|The President writes - September 2013|
|Monday, 26 August 2013|
The political environment in surgery remains turbulent. The fall-out from the Francis Report will be with us for many years but one of the most obvious effects in the recent past has been the publication of surgical outcomes in all surgical disciplines, but for only one index procedure in each discipline.
There is, of course, no surprise that this has caused some disquiet in the surgical community. Any new departure inevitably raises questions about the quality of the data that is being used to assess surgeons. However, I think that we can be reassured that, though uncomfortable, it is merely the start of a process that should give us more clarity about our work, and also help our patients to be sure that any procedure they have done will be done to the highest standard possible.
I think we can also take some comfort from the fact that, while this is a process that affects surgeons at present it is because surgical procedures are the low-hanging fruit in outcomes assessment. As the process of measuring and assessing outcomes becomes more refined, I have absolutely no doubt that this process will expand to all medical disciplines. It is pretty certain that our physician colleagues are observing what is going on with some anxiety and no little interest.
Finding the balance
Although this has been a statement that I have heard regularly over the past 10 years, in surgery the data suggests that whilst we have seen an increase in the number of women entering surgical training, they have a higher attrition rate. Therefore, this growth has not translated into a significant increase in the number of female surgical consultants, which disappointingly remains well below 15% of the consultant population. In 2009, just over 4% of the UK surgical workforce was female, rising from 3.3% in 2006. Anecdotally, I have heard from a number of young female doctors that they would not consider a career in surgery because the demands on them are too great in terms of lifestyle and a failure to accommodate their legitimate desires to work part-time and have families. This is a concern for surgery as the medical graduate population is approximately 60% female and, frequently, the majority of academic accolades at medical graduations are achieved by women.
It may be that surgeons are ignoring wider changes taking place across the whole of medicine. However, we cannot afford to maintain such a blinkered approach to inevitable shifts in our environment. This has been most evident in the outcry against the European Working Time Regulations (EWTR). At their most beneficent, the EWTR are an attempt to ensure that the medical profession has the same rights as any other profession to engage in a fulfilling career and also to have a reasonable work-life balance. Perhaps we should take more interest in the way our workforce services are organised so that all our colleagues, both in training and in permanent posts, have a realistic and rational work-life balance.
The medical profession is not immune to the problems of alcohol misuse, suicide and marriage breakdown. As a profession, we have a responsibility under the General Medical Council to ensure the well-being of our fellow doctors, as well as our primary role of ensuring patients are cared for to the best of our ability. How we match these ambitions is a matter that will require our intelligent concentration as we look to shift from an all-consuming focus on work, which acts to the detriment of our family life. Providing a work style that accommodates a surgeon’s desire to have a family and be part of the development of that family applies not only to women but to the whole of the surgical workforce, both male and female. Leadership, teamwork and communication will be the keys to unlocking that particular secret. In this context we should note that the Francis Report recommendations certainly refer to leadership, teamwork and communication as being major features missing in the Mid-Staffordshire situation. Our response to this challenge is crucial, or surgery condemns itself to selecting its future surgeons from the minority of medical graduates, and not necessarily the highest achievers. If we allow women to lead the way, it provides all of us, whether male or female, with an opportunity to redress some of the imbalance between our professional and home lives.
A healthy workforce
Of course, it is also relevant to point out that a surgeon’s advice on exercise is more likely to be taken if the surgeon is practising what she (or he) preaches. When considering how best to deliver patient care, it can be easy to overlook the simple fact that we can look after our patients better when we also look after ourselves. Surgeons are sometimes guilty of pushing themselves too hard professionally at the expense of other areas of their lives. But our overall wellbeing as individuals comes to bear on our performance as surgeons. The shape of the surgical workforce is going to change over the next few decades and with that the way in which it trains and delivers service will also change. We should take this opportunity to both work and live better.