Double or quits: calculating how many more medical students we need

This policy brief by RCP registrar and president-elect Dr Andrew Goddard outlines new calculations for the number of doctors needed, and sets out key issues facing workforce planning in the UK that affect the current supply, future service demand and predicted losses in the workforce.

Despite loud calls from the profession for years, the realisation that the NHS is understaffed is only now dawning on those at the helm. The secretary of state for health and social care, Health Education England and NHS England have all accepted the need for more doctors.

Increasing the number of ‘home-grown’ doctors is a long process: any expansion of medical student numbers will only impact on consultant and GP numbers in 2030. Assuming we take this approach, how many more students do we need? While workforce planning is at best an inexact science – and at worst an oxymoron – it is possible to make an informed estimate.

Despite loud calls from the profession for years, the realisation that the NHS is understaffed is only now dawning on those at the helm.

Double or quits: calculating how many more medical students we need

The key is accurately understanding the three pillars of supply, demand and loss:

Current supply

Physicians make up around a third of all consultants in the UK, just over 15,700 of 47,800. Of these, 36% are women and 64% are men. 42% of the women and 10% of the men work less-than-full-time (LTFT). Those that work LTFT are contracted to work an average of 7.4 programmed activities (PA) compared to 11.4 for full-timers. That means a headcount of 15,700 equates to 14,510 FTE.

We also need to correct for the current shortage. Based on vacancy data, we are short of 2,330 consultants. Physicians make up a third of this, which means 760 heads or 630 FTE. This seems a reasonable estimate as there were 679 unfilled consultant physician posts advertised in 2017. Correcting for this shortfall, if our current workforce was replete we would have 15,140 FTE consultant physicians.

Future demand

An ageing population with associated multi-morbidity, increasing obesity, the explosion in genomics and new technology will all mean increased demand for doctors. Hospital activity - both emergency and elective - has increased by 3.6% per year over 12 years. If this continues, there will be an increase in demand of 47% between now and 2030. If we assume that consultant productivity will remain the same, we will need 7,120 more FTE consultant physicians in 2030.

We need to increase numbers quickly, but increasing student numbers to create 7,120 FTE in 1 year is unrealistic. If we look to spread the increase over 5 years, the number of FTE per year needed just for increased service demand is around 1,420.

There will be a 47% increase in patient demand by 2030

Losses

Losses occur either during training or from retirement. Due to consultant expansion in previous years, the numbers retiring will be higher by 2030, 680 retirements per year by 2030 - 460 more than currently. The increase in part-time or flexible working means that for 370 FTE now we will need 460 FTE doctors by 2030. A potential further 10% loss due to Brexit and other factors leads to an additional 60 FTE posts. This means we will need a total of 1,850 FTE consultant physician posts – this equates to 2,270 people.

Losses during training occur from entry into medical school to when consultants obtain their certificate of completion of training. 5% loss occurs during medical school, 3-4% immediately after qualification, at least 10% at the end of foundation training and around 5% in higher training. Putting this all together, we can approximate that the total loss from medical school to appointment as a consultant is 25%.

We will therefore need an additional 2,840 medical students per year for the next 5 years to create 2,270 additional consultant physicians in 2030.

Double or quits: calculating how many more medical students we need

How many medical students do we need?

Physicians

We will therefore need an additional 2,840 medical students per year for the next 5 years to create 2,270 additional consultant physicians in 2030.

All doctors

Physicians are just one third of the workforce: general practice, psychiatry and emergency medicine are all equally under pressure and have a similar shortfall. A reasonable estimate would lead to an additional 7,500 medical students needed at the very least.

Conclusion

Putting this all together, we can approximate that the total loss from medical school to appointment as a consultant is 25%. We will therefore need an additional 2,840 medical students per year for the next 5 years to create 2,270 additional consultant physicians in 2030.

While this seems a very large number, we have been conservative in some of my estimates. It becomes even more frightening when we remember that physicians are just one-third of the workforce: general practice, psychiatry and emergency medicine are all equally under pressure and have a similar shortfall. We have not done the maths for each of those but it seems a reasonable estimate to say that an additional 7,500 medical students per year will be needed at the very least.