Manpower imbalance in obstetrics and gynaecology.

Abstract

The present imbalance between the number of middle grade posts (registrars and senior house officers) and the career opportunities in the hospital service is clear to all. It has, however, proved hard to reconcile the conflicting interests of patients, consultants, junior hospital staff, and government paymasters. Some of the more radical solutions that have been put forward, such as increasing the number of consultants and financing this by reducing junior staff, may be possible in some of the more contemplative specialties such as general medicine, pathology, radiology, etc, but in obstetrics and gynaecology this solution is totally inappropriate. This is largely because of the need to provide skilled resident medical cover; the modern labour ward is an intensive care unit. In the belief that the present service has many good qualities that should not be needlessly jeopardised by sudden or too radical change the obstetric and gynaecological specialist subcommittee of the South East Thames Regional Health Authority asked us to visit each district in the region to look at the workload, including any geographical and structural problems. We were also asked to examine staffing levels and to see how changes could be effected that would eventually satisfy the patients' request for a higher level of direct consultant care and provide better training and a properly balanced career structure, without destroying what is best in the present service. We were looking particularly for practical steps that could be taken without heavy financial commitments. This excessive workload has to be considered against a background of the need for improving existing maternity services, the shortcomings of which included the following: * About half the units in the South East Thames Regional Health Authority are depressing, appalling units in dingy surroundings.* Overcrowded outpatient departments, pressure on beds and theatre time, difficulty in maintaining turnover and controlling waiting lists-circumstances that often lead to crisis conditions. * Split units (sometimes 20 miles apart) with divided responsibility cause extra stress and anxiety about adequacy of junior cover.If these shortcomings are to be remedied extra money is needed and this is a high priority.Proper obstetric care requires 24 hour coverage by staff at a uniformly intensive level. Isolated attempts to restrict the working hours of obstetric units by induction and acceleration of labour have been opposed, both by the public and by the profession.The average gynaecological workload for England and Wales is probably around four major and 10 minor operations a week. The mean number of major operations in the South East Thames Regional Health Authority is three and a half by each consultant a week-ranging from three in one district where there are serious limitations on operating theatre space to five in another district where there is a relatively elderly population. Medical gynaecology is an important part of the gynaecologist's workload but is not easy to assess as ...

Can out‐of‐hours work by junior doctors in obstetrics be reduced?

“…There are two principal types of doctor involved. The majority are on general practice vocational training programmes and do not intend to pursue a career in the speciality (Hill et al 1983). In many hospitals very few SHOs will have more than 6 months experience while the small number who plan to stay in the specialty may have been working in obstetrics for 3 or more years.…”

“…In many hospitals very few SHOs will have more than 6 months experience while the small number who plan to stay in the specialty may have been working in obstetrics for 3 or more years. The limited ability and experience of the SHO has led some consultants to advocate that it is essential to have resident registrars (Hill et al 1983), although others have argued that a consultant SHO team is acceptable (Pentecost, 1983).…”

Hours of Work of Junior Hospital Doctors: Is There a Solution?

“…A review of obstetrics in South East Thames Region [26] argued that 24-hour cover by a registrar was essential for all busy labour wards. There is general agreement that the work of a consultant in a two-tier unit is greater than in a three-tier unit.…”