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Reasons to be cheerful 1.2.3 with Iain Beardsell

16 Jan, 14 | by scarley

There are many reasons to be cheerful in emergency medicine….

The almost constant talk in the media of a “Crisis in A&E” (sic) has made me contemplate why I’m not always dreading work or considering other employment options.  Daily news headlines are a constant reminder of the difficulties we face on a day to day basis and the problems the specialty is having in recruiting doctors in training into its ranks and made contemplate why it was I chose to be an Emergency Physician (EP).

I knew at a relatively early age that I wanted to study medicine at University. I don’t remember it being a conscious decision; it was simply what I was going to do. Chronic illness in close family members meant I had been visiting hospitals since I was young and there was something about it that I liked. Combined with an aptitude for the sciences and general expectation that high achievers either did medicine or law and my destiny was almost out of my hands.

It wasn’t until seven years later, after A levels and medical school had been safely negotiated, that I faced another choice about what branch of medicine I would pursue. The truth is, I’d probably decided this all those years before, in, what we then called, “third year” at school and was determined by what I’ve always believed is the essence of being a doctor – saving lives.

Emergency Medicine is Medicine. Anything and everything is our business, which makes the speciality endlessly satisfying. I will never know it all and I learn something new everyday. I see people at their most vulnerable , I take away their pain, allay their fears, and yes, very occasionally, save a person’s life.

Now, that’s all well and good, but how do we ensure that young doctors can see just what it is that we do and not be put off from applying for training posts in EM.  Undoubtedly, there is a danger of us starting to believe our own publicity, although I am by no means play down in any way the challenges we face. Medical students and junior doctors need early exposure to EM in well functioning, and most importantly, happy EDs. Training forms only a fraction of a medical career – the majority is spent as a consultant and we need to make sure that we are excellent role models to whom our junior colleagues can aspire. Disenfranchised, unhappy consultants will never inspire others to follow in their path.

Emergency Physicians are, by the nature of our job, “cup half empty” type people. We spend our working days fearing the worst case scenario and often can see the world as a bleak, unforgiving place. We need to change our outlook on how we view our work. I believe we have the most rewarding job that medicine has to offer. With appropriate job planning a decent worklife balance is not just a dream, but an achievable reality.  Yes, we work more “out of hours” than some of our medical colleagues, but this can provide opportunities unavailable to others. Prehospital and Sports medicine, medical journalism, management, teaching and training are all ideally suited to us. It is no coincidence that EPs across the world are leaders in online education and social media. These portfolio careers provide balance to the stresses of our ED clinical work.

We should remember that the grass is not always greener. As a speciality we may be receiving a lot of media attention, but our colleagues, both in hospital and primary care, are also having a tough time. Spend a day with an on call medical registrar and this becomes all too obvious. An ED shopfloor can often be a negative place to be – complaints about why doctors aren’t answering their bleep, or worse, answering their bleep with negativity and unhelpfulness. This usually just reflects other stresses they are feeling and we need to remember it isn’t personal. An offer of support and understanding to them often yields great results, both for the doctor-doctor relationship, but most importantly for the patient. Amongst the clipboards and pressure we have to try to make our EDs a happy place to be.

We have a job with endless variety and never-ending job satisfaction. An arbitrary government target has seemingly sought to destroy our specialty, but we need to move beyond that and remember what a privilege it is to do what we do. I believe our cup is, indeed, half full, and with judicious planning and appropriate support can be overflowing.


Iain Beardsell

Consultant in Emergency Medicine

Associate Social Media editor EMJ

Health Education England outlines recruitment drive to UK Emergency Medicine.

18 Dec, 13 | by scarley

UK readers will be fully aware of the staffing difficulties currently faced by UK emergency medicine. Arguably the difficulties are so severe that our international readers will also be aware, since many of them trained in the UK before moving abroad to achieve a better work/life balance.Screen Shot 2013-12-18 at 18.25.30

This is not the time or place to review why UK Emergency medicine finds itself  in trouble, but in my opinion demand has simply outstripped the resource that the UK emergency physician provides with a cycle of underfilled posts leading to a progressively more dissatisfied workforce. Many departments are held together with a mixture of locums, non-specialists and overtime. This is not a sustainable solution to the pressures of emergency care and progress must be made. This will not be easy as EM faces the twin difficulties of both recruitment (most notably at middle grade level) and retention for all grades of staff.

This week we may have seen the first part of the jigsaw appear. Health Education England has published its first workforce plan for Emergency Medicine. You can download the full report here. This joint report addresses the issues around recruitment and workforce expansion.

There is a clear recognition that the speciality needs to expand with an initial increase of 125 new training posts in 2014 (75 at ACCS and 50 at ST4*). More trainees and medical students will be exposed to EM during their training and alternative routes into EM are to be developed with the possibility of dual accreditation and/or credentialing in EM by other professional groups.

The HEE report goes some way to outline how the issues of workforce expansion and recruitment will be addressed in the next 3 years. It is less explicit in its consideration of workforce retention. Increasing pay is ruled out as an option and other options such as the alteration to working practices for older consultants are unclear and arguably aspirational. This may be because such changes to working consultant working practice are not within the remit of HEE. However, unless retention is addressed with as much energy and resources as recruitment I fear the crisis will remain.


Simon Carley

Associate Editor EMJ




* ST – Specialist Trainee

* ACCS – Acute Common Care Stem

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