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Working differently in the shadow of COVID-19: the UK 2021 census of consultant, higher specialty trainee and SAS physicians

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Every year the Royal College of Physicians (RCP) conducts a 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). Our aim is to provide robust data on the state of the physician workforce in the UK. From this year the census also includes staff, associate specialist and specialty (SAS) doctors.

The 2021 census was conducted between 19 October 2021 and 16 December 2021. We received 5,943 completed forms for consultant, SAS and HST grades and confirmed data on an additional 14,027 consultants in the NHS.

Key findings

Please click here to watch a video presentation of Dr Sarah Logan, Director of the Medical Workforce Unit, providing an overview of the key findings from the 2021 census.

The census results for 2021 reflect a workforce emerging from a life-changing pandemic which will be remembered for the rest of every physician’s career. The way in which doctors want to work – and indeed are working – was already significantly different from just 10 years ago, but change has been accelerated by the response to COVID-19:

  • 52% of advertised consultant physician posts in England and Wales went unfilled last year. 74% of these were unfilled because of a lack of any applicants at all.
  • 18% of HSTs and 25% of consultants worked less than full time – the number of doctors working less than full time increases every year.
  • Full time consultants worked 10% more than they were contracted to, and those working less than full time worked 20% more, mainly due to clinical workload.
  • 20% of the current consultant physician workforce will have reached their intended retirement age by 2025. 44% of current consultant physicians will reach retirement age in the next 10 years. 32% of consultant physicians said they had brought forward their retirement age over the past year.
  • 76% of consultant and SAS physicians undertook some work remotely.
  • The pandemic continues to have a significant impact on training. 74% of HSTs reported missed training opportunities due to COVID-19, predominantly in outpatients and local teaching.

The demands on the physician workforce are increasing in an unsustainable way. Now more than ever, it is vital that we adapt and innovate in order to retain these doctors within the NHS. However, our efforts will continue to be hampered by a lack of workforce planning that takes into account demand to estimate the number of clinicians needed.

Next steps

We will continue to:

  • use the census data in our discussions with government about the need for accountability and transparency in workforce planning
  • work with government and our partners to double the number of medical school places, with a focus on regions with fewer doctors
  • work with the NHS in England to help develop the workforce strategy commissioned by the Secretary of State for Health and Social Care
  • highlight the urgent need for transparent job planning and scrutiny of the amount of work that goes unpaid
  • identify and promote ways of encouraging trainees to work in specialties and locations with the largest recruitment gaps
  • make the case for the UK to be accessible and welcoming to trainees and doctors from other countries.

We will also develop the census and our data collection and presentation so that we:

  • have a picture of the medical workforce by NHS Trust/healthboards
  • improve our understanding of specialty-specific workforce challenges
  • improve our understanding of the SAS doctor workforce
  • better understand the role of research in a physician’s career.

Further information

To view the data and learn more you can download Focus on physicians. If you would like to discuss a bespoke analysis of data by region or other factor, please contact us via policy@rcp.ac.uk.

The RCP Medical Workforce Unit independently verified consultant headcount by nation, specialty and demographics by checking with specialty representatives, the GMC and with consultants’ work locations.