Journal of the Royal Society of Medicine
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There is much ambiguity about consultant leave allowances and arrangements for cover in the National Health Service. We analysed job descriptions for 47 consultant posts advertised in mid-2000. 35 defined a duty rota but only 3 mentioned specific available leave (all different). ⋯ This arrangement is particularly hazardous in surgical specialties. If elective surgery is to continue when the consultant is absent, arrangements for leave and cover need to be more clearly defined.
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A large and continuing increase in medical emergency admissions has coincided with a reduction in hospital beds, putting the acute medical services under great pressure. Increasing specialization among physicians creates a conflict between the need to cover acute unselected medical emergencies and the pressure to offer specialist care. The shortage of trained nursing staff and changes in the training of junior doctors and the fall in their working hours contribute to the changing role of the consultant physician. ⋯ Excellent bed management is essential. There must be guidelines for all the common medical emergencies and all units must undertake specific audits of the acute medical service. Continuing professional development (CPD) and continuing medical education (CME) should reflect the workload of the physician; that is, it must include time specifically focused on acute medicine and general (internal) medicine, as well as the specialty interest.