General medicine more important to hospitals

In medicine there is a move away from specialist working to more generalist roles treating acutely ill patients.

This is the key finding of the latest census of consultant physicians in the UK, produced by the Royal College of Physicians (RCP).

The annual census measures the number of consultants in all medical specialties. Acute Medicine saw the largest increase, with a dramatic 33% expansion. The specialty remains relatively small in real terms, with just 393 practising physicians, but this has leapt from 295 the previous year.

The massive increase in demand exceeds supply of trained acute medicine specialists. 41% of advertised acute medicine posts could not be filled due to a lack of suitably trained applicants.

The largest medical specialty is geriatrics, with 1,252 consultant physicians across the UK, representing 10% of the workforce.

The nature of patients presenting at hospital is changing. 65% of people admitted to hospital are over 65 years old and many have multiple complex conditions. Such patients require more generalist care, as highlighted by the RCP’s Future Hospital Commission report.

It has also prompted the health secretary to call for the development of ‘Whole Stay Doctors’, who can provide greater continuity of care to older patients.

There has been a marked increase in the provision of acute care by some specialties. Between 2011 and 2012, the number of renal medicine specialists contributing to acute care rose from 48% to 58% and the number of rheumatology specialists providing acute care shot up from 22% to 44%.

Specialities that have traditionally offer more general medicine continue to have a large number of consultants providing acute care, such as respiratory medicine (79%), endocrinology and diabetes (82%) and geriatric medicine (83%).

Dr Harriet Gordon, director of the RCP’s Medical workforce Unit, said: “NHS trusts are looking for more generalists, and those acute medical posts may have a secondary focus on a particular specialty. However, it is clear that the demand for more generalist physicians is not being met, with only 59% of acute medicine posts being filled.”