The UK 2022 census of consultant physicians

The 2022 census of consultant physicians in the UK reiterates the need for long-term strategic planning to grow the medical workforce and for robust retention policies to reduce the pressure on existing staff.

The three royal colleges representing consultant physicians across the UK have long called for better workforce planning and an increase in the number of medical school places. In response to the results of the 2022 census, they have today urged the government to deliver the long-term workforce plan, with independently verified forecasts of the numbers of staff needed to meet demand in future, underpinned by the necessary funding.

Key findings

• Consultant posts are not being filled: 58% of consultant physicians reported having vacant consultant posts, with an average of 2.2 vacant posts per department. 81% reported that a consultant vacancy went out to advert but was not filled.
• Consultants are frequently seeing gaps in the trainee rota: 69% of consultant physicians were aware of gaps on trainee rotas either daily or weekly.
• Rota gaps are impacting patient care: 73% felt rota gaps had impacted patient care, with reduced access to outpatient care (26%), inpatient care out of hours (23%) and increased length of stay (23%) the most commonly cited impacts.
• Consultants continue to work beyond their job plans, with 86% saying they routinely work more than their job plan – most commonly to do administrative work related to patient care (68%) or to provide direct patient care (54%).
• Less-than-full-time working continues to grow: 28% of consultants are working less than full time, with over half (53%) saying they’d like to reduce their programmed activities (PAs). The census projects that by 2027, a third (31%) of consultants will be working less than full time. A quarter (25%) of higher specialty trainees are also working less than full time.
• Almost a third of consultants are either working flexibly or less than full time, underlining the importance of workforce planning in full-time equivalent (FTE) rather than headcount.
• Consultants feel their workload is unmanageable, with almost a fifth (18%) saying they almost never feel in control of their workload and 19% at risk of burnout overall. Only a third (34%) said they felt in control of their workload almost always or most of the time. 44% of consultants said they had an excessive workload almost always or most of the time and 41% said they worked excessive hours.
• But the majority of consultants still feel valued: 84% say they feel valued by patients, 77% by their medical colleagues and 74% by their non-medical colleagues.
• Leadership roles are key to job satisfaction: 47% said they had an additional leadership role (either clinically or in education). While 50% said they did not feel it was recognised in their appraisal, 72% said they enjoyed their job more due to a leadership role.
• And consultants would still recommend their workplace, with 79% saying they’d recommend their workplace to other consultants, 84% saying they’d recommend their workplace to trainees, and 80% saying they’d recommend it to SAS doctors. 81% said they would recommend their workplace to their friends and relatives if they were patients.

Who are consultant physicians?

A physician is a medical doctor who usually focuses on the non-surgical treatment of patients’ conditions, such as outpatient care and diagnostic investigation. Consultant physicians are senior hospital doctors working across over 30 medical specialties from cardiology, gastroenterology, respiratory and geriatric medicine to clinical genetics and sports and exercise medicine.

The three royal medical colleges of physicians represent around 50,000 physicians worldwide.

Who are higher specialty trainees (HSTs)?

Physician HSTs are doctors in training who are hoping to gain certification through the JRCPTB (Joint Royal Colleges of Physicians Training Board), which oversees the training in physician specialties. There are currently 6,825 doctors in these higher specialty training positions in the UK based on data provided by the Joint Royal Colleges of Physicians Training Board (JRCPTB) and we can report some data from this cohort.

Who makes up the UK physician workforce?

• Most physician consultants are employed by the NHS (78%). 15% are on an academic contract, 3% on a joint NHS contract (for example, a hospice) and 4% are ‘other’ (specialist societies, royal colleges).
• 48.59% describe their ethnicity as White British, 29.6% Asian/Asian British, 2.56% Black/Black British, 2.22% mixed ethnicity, 2.52% White Irish, 10.17% White other and 4.29% other.
• 85% work in England, 8% in Scotland, 4% in Wales, and 3% in Northern Ireland.
• Women make up 41% of the consultant physician workforce and men 59%. On current trends, women will make up 46% of the consultant physician workforce by 2027.
• Women make up 51% of higher specialty trainees. There have been more women than men in training since 2013.

Workload

• 92% of consultant physicians have a current job plan. 89% of consultant physicians had their job plans reviewed or agreed in the last year.
• 86% of consultant physicians said they routinely work more than their job plan – most commonly to provide direct patient care (68%) or to do administrative work related to patient care (54%).
• Almost a fifth (18%) said they almost never feel in control of their workload. Only a third (34%) said they feel in control of their workload most of the time or almost always.
• 44% of consultant physicians said they had an excessive workload almost all or most of the time and 41% said they worked excessive hours.
• Consultant physicians on full-time and less than full time contracts work on average one PA more than they are contracted. On average full time consultant physicians contracted to work 11 PAs work 12 PAs; those on a less than full time contract work 9 PAs versus the 8 PAs they are contracted to.
• From those reporting 3 or more high scores on the Maslach burnout inventory, 19% of consultant physicians were at risk of burnout overall.

Less-than-full-time working

• 28% of consultants work less than full time. The census projects that by 2027, a third (31%) of consultants will work less than full time.  
• If we also take flexible working into account, just under a third (30%) of consultants either work flexibly or less than full time. This breaks down into 45% of female consultants and 18% of male consultants.
• According to the 2022 UK census, 49% of female consultants aged 35–44 work less than full time compared with 10% of male consultants in that age bracket.
• LTFT working is most common in the older than 65 bracket, where 66% work LTFT.
• A quarter (25%) of HSTs worked less than full time in 2022. In 2021, it was 18%. We will monitor the reasons for this change.

Types of work undertaken

• Based on the 4,477 survey responses from current practising NHS physicians, 45% say they do some general or acute medicinal care. This appears to be a reduction from 55% in 2021.
• 43% say they usually provide care for general (internal) medicine inpatients and 35% say they usually participate in the acute unselected medical take.

Remote working

• 84% of consultant physicians said they already undertake some remote work; 16% said they did not.
• The most common types of work undertaken remotely were administration related to patient care (76%), CPD (75%), education (45%), audit/quality improvement (41%) and meetings to discuss patient care (40%).
• Just over a quarter (26%) carried out outpatient clinics remotely.
• Of the 16% of consultant physicians not currently undertaking remote work, over half (53%) said they wanted to undertake remote work in the future; 47% of that cohort said they did not.

Leadership roles

• Almost half (47%) said they had an additional leadership role.
• 50% said they did not feel it was recognised in their appraisal and 50% said they did not have it included in their job plan.
• 72% said they enjoyed their job more due to a leadership role.

Working with physician associates

• 28% of consultant physicians said they worked with physician associates (PAs), most commonly in acute internal, stroke and respiratory medicine.
• Consultant physicians said the benefits of working with PAs included continuity of care for patients (79%), supporting medical staffing on the ward (64%), organisational knowledge being maintained within the team (54%) and allowing trainee doctors to attend more teaching (36%).

Feeling valued

• 77% of consultant physicians said they felt valued by their medical colleagues almost always or most of the time.
• 74% of consultant physicians said they felt valued by their non-medical colleagues almost always or most of the time.
• 84% of consultant physicians said they felt valued by patients almost always or most of the time.

Job satisfaction

• The majority (85%) said they their found their work in their specialty satisfying almost always or often.
• A third (33%) said they found their work in general internal medicine (GIM) satisfying almost always or often.
• This difference in job satisfaction between specialty work and general medicine is consistent with previous reports.

Recommending their organisation

• The majority (79%) said they would recommend their place of work to another consultant. 84% said they would recommend it to a trainee and 80% to an SAS doctor.

Sickness, CPD and annual leave

• 42% of consultants did not take all their annual leave.
• The majority of those who had not taken their full entitlement (52%) had one week left.
• The main reasons for consultants not taking all of their leave were either being unable to find cover or being too busy.
• 50% of consultants were off sick in 2022 – 69% of those were due to COVID.
• 80% took some continuing professional development (CPD) leave, with over half (52%) taking between 2–5 days.
• 41% of this CPD leave was not paid for by the provider – of those whose CPD leave was not provider-funded, 70% self-funded and 21% had access to charity, research or commercial funds.

The Medical Workforce Unit (MWU) of the Royal College of Physicians (RCP) conducts an annual consultant physician census on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG).

There are 23,937 physicians on the General Medical Council (GMC) register. We know that 21,182 of them are practising consultant NHS physicians in the UK. This year’s census survey was sent electronically to 19,187 consultant physicians and 5,244 (27%) responded. After removing retirees and those who had otherwise left medicine, 4,774 responses to the survey were from practising consultant NHS physicians.

You can download our data toolkit, which enables analysis down to a provider level. 

There is also a slide set that can be downloaded for use in presentations.