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Psychiatry - Athona

Where have all the SHO's gone?

11 posts in this topic

Since the last changeover back in August there has been an increased need for SHO's to cover vacant on-calls and long days around the country. We are receiving at least 10 requests per week from our contracted clients along with other MH Trusts. There has even been Trusts coming to us with vacant slots from changeover, with us supplying over a dozen SHO's into 3-6 month locum roles. After the MMC mix up I'm surprised there seems to be a shortage again.

Could anyone shed any light on where all the SHO's have gone?? Is it just no one wants to do these roles, or is there a shortage again?

Steve Anthony

Athona

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Hi Steve

I thought you knew the answer!! Just kidding!!

There is a reason why I believe you should have an answer to this question. The reason is you are an agency ie a business and we are doctors ie professionals just providing services (be it substantive/locum depending on individual circumstances).

After the above statement, if your answer is still, 'I don't know,' in all probability your agency is 'naive' in locum business.

Ok now I will give the answer to your question- Athona deviated significantly but rather naively from locum market practices by agreeing to supply 'cheap and innocent' doctors to the trusts on substantive contracts when the trusts were struggling to pay for agency locums.

I am afraid now there are no 'cheap and innocent' doctors to take up your roles. That does not mean there are no locum doctors!

Steve no disrespect intended.

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Thanks for your honest reply Kris, and I hope you are keeping well.

I would say that we have never deviated from the locum market, but more in the way of reacted to the market still within a locum capacity. We have always set ourselves out as being an honest & transparent agency, and where possible we will always try to match locum pay expectation, but as the Trusts are the ones who pay the rates this can sometimes be out of our hands. A locums interest is always at heart and we certainly don't look for 'cheap innocent' doctors.

After speaking with the majority of Trusts the feedback I have received is that their has been a number of positions being left vacant, which is why they have had to come out to agency and makes me pose the question.

I do always welcome any feedback.

Thanks

Steve

Athona

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I would have thought it was as follows - Historically the pattern was - overseas doctor comes into the country, sometimes with limited psychiatry experience, gets first SHO post in psychiatry, carries on as a locum SHO for a number of years after which they will be looking at midgrade posts. Thus there was a "steady supply" of people to do locum SHO posts.

These days immigration has dried up from Africa/India/Pakistan, but there has been an increase from Eastern Europe, these doctors however are coming over in the "first wave" so to speak, and are at all stages of their careers, consequently a lower proportion are willing to fill SHO posts, or happy to do so only for a limited period of time.

As there is still a low competion ratio for entrance to to CT1, most "native/already here" doctors who want to train in psychiatry, are on a training rotation anyway, leading to a lack of candidates from the local pool.

Ultimately the NHS is going to have to rebalance it's requirements for doctors to fit the training system as delivered, as if someone follows the "classic" career path of FY1 - FY2 - CT1 - CT2 - CT3 - ST4 - ST5 - ST6, with limited breaks from training having graduated from Medical School at 25ish, they will have a CCST at about 35. This means they will be working as a Consultant for about 25-30 years, but will only have worked as an SHO for 3 and "midgrade" for 3 years. The ratio of the time spent will be 1:1:8.

Even allowing for people falling out of the training, and late starters, the days of every consultant having juniors, have to be numbered. The maths doesn't allow for any other option, unless we continue to recruit juniors from abroad, and not allow them into training posts, the problem being the charge rate for a locum Staff Grade through an agency for instance is about what it costs to employ a consultant substatively (before anyone panics about our margins, remeber we have to charge VAT (generally)) So why not just expand the training programme and have more consultants.

My own views only - and I could be horribly wrong

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The simplest answer is: Psychiatry is not as attractive as other branches to medical students. As it was mentioned above visa restrictions means that outsiders couldn't come in and jobs remain vacant.

The other thing is, with the financial climate, trusts are keeping the jobs on locum for 6-12 month and trying to cut them after a while. Same situation with a number of consultant jobs happening across the UK.

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Views of my nonpsychiatric friends,

Psychiatry is not attractive to medical students because it doesnt appear scientific. To make the matters worse, psychiatric training is getting more intense with less direct clinical contact with patients. Too much emphasis being placed on leadership and management. People organise charity events with the sole intention of putting it on their CV/Portfolio. People are obsessed with publications which is perhaps the only way to say one candidate is better than the other in interviews. Thousands of publications are coming out each year yet the past 30 years have produced no significant discoveries, what are these changes leading upto? In psychiatry, If you have Good verbal skills, you can get away with substandard clinical skills.

If you go and speak to any psychiatrist, he will talk and behave as if he is the best because there is no tool to assess who delivers the best. One paediatrician went to the extent of saying that in psychiatry, you have three or four categories of medicines (antidepressant, antipsychotic, anxiolytic), most patients are given one from each category so whats the training fuss about?

In summary, this is how medics view psychiatry, psychiatric research and training is getting nowhere because it is like a headless chicken, lack of job satisfaction etc is driving candidates away from psychiatry. Many CT1 posts are left unfilled now and will remain so until government open doors for foreign graduates who will take it up only for financial reasons, only a fraction of those are really interested in psychiatry.

Edited by DKS
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well said DKS...

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Views of my nonpsychiatric friends,

Psychiatry is not attractive to medical students because it doesnt appear scientific. To make the matters worse, psychiatric training is getting more intense with less direct clinical contact with patients. Too much emphasis being placed on leadership and management. People organise charity events with the sole intention of putting it on their CV/Portfolio. People are obsessed with publications which is perhaps the only way to say one candidate is better than the other in interviews. Thousands of publications are coming out each year yet the past 30 years have produced no significant discoveries, what are these changes leading upto? In psychiatry, If you have Good verbal skills, you can get away with substandard clinical skills.

If you go and speak to any psychiatrist, he will talk and behave as if he is the best because there is no tool to assess who delivers the best. One paediatrician went to the extent of saying that in psychiatry, you have three or four categories of medicines (antidepressant, antipsychotic, anxiolytic), most patients are given one from each category so whats the training fuss about?

In summary, this is how medics view psychiatry, psychiatric research and training is getting nowhere because it is like a headless chicken, lack of job satisfaction etc is driving candidates away from psychiatry. Many CT1 posts are left unfilled now and will remain so until government open doors for foreign graduates who will take it up only for financial reasons, only a fraction of those are really interested in psychiatry.

still royal college thinks that it is the most toughest branch in the universe by keeping the pass rate low.

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I think a senior nurse with 6-12 months training in nurse prescribing can effectively run the clinics and ward. doctors can just supervise may be.. this way nhs can cut budgets

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I think a senior nurse with 6-12 months training in nurse prescribing can effectively run the clinics and ward. doctors can just supervise may be..this way nhs can cut budgets

Then you will have another Midstaff Hospital Fiasco

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