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I recently listened to two anaesthetists talking in a coffee-shop queue. One was of a certain age and clearly exasperated at having to contemplate the supposed burnout levels in my generation of anaesthetists in training. He simply couldn’t understand it. After all, in his day they worked hundred hour weeks! ‘Bloody snowflakes’, he reflected. The other nodded gravely.

‘Snowflake’ is a term commonly wielded by our elders to bludgeon what they deem to be a fragile, over-sensitive and under-resilient youth of today. A people unable to cope with life. It does however require a certain amount of historical amnesia to use this slight without some irony catching in the throat. Did they not enjoy rock bottom housing prices, free higher education and high levels of job security, only to then preside over their decimation?

Authors:

• Dr Xiaoxi Zhang, ST6 Trainee, University College London Hospitals NHS Foundation Trust
• Dr Helgi Johannsson, Consultant Anaesthetist, Imperial College Healthcare NHS Trust
• Dr Amardeep Riyat, Consultant Anaesthetist, London North West University Healthcare NHS Trust
• Dr Roger Sharpe, Consultant Anaesthetist, London North West University Healthcare NHS Trust

Email Dr Zhang

Becoming a consultant is a stressful and vulnerable time during a doctor’s career. Negotiating a new identity, taking on ultimate responsibility for patient care, becoming the team leader rather than a team member are all difficult even in the best circumstances, especially when integrating into a new team.

When the COVID-19 pandemic struck, changing the role from doctor in training to consultant became even more challenging, especially as many hospitals were at that time utterly overwhelmed. We conducted a qualitative analysis of the experiences of anaesthetists and intensivists transitioning to consultant positions during the pandemic,¹ and in this article we want to share the experiences of those doctors who transitioned into their consultant roles during the absolute peak of this global crisis. Their stories offer unique insights on ways of supporting new consultants and highlight the urgent need to improve staff retention and wellbeing in today’s NHS.

SAS doctors play a pivotal role within the anaesthetic workforce, and it is imperative for organisations to establish robust support structures to nurture their professional development. Unlocking the full potential of each SAS doctor not only benefits them personally, but also augments the services they provide and ultimately enhances patient care.

SAS doctors are crucial in anaesthesia, necessitating robust support structures for their growth. Unleashing their potential both benefits them personally and enhances patient care. Vital support includes that of an SAS tutor, a trust local negotiating committee representative, and an SAS advocate. The Guidelines for the Provision of Anaesthesia Services (GPAS) define exemplary departments and highlight non-clinical attributes vital for success. Notably, roles like ‘SAS clinical lead’ and ‘SAS mentor’ empower SAS doctors for self-determined career paths.

We hope you will find this information useful in helping all anaesthetic staff within your department access the educational supervision or mentorship they require.

Introduction

In addition to consultants and doctors in formal training, anaesthetic departments frequently contain SAS and Locally Employed Doctors. SAS doctors are employed on national SAS contracts, the current of which are ‘Specialty Doctor’ and ‘Specialist’. Locally employed doctors (LEDs) are employed on non-national Trust-derived contracts. LEDs have multiple titles including ‘Clinical Fellow’ and ‘Trust Doctor’. Medical Training Initiative (MTI) doctors are also commonly employed as LEDs and form part of this latter group. 

Within this combined cohort are doctors at all stages of their careers, with individual development needs. To maximise the potential of the existing anaesthetic workforce, it is imperative that these doctors are offered support to achieve their potential and reach their career goals. These goals may include broadening their role into non-clinical domains, (re)entering formal training, becoming consultants through the GMC Portfolio Pathway or becoming Specialists. 

In a recent correspondence, I wrote: ‘So many ideas flying around in my head (ADHD). I need to pin them down, put them in order (ASD), and get started (ADHD inertia). I’m over the “I’m broken” phase and now feel that my mission before I finally retire is to help others realise they’re not broken either’.

Why? A Bulletin article entitled ‘Equality, diversity and inclusion (EDI): what it means to the College’¹ with no mention of neurodiversity! The College wants to ‘develop a dataset of the profile and diversity of their membership and workforce’, but without neurodiversity questions I feel excluded!

One in a hundred young people have an autism spectrum disorder (ASD); 10 per cent of these may become high-functioning adults.² Between three and six per cent of children have attention deficit hyperactive disorder (ADHD), and for one in seven of these ADHD will continue into adulthood.³ Also, adults with ASD are more likely to have ADHD!² Everyone has individual attributes and characteristics. Experience of autism is also unique; this is the power of neurodiversity. Some professions, for example aerospace, screen positively for autistic traits⁴ – methodical, attention to detail, ability to hyperfocus, pattern recognition, visual memory, and novel approaches to problem solving. 

You may well ask why you should think of becoming an AAC (advisory appointments committee) assessor. Perhaps it will be too arduous/boring/difficult. We hope to persuade you that this is not the case, and further explain what it can do for you and your department.

When your department appoints a new consultant or specialist doctor, there are specific requirements that must be fulfilled. One of the most important of these is to hold an AAC. This is a legally constituted interview panel established by an employing body. Its function is to decide which, if any, of the applicants is suitable for appointment and to make a recommendation to the employing body.

More than one in five of the non-trainee anaesthetic workforce are SAS doctors, yet the grade is still sometimes misunderstood.

The College is keen for SAS doctors to get the recognition and support they deserve. As SAS Wellbeing lead, I started an initiative last year to spotlight the achievements of our SAS members by asking them to share their stories with us for publication on the College website and social media. Our aim was to enhance people’s understanding of the huge range of skills, experience and responsibilities of SAS doctors, to boost pride in being an SAS doctor, and to improve wellbeing.

• Dr Jonathan Rajan, Consultant in Pain Medicine and Anaesthesia, Salford Royal NHS Trust
• Dr Katharine Ireland, Pain Medicine Trainee, Northern Care Alliance NHS Foundation Trust
• Dr Victoria Winter, Pain Medicine Trainee, Northern Care Alliance NHS Foundation Trust
• Dr Helen Makins, Consultant in Pain Medicine and Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust

Multiple reports have highlighted the importance of workplace wellbeing. Institutions that prioritise workplace wellbeing perform better, with improved patient experience, higher staff satisfaction and lower rates of sickness absence.

38% of NHS staff in England reported suffering from work-related stress, and the 2023 GMC Survey showed the proportion of trainees at risk of burnout to be the highest since they started tracking this in 2018. The impact of a career in pain medicine on the wellbeing of a pain physician can be significant, including the emotional burden of treating patients in distress, and the additional impacts of training, career development and examinations. Access to wellbeing support can be further nuanced in smaller subspecialties, with fewer trainees, less potential jobs and a far smaller community of working clinical practice.

With this in mind the issue was raised at the FPM Board, and work began to identify barriers to the reporting of uncivilised behaviour, and to identify possible solutions.

It’s only the start of meteorological winter, but the recent rhetoric of the newish government does seem to chime for the multidisciplinary team working in critical care services. It is becoming more difficult each day to keep safe services afloat, with bed occupancy well above recommended levels throughout the four nations.

While there’s a definite wish in critical care to accommodate the long list of elective surgical patients and for emergency patients to be located in the best place, be that enhanced or critical care, it will be most welcome to see details forthcoming from government. We hope they lead to the better flow of patients through our ICUs in 2025 and beyond.

Two years ago, the clinical leads census revealed that 50% of responding ICUs have at least one gap on their consultant rota. We continue to seek triangulating information on recruitment challenges, which appear to be in less urban areas and specialist ICUs. FICM continues to engage with relevant stakeholders, including NHS England and the Academy, to make the case for more intensivists in the future.

Although many ICM doctors-in-training (DiTs) are now either training in ICM alone or with another partner specialty, just under half of our future ICM workforce are working towards a dual CCT with anaesthesia. 

Furthermore, many intensive care units around the UK rely on the knowledge, skills and experience brought by our anaesthetic colleagues in order to provide high-quality, patient-focused care. 

Consequently, anaesthetists will continue to hold a critical role in training the intensivists of the future.