relevant now'.
Government requirements to reduce waiting lists and cut waiting times have meant more people are being operated on, says Dr Waite. There is more use of intensive care, more women in labour want epidurals and more people want treatment for chronic pain.
Charles Reilly, professor of anaesthetics at Sheffield University, points out that nurse anaesthetists would need to be recruited from theatre and intensive care specialists, where there is an acute shortage. 'To try to replace one shortage specialty which is no longer suffering a shortage with another which is in crisis would not seem to be the right way of going about things.'
Dr MacRae hopes that the situation with anaesthetists does not follow that of obstetricians.
'Next year I understand there will be something like 400 obstetricians looking for a job,' he says.
'There is no evidence that people are having to wait around for jobs in anaesthetics and we hope it stays this way.'