BMA warns of 'perfect' storm of missing consultant vacancies and retirement exodus

These are excluded from Scottish Government data, which put the vacancy rate at 6.3%, something the trade union warns means they “significantly underestimate the scale of the problem”.

The report, ‘Consultant Retention in Scotland in 2021’, added: “To put it in perspective, the equivalent of a whole, large hospital could be staffed from vacancies left out of the official figures.”

A survey by the trade union also reveals a looming retirement timebomb among senior consultants, with nearly half of the 261 respondents saying they plan to end their career in the next five years - and half of those saying they would be doing so early.

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This points to an acceleration of existing trends, with workforce data showing that one in five consultants aged 45-49 in 2010 had left by 2020 - mostly due to with early retirement.

Doctors blamed disillusionment with the job, punitive pension tax charges, work-life balance, and their own personal health and wellbeing.

One told the BMA they felt “totally burnt out”, adding “the prospect of early retirement [is] all that’s keeping me going”.

Dr Graeme Eunson, chair of BMA Scotland's consultant committee

The scale of the shortages raise questions about how the NHS will recover from the Covid crisis, which has seen record thousands of elective, treatments and diagnoses delayed.

Figures this week revealed there were more than 31,000 patients waiting for an endoscopy by December, with 18% of them having already waited 39 to 52 weeks.

Over 100,000 patients were also waiting for a diagnostic CT, MRI, or non-obstetric ultrasounds - up 15 per cent in a year - while the number of elective operations scheduled during April to December 2020 was down by more than 140,000 compared to the previous year.

There are reports that newly-referred patients could wait more than five years in some areas for routine procedures such as hip and knee replacements.

The report states: “The NHS in Scotland is facing a perfect storm of consultants choosing to retire earlier than they otherwise would have, a significant proportion approaching retirement age, many consultants seeking to reduce their workload, ever rising vacancies across Scotland which are not being filled, and a year of unparalleled pressure on the service leading to stress and burnout for those who choose to remain.”

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Previous research indicates that shortages are most acute in specialties which have borne the brunt of the pandemic, such as anaesthetics, emergency medicine, care of the elderly, and psychiatry.

Dr Graeme Eunson, a consultant paediatrician at Borders General Hospital and chair of BMA Scotland’s consultants’ committee, said it was vital that the Scottish Government base workforce planning on accurate vacancy figures “otherwise you’re planning to replace fewer people than you need”.

In his own department, Dr Eunson said that two out of the seven consultant posts had been vacant for 18 months and that these situations deter medics from taking much-needed annual leave “because the workload just builds up or it’s piled on to colleagues”.

Many of today’s senior consultants started out as junior doctors in the 1990s, in an era of 110-120 hour working weeks, and had simply “run out of gas”, he added.

“There’s a lot of people who are just looking to get through this winter, spring and summer and are then going to sit down with their families and look at what they’re planning to do for the next few years.

“Some are going to try to reduce their working hours, but I think a lot of people are going to bring forward their retirement because they can’t see any way out unless more is done to improve the day to day working conditions for consultants.”

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The Scottish Government said the number of consultants employed in Scotland had risen 56% since 2006, to a record 5,702 'whole time equivalent' (a measure used to adjust for part-time working).

A spokeswoman said: “We are committed to improving the wellbeing of health and social care staff across Scotland and have taken immediate action to provide support while they respond to the pandemic.

"We are also working to build a sustainable culture that will continue to prioritise staff wellbeing in the future.

“We have asked our NHS and social care staff to work through unprecedented times and often in unfamiliar settings. Many have been asked to learn new skills and work in new roles in unfamiliar teams.

“They have also had to adjust to the impact the pandemic has had on our personal lives and communities, including having to care for their own families.

"This has been, and continues to be a huge ask and we are deeply grateful for the hard work, commitment and professionalism of those working in health and social care, at this time of unprecedented challenge.”

Vanessa Mackay

Vanessa Mackay, clinical lead obstetrics and gynaecology at the Queen Elizabeth University Hospital in Glasgow, says her department has seen a “big decline” in non-emergency operations during the pandemic as staff were redeployed to intensive care.

“We now have a significant surgical backlog and our waiting list is growing – and then there are routine follow ups too,” she said, adding that for consultants already nearing the end of their career the very different ways of working across all departments which are likely to follow the pandemic “may be the final thing that pushes them towards finishing up or cutting back their hours”.

“I think we have a very long road ahead of us and there is also a very real potential for a lack of retention once this is finally over.

“We’re already seeing colleagues who are having to take time off because they’re shielding or because they’re ill and it may be that they expedite their retirement because they’re just not able to commit to the changes being asked of them – both during Covid and in the future.

“Because I think in the long-term we’re probably going to be asked to continue with more remote consultations, more attend anywhere, more shifts to reduce the waiting lists – rather than just returning to the ‘norm’ as it were, before we ever had this pandemic.”

Rajmohan Padmanabhan, a consultant anaesthetist in NHS Lanarkshire, says the past year has seen him working shift patterns for the first time in 14 years, and napping when he could in a sleeping bag on the floor of his office.

He says workload “has gone up significantly” during the pandemic and frontline staff “are exhausted”.

“Morale is low. It doesn’t help that consultants have had years of below inflation pay increases – which works out at something like a 20% pay cut in real-terms.

“There’s a misconception that senior doctors are asking for the world: we are not – we’re asking for on-par pay rises, in line with inflation and other recommendations, and for our pensions not to be punitively taxed.

“I think in a few years, if these issues are not rectified, a lot of people in the workforce currently might disappear. It’s a distinct possibility – in fact, I think it’s a reality – if the government doesn’t do something soon.

“And this isn’t just for doctors alone – this is for all NHS staff who deserve a good pension and savings for their retirement.

“It’s really not about doctors simply wanting to stop working early. People do want to work longer – but in addition to issues around pay and pensions, exhaustion and burnout, with age also comes co-morbidities: doctors are not super-human.”