The 2021 Consultant Census Report

The 2021 Consultant Census Report has been jointly published by the College, alongside our colleagues in London and Glasgow. This year’s census also includes staff, associate specialist and specialty (SAS) doctors for the first time. Over 4,000 consultants and SAS doctors working across the UK contributed to the census.

The 2021 report highlights that COVID-19 continues to have a major impact on the NHS, its staff and patients, while long standing recruitment and retention challenges look set to intensify as over 50% of consultant vacancies remain unfilled - the highest rate since this data was first collected in 2008.

Key findings from the report include:

• 52% of advertised consultant posts were unfilled in 2021, with three quarters of these remaining unfilled due to having no applicants;
• 44% of the consultant physician workforce is set to reach retirement age in the next decade, while 20% of the workforce will have reached their intended retirement age by 2025;
• One in five respondents are at risk of burnout;
• Consultants estimate that they work 11% more than they are contracted to work, mainly due to their clinical workload;
• 74% of higher specialty trainees (HSTs) missed training opportunities due to the Covid-19 pandemic.

In addition, the census reveals that 45% of consultants say they work excessive hours or have an excessive workload ‘almost always’ or ‘most of the time’ – while more than 50% of consultants (53%) didn’t take their full annual leave allocation for the full year.

Among the more positive findings, more than three quarters of consultants (77%) felt valued by their medical colleagues almost always or most of the time, and more than 80% (82%) felt valued by their patients almost always or most of the time.

While COVID-19 did impact significantly on training opportunities, 70% of trainees stated that training in their specialty was excellent or good. Despite significant challenges, job satisfaction remained remarkably resilient, as in previous years, with 83% of consultants saying that they always or often enjoyed their work.

This detailed annual census is a vital source of data on the physician workforce in the UK. The College will continue to use these data to lobby governments throughout the UK to prioritise investment in the medical workforce, and to focus on supporting the recruitment, retention and return of consultants in our health service where appropriate.

This means providing additional medical school places and placements, as well as practical support for those consultants who offer specialist training in placements, ensuring that they have the time within their own jobs plans to provide this. It also means doing more to ensure that physicians  have adequate rest and refreshment facilities and sufficient administrative support so that they can focus on delivering safe patient care. All of this must be underpinned by a comprehensive, long-term workforce strategy that will help meet patient demand in the future as our elderly population continues to increase significantly. This is a welcome development, as peoples’ life expectancy has improved over across a number of decades.

Commenting, Professor Andrew Elder, President of the Royal College of Physicians of Edinburgh said:

The census highlights the need to have an effective recruitment and retention strategy in place for doctors across each of the four nations of the UK.

While increasing the number of medical school places and placements is welcome and vital, governments across the UK should also look to increase international recruitment as a means to boost the number of doctors working in our NHS.

This should be a temporary solution however, while the NHS workforce strategy is implemented and we must also remember that medical students and postgraduate doctors in training need structured education, supported training and mentorship. That, in turn, requires a strong foundation of more experienced doctors capable of taking these roles on.

Dr Marion Slater, Consultant Physician and a Fellow of the Royal College of Physicians of Edinburgh, said:

Year on year, the census data demonstrate rising risk to the safe provision of patient care, with an alarming and rising proportion of unfilled consultant posts and consultants approaching retirement. Almost three-quarters of doctors in training, our consultants of the future, describe missed training opportunities due to the Covid pandemic, risking slowed or reduced progression to consultant level, further exacerbating the challenges.

Year on year we highlight this looming workforce crisis and emphasise that workforce shortages undermine patient safety and staff wellbeing. Hearteningly, despite the additional workload and negative impact on morale described in the census, the majority of doctors describe feeling valued by their medical colleagues and patients in their day-to-day work, offering hope that we can continue to attract motivated, enthusiastic colleagues to a career in medicine.

To ensure safe, sustainable, high quality patient care, and safe, sustainable careers in healthcare, it is vital that there is a focus on health service recovery and redesign, workforce planning and training, with independent projections of workforce, prioritisation of time to train, meaningful engagement with patients and staff, and a clear line of accountability.  The status quo is unsustainable and will continue to risk patient and staff safety and wellbeing.