FORUM FOR ASSOCIATE SPECIALIST AND STAFF GRADES IN EMERGENCY MEDICINE (FASSGEM)

Survey of issues relevant to the current problems with recruitment and retention of Staff Grade Practitioners in Emergency Medicine

Author: Dr Andrew Newton, Associate Specialist in Emergency Medicine – Chair of FASSGEM

Aim:

The aim of this study was to determine to what extent Emergency Departments in this country have been affected by difficulties in recruiting Staff Grade Practitioners and also to what extent they have experienced problems in retaining those Doctors in post.

Methods:

Two questionnaire studies were sent out by post. One questionnaire was sent to all Staff Grades on the FASSGEM mailing list with a second questionnaire being mailed to all Emergency Departments in England, Scotland, Wales and Northern Ireland (mailing list based upon the British Association for Emergency Medicine Handbook). Responses were invited by post, fax or email.

Response Rate:

138 responses were received to the Emergency Department questionnaire whilst less than 30 responses were received from individual Staff Grades. The very low response rate from individual Staff Grades invalidated the data set from that questionnaire and therefore this report is based entirely upon the responses to the Emergency Department questionnaire.

Results:

138 Emergency Departments returned completed questionnaires and the analysis of these returns are presented below.

Consultant Staffing

Departmental workload / Number of completed questionnaires returned / Average number of Consultant Staff (Range in brackets)
Less than 30,000 / 23 / 1.1 (0 – 2)
30,000 – 50,000 / 29 / 2.2 (1 – 3)
50,000 – 70,000 / 47 / 3.1 (1 – 5)
70,000 – 90,000 / 26 / 3.6 (1 – 5)
90,000 + / 13 / 4.7 (3 – 8)

Associate Specialists

Only 41% of responding Emergency Departments reported having an Associate Specialist in Emergency Medicine in post. (Only 8% of departments reported having more than one Associate Specialist.)

Departmental Size / Departments with an Associate Specialist in Emergency Medicine in Post
Less than 30,000 / 9 out of 23 departments
30,000 – 50,000 / 15 out of 29 departments
50,000 – 70,000 / 20 out of 47 departments
70,000 – 90,000 / 11 out of 26 departments (with 6 departments having 2 or more Associate Specialists)
90,000 + / 2 out of 13 departments

Staff Grades

The reported Staff Grade complement for each size class of department is presented in tabular form below.

Size of department / Average number of Staff Grades (range in brackets)
Less than 30,000 / 1.4 / (0 – 5)
30,000 – 50,000 / 1.9 / (0 – 4)
50,000 – 70,000 / 3.8 / (0 – 9)
70,000 – 90,000 / 4.1 / (0 – 7)
90,000 + / 4.7 / (1 – 10)

Staff Grade Vacancies

The number of departments with Staff Grade posts currently vacant is indicated below (in tabular form) with a calculation of the average number of vacant posts per department.

Size of department / Number of departments currently having Staff Grade posts vacant / Average number of vacant posts per department
Less than 30,000 / 15 out of 23 departments / 1.6 vacancies
30,000 – 50,000 / 16 out of 29 departments / 1.8 vacancies
50,000 – 70,000 / 36 out of 47 departments / 2.4 vacancies
70,000 – 90,000 / 20 out of 26 departments / 1.9 vacancies
90,000 + / 9 out of 13 departments / 2.5 vacancies

Across the board, 70% out of departments currently have vacancies at Staff Grade Practitioner level with the vast majority of departments having more than one vacant post.

Staff Grade Retention

A significant percentage of departments reported loss of Staff Grade Practitioners over the preceding year. The problems surrounding retention are summarised in tabular form below.

Size of department (number of departments in brackets) / Departments reporting the loss of a Staff Grade Practitioner to Primary Care / Departments reporting the loss of a Staff Grade Practitioner to another Emergency Department / Departments reporting the loss of a Staff Grade Practitioner to another Specialty
Less than 30,000 (N = 23) / 16 / 2 / 0
30,000 – 50,000 (N = 29) / 16 / 5 / 0
50,000 – 70,000 (N = 47) / 28 / 12 / 4
70,000 – 90,000 (N = 26) / 16 / 10 / 5
90,000 + (N = 13) / 9 / 6 / 1

Taking all responding departments into account, 62% of departments reported that they had lost a Staff Grade Practitioner to a Primary Care post within the last year, whilst only 25% of departments reported the loss of a Staff Grade Practitioner to another Emergency Department and only 7% of departments reported the loss of a Staff Grade Practitioner to another specialty (either within the same hospital or to another hospital).

Staff Grade Recruitment

59% of departments reported that their last attempt to recruit a Staff Grade Practitioner in Emergency Medicine was unsuccessful.

Size of department / Number of departments unsuccessful at last attempt to appoint a Staff Grade
Less than 30,000 / 12 out of 23 departments unsuccessful
30,000 – 50,000 / 16 out of 29 departments unsuccessful
50,000 – 70,000 / 30 out of 47 departments unsuccessful
70,000 – 90,000 / 15 out of 26 departments unsuccessful
90,000 + / 8 out of 13 departments unsuccessful

Staff Grade Satisfaction

Departments were asked to rate “The degree of satisfaction” amongst their Staff Grade workforce. The following table records the number of departments reporting either that the majority of Staff Grades were “highly unsatisfied” or “completely disillusioned” with their current post and its conditions of service.

Size of department / Percentage of departments reporting severe levels of dissatisfaction amongst Staff Grade Practitioners
Less than 30,000 / 13%
30,000 – 50,000 / 48%
50,000 – 70,000 / 51%
70,000 – 90,000 / 58%
90,000 + / 61%

It can be seen that higher levels of dissatisfaction amongst Staff Grades are reported by larger departments. In all probability, this is because in smaller departments Staff Grade Practitioners are given greater degrees of responsibility and are incorporated more into the senior staffing structure of the department and therefore feel more valued within their role.

Additional comments

Respondees were also asked to offer comments and suggestions when returning the questionnaire and a large number of valid comments were received.

More than half of all respondees indicated that they felt that there was a very urgent need for the “New Staff Grade Contract” negotiations to be commenced with an emphasis being placed upon achieving a contract which allows for career progression, recognition of accumulated skills, experience and the potential to re-enter training if the post holder achieves appropriate criteria.

About 75% of respondees made reference to the inequality in pay which currently affects Staff Grade Practitioners, with suggestions being made that immediate redress should be made to the level of remuneration awarded to Staff Grade Practitioners within the specialty.

Many respondees indicated that they felt that remuneration should be based on a formula taking into account anti-social hours working and work intensity. Many respondees indicated that they had found that the only way that they could make their Staff Grade posts attractive to applicants was to offer a rate of remuneration based on 13 sessions of pay for 10 sessions of work (at this level, Staff Grade Practitioners are paid more than Senior House Officers, rather than less, for an average working week).

Several respondees indicated that Staff Grade remuneration should be based on a salary calculation which takes into account the rate of pay offered to out-of-hours GPs (namely £50 - £70 per hour during evening shifts, £70 - £100 per hour at weekends and £120 per hour for night shifts and at bank holidays). Those respondees indicating this proposal suggested that the criteria for eligibility for such a rate of remuneration should be

1The possession of a higher qualification in medicine (specifically the MFAEM), plus

2A minimum of three years clinical experience in Emergency Medicine, Primary Care and other relevant specialties.

Summary

In summary, this survey has shown the very great extent to which Emergency Departments in this country are experiencing problems with Staff Grade recruitment and retention.

70% of departments currently have Staff Grade vacancies; 62% of departments have reported the loss of a Staff Grade Practitioner to a Primary Care post within the last year and 59% of departments report that the last time they tried to recruit a Staff Grade Practitioner they were unsuccessful.

The comments received from questionnaire respondees eloquently summarise the main problem areas, namely the urgent need for a new contract, the need for Staff Grade Practitioners to be given opportunities for career progression, the overwhelming need for Staff Grade Practitioners to be offered a reasonable and appropriate rates of remuneration and above all the need to make Staff Grade posts in Emergency Medicine an attractive proposition by comparison to other posts which are available within the Health Service at the current time (especially those in out-of-hours Primary Care work).

The data on levels of Staff Grade satisfaction suggest that greater degrees of Staff Grade satisfaction are achieved in smaller departments where there are fewer Consultants in post, presumably reflecting the fact that in such departments Staff Grade Practitioners are given greater degrees of responsibility and accordingly feel more valued for the work that they do – an important message for all departments to heed, regardless of size or Consultant staffing level.

It is of significance that only 41% of departments have an Associate Specialist in post at the current time. Given the current BMA recommendations on the upgrading of all eligible Staff Grades to Associate Specialist status, this would suggest that a significant percentage of Trusts have either not heeded the advice from the British Medical Association (or that Trusts have chosen to block internal regarding of eligible Staff Grades to Associate Specialist status for whatever reason).

Conclusion

This study can be best concluded by quoting from one respondee, who wrote on the bottom of the questionnaire “We have a very competent Staff Grade who is about to retire after many years of service. He is paid less than a “day one” SHO. I think this sums up the way that Staff Grade doctors are exploited and treated. Pay them what they deserve”.

Acknowledgements

Thanks are due to all Emergency Departments who took the time and trouble to take part in the survey and to my secretaries Sue and Dona for putting up with the fax machine churning out an endless stream of paper for weeks on end!

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Dr Andrew Newton BM BS BMed Sci MRCGP DCCH MRCS MSc

A&E Associate Specialist

Chair of FASSGEM