THE EXPANSION OFCONSULTANT PROVISIONFOR THORACIC SURGERY

IN THE UK.

Peter Goldstraw.Royal Brompton Hospital,LONDON.

The Critical Under-Provision of Thoracic Surgery in the UK.

Up to 50 extra surgeonsare urgently neededto bring the UK up

to European Standards!

Joint Working Party of the BTS and SCTS, 2002.

The Critical Under-Provision of Thoracic Surgery in the UK.

Up to 50 extra surgeons are needed. Commensurate increase in beds and

infrastructure. Additional Training Posts in Thoracic

Surgery. Rethink Entry Pathways into Thoracic

Surgery.

Joint Working Party of the BTS and SCTS, 2002.

The Critical Under-Provision of Thoracic Surgery in the UK.

Joint Working Party of the BTS and SCTS, 2002.

10,654 major operation per year in UK.- 3,378 major resections for lung cancer.- 7,276 other major thoracic operations.- 16,739 minor thoracic operations.

150 major operations per year EU recommendations

= 71 WTE Thoracic Surgeons.

The Critical Under-Provision of Thoracic Surgery in the UK.

Joint Working Party of the BTS and SCTS, 2002.

If Lung Cancer Resections increase from 11% to 15%.- 12,000 major thoracic operations per year.

= 80 WTE Thoracic Surgeons.(presently about 40 Thoracic Surgeons).

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

1980:4,695 Lung Cancer operations.8,171 Major Thoracic operations.36 Thoracic surgeons.

2001:3,765 Lung Cancer operations.9,134 Major Thoracic operations.40 Thoracic surgeons.

Yes !These figures do not

give the whole picture.

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

In 1980:36 Thoracic surgeons undertook 30% of the thoracic work,supported by 130 Cardiothoracic surgeonswho also undertook 11,761 Cardiac operations.

In 2001:40 Thoracic surgeons undertook 50% of the thoracic work,supported by 160 Cardiothoracic surgeonswho also undertook 38,215 Cardiac operations.

Lobectomy for Lung Cancer: Surgeon Specific Indicator.

2,000 operations / yr (22% of majors). Undertaken by 122 surgeons (16.4/yr/surgeon).

Only 37 surgeons (30%) undertook >20/yr. 47 surgeons (39%) undertook <10/yr. 5 surgeons (4%) undertook only 1 that year!

1997/8

Annual Returns of the SCTS.

Cardiothoracic Surgeons have progressively,and understandably, reduced the amount of

Thoracic work they perform.

In some cases to the point wherethere are serious quality issues.

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

Resection rates for Lung Cancer in the UK are < 10%, less than half the rate achieved elsewhere in the EU and developed countries.

Cancer plan has increased the time surgeons spend in MDMs and at meetings.

Increased range of thoracic surgical treatment in other malignancies and in palliative treatment.

In Addition (1):

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

NSF increasing pressure on Cardiac provision and reducing further the support provided by Cardiothoracic colleagues.

Time spent on Audit, Training, Research and Clinical Governance increased for ALL Consultants.

Increasing specialisation by Cardiac surgeons.

In Addition (2):

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

A reduction in exposure to Thoracic surgery by trainees.

In Addition (3):

Less interest in Thoracic work as a Trainee.

Less competence and experience as a Consultant.

Trainees feel overwhelmed by the skills in which they have to achieve competence, and feel they have exclude some areas of practice.

“Single-handed” Thoracic posts carry arduous on-call commitments.

Most private income is in Cardiac surgery,

- Income suffers with a Thoracic practice!

IS THERE A CRITICAL SHORTAGE OF THORACIC SURGEONS?

In Addition (4):

EXPANSION OF CONSULTANT PROVISION FOR THORACIC SURGERY.

More British-trained Thoracic surgeons. Ideal solution, Slow process. 5 trainees in designated posts, ?5 more next year. All trainees have 1 yr in Thoracic in first 3 yrs.

Can we speed the process? Can we recruit “converts” from General

surgery? Can we “poach” overseas-trained Thoracic

surgeons?

EXPANSION OF CONSULTANT PROVISION FOR THORACIC SURGERY.

More support for Thoracic Surgeons? “New Age” Cardiothoracic surgeons? Less surgeons, more interest.

Thoraco-General Surgeons??

Specialist centres – an obligation and an opportunity for managers and surgeons.

A SPECIALIST THORACIC UNIT.

Within existing Cardiothoracic Departments? Sufficient WTEs for manageable rotas. Core of Thoracic surgeons supported by

Cardiothoracic +/- Thoraco-General surgeons. Minimum levels of total and individual activity. Dedicated infrastructure with specialist

support. Encouraged +/- Funded thru Cancer Plan?

Joint Working Group of EACTS/ESTS, 2001.

INTERNATIONAL FELLOWSHIP SCHEME.

Obstacles: xenophobia? Skill mix. GMC Specialist Register, experience

recognised, PMETB ?

Quick Fix.

Pump-prime Specialist Thoracic Units?

INTERNATIONAL FELLOWSHIP SCHEME.

Is it the best use of the money? Doubling the salary would soon fill the gaps!

Short-term solutions should not disrupt long-term plans. Trainees have made a long-term commitment.

Fixed-Term contracts should be enforced!