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President’s Bulletin: Where does the time go?

Updated on: 10 Sep 2021   First published on 10 Sep 2021

Author:  Dr Alastair McKinlay 

– hopefully into the BSG diary, shortly.

One of the BSG’s current projects is W3: Workforce, Workload, Worklife.

We were on track to take this forward in 2020, but as BSG members probably noticed, 2020 was not a normal year. For most BSG members, it meant a different work pattern from usual. Most people would not want to relive 2020 with all the worry and stress of the virus on the wards, the PPE shortages, and the horrors and joys of homeschooling.

Locked down and being forced to work from home when not required in the hospital also meant that people rediscovered the joys of regular walks, staycations, and binge-watching TV. In short, some people got a glimpse of what life might be like with more fixed hours and less time at work or in the hospital.  For some colleagues, their quality of life briefly got better, in some respects.  Then came 2021, the second wave, the second lockdown, the full impact of the waiting lists, and hundreds of stressed and worried patients. Not surprisingly, everyone is very tired and morale is low.

Even before COVID, some people were sounding warnings about the workload that gastroenterologists and hepatologists were expected to undertake. Dr. Nigel Trudgill, from the RCP Workforce Unit, himself a gastroenterologist, pointed out that we have one of the highest burnout rates of any of the medical specialties.  Dr. Harriet Gordon has argued cogently that, whilst increasing the number of medical school places is good in the long term, it does not solve the problem of an under doctored NHS if a cohort of senior consultants all retire early.  To paraphrase the old saying, a case of: “Jam in 15 years” – when the new students are fully trained, – “but no bread tomorrow,” if the experienced physicians all retire ahead of schedule.  Keeping people engaged and active as they approach the end of their careers is equally, and arguably in the short term more important, if we are to avert a workforce crisis.

It would be bad enough if we simply had a doctor crisis.  Nurses and AHPs have coped heroically with levels of stress rarely encountered outside the circumstances of war, but it takes its toll.  It is little wonder that many are deciding to move. Some between specialties, to experience something different.  Some back to education to improve their skill sets, which is highly commendable.  Some regrettably out of their professions altogether.

So what can we do?

W Edwards Deming said,

“In God we trust, but everyone else bring data to the table.” 

It is one thing to feel tired and overworked. It is another thing to prove it.

With this in mind, we have renewed our work on W3 and made some real progress.  The original concept had been to develop an app that would allow members to record their work activity and enable the BSG to gather some real-time data.  This would give us an insight into how gastroenterologists work and we would then extend the resource to include trainees and nursing colleagues.

We are making real progress.  Rather than ask members to maintain a complex ongoing diary, we will probably invite people to record 1-2 weeks of activity prospectively. It is likely that people will be able to continue to use the app for longer periods if they wish, perhaps to record their workload before job planning discussions, but for the purposes of the BSG, we want to make things short and simple, and if necessary, hold more than one census point in the year.

What do we hope to find out?

In addition to the obvious, like how much time we spend in clinics and doing endoscopy lists, we would like to have data on the hidden workload.  The administrative tasks like processing referrals and results, and how much time is spent doing this outside of contracted hours, or at home.

How much general medicine is done by gastroenterologists and how often are we on call?

Will it change the world? 

Probably not, but having some data is the first stage in trying to redress the work-life balance.  If W3 is to be successful, it will need buy-in from as many of our members as possible.

In the past, I used to think that time was like a great river that carried us through life towards the sea, or whatever you believe marks the end.  Now I think we are more like stones in the middle of a spate.  Within ourselves, we don’t change perceptibly, but life roars by us like a flood.  One day you wake up, the children have grown up, retirement suddenly seems close, and you think “where did it all go?”

Too many weekends sitting in the office talking to a Dictaphone.

Too many hours waiting for GI bleeds to arrive.

Too many extra sessions.

If the next generation of gastroenterologists, trainees, and nurses are to have any quality of life, we need to understand how this generation works.

W3 = workforce + workload = work life. 


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