How many beans make 5?

More importantly, how many consultants make a department?

We interviewed for two new colleagues recently. 2 posts, 2 applicants, 2 shortlisted, 2 interviewed, 2 appointed. All smiles down at the DCA that night.

This brings us up to 6 consultants, but 5 Whole Time Equivalents, for our teaching hospital service. The Royal College of Physicians has a document to guide how many respiratory physicians are required for a typical DGH with a catchment of 250,000. It makes interesting reading.

Inpatient work
2 ward rounds a week, with the extra responsibilities of discharge planning, family meetings, etc, makes 3 PAs for inpatient work. Daily review of patients in MAU, add another 0.5PA. If the respiratory physician does some GiM – add another PA. And add in 0.5PA for each MDT.

Outpatient Work
For a population of 250,000 people, 900 new referrals will be generated per year, requiring 11 – 12 PAs per week to cover the clinics – not including the cancer workload. And there will be general medicine follow up appointments added to this, in some centres. 30 mins per New, and 15 mins per Return mean in 4 hours we should see 4 New and 8 Returns – this ignores the need for CXRs and PFTs, of course.

Everyone likes to keep their skills up – so most physicians undertake one PA of bronchoscopy a week, with no more than 6 patents per list.

More excitement for the chest physician, but it is demanding, so requires a PA for every 2 patients per session.

Sleep Disordered Breathing
2-4 PAs of consultant staff, 2 WTE nurses, 0.5 WTE secretarial staff.

Ideally one consultant should supervise the service, requiring 1 or 2 PAs.

Lung Cancer
0.5 PAs for everyone who goes to MDT, and 0.5 PA for the the local clinical lead. A DGH of 250,000 population generally requires 10 PAs of consultant time to run the lung cancer service.

Generally requires 2 consultant, with a lead taking 0.5 PAs for each 25 annual cases.

Specialist Clinics
Difficult asthma, bronchiectasis, ILD, transition clinic – all require another PA for the consultant carrying out the work.

0.75 PAs for every 50 patients

And there’s some more, less common, more esoteric things that we might like to do too.

This adds up to a lot of clinicians. I don’t think we’re any different in respiratory medicine; I’m sure every speciality feels they are under-staffed, overworked, etc, and they’re probably right. I’ve written previously on the increasing number of junior doctor roles we have to cover when on call, and the lonely figure of the on call consultant, writing in notes, rewriting drug charts, fluid charts et al at the weekend – it’s not just the chest physicians.

But, reading through the list of things chest physicians get to play with, I’m sure we should be inundated with applications for ST3 numbers in our speciality. We’ve filled all our permanent, and LAT posts here in Sunny Dundee, but the national picture is not as rosy – many centres have unfilled LAT positions, meaning consultants will be ‘acting down’ more and more.

How many consultants does a respiratory service need? How many registrars? If you had the choice, would you want a consultant, or 2 registrars?

How many beans make 5? 2 consultants, 2 ST3s and 2 LATs, seemingly.

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