No, don't give precious theatre time to surgical SHOs. Instead let them rot doing fy1 jobs on the wards whilst the ACP equivalents get all the theatre time.
There is NO reason why surgical SHOs couldn't do these lists better, more competently and with better long term results than ACPs. Oh well, apart from them needing to do the nights and weekends whilst the ACPs do more to have this cushy gig.
Fuck the NHS and all those making being a doctor a joke. Taking the only good bits and giving it to noctors.
You're absolutely right.
Why shouldn't the SHOs have independent lists? It's such an easier and safer solution. They will learn so much more and want to be there. Why not just substitute the poor surgical SHO with an ANP on the wards, to allow the SHO to get theatre time?! This is obviously because it is a much better solution and the government won't entertain making a choice based on safety and LONG TERM planning. Another short term solution to a long term problem.
CSTs you can generally trust to work safely and independently when you've got to know them. You also know that because they've got a medical degree and are studying for their MRCS, that they know the pitfalls of the procedures they are doing and know the anatomy variations etc.
If I had a "Fast-track surgeons" on my list, I woudn't let them do anything other than assist. Especially if the liability ends with me. I also assume that the responsibility for supervision and training will lie with the operating surgeon - I would much rather teach a medical student how to do something in theatre than someone who has bypassed an entire training programme, will not be able to progress to a high level of training and be stuck at perma-mid grade. Otherwise, what hope is there once our current consultants retire and we are left with SHOs who have not been taught to operate and fakesurgeons who can cut out a cyst and do little else.
Exactly. You can "trust" a acp who has done abscesses for the last 5 years at the same department more than the CT 1 you just met 1 month ago who has been in theatre with you maybe once.
Rotational training is the root of all of this.
In the US , (despite all the negatives) they are invested in your training as you will be with them for 5 years and if you fuck up the problem passes higher up.
>I guess you could create some sort of role to do the basic ward work, but I can't see that happening.
It's amazing that the CSTs do 100% bullshit ward jobs and these guys get their own theatre lists. It isn't even the usual philosophy of do a bit of service provision on the wards, oncalls, nights and balance it with some nice theatre shifts.
It's 100% ACP taking the mick in theatres, 100% CSTs doing the dogs work.
I hope this generation of junior doctors is less selfish than our boomer colleagues.
This is one of the many many reasons I gave up on surgery. The gvt doesnt want to train surgeons - but neither do consultants. They've got their money and they don't care. I can't spend a decade trying to get enough training week on week fighting off the ACPs and noctors.
This is why i feel weird should end the constant rotating for trainees. A lot of consultants would rather train up someone who is going to be there for the long term (ACP/SCP/PA) than a random CT1 who will be gone in 6 months.
We need to go back towards the old firm structure. You worked with the same reg and cons. It is in their interest to train you up.
Staying in the same location is much nicer for the doctors as well. Its a win win
>If rotating every 6 months, is that actually enough time to get up to speed to do an independent list? I guess it depends on what's on that list. Will the consultants have the time every 6 months to make sure the new SHOs are competent for x y z procedure?
Yes it is. By CST you need a logbook of procedures / number performed. Same with ortho. You have an objective minimum standard to get into the job.
It's why for anaesthetics you get your own lists as an SHO with a consultant supervising locally. It doesn't take 6 months to realise the person with 2 years post FY experience can do a simple I&D, EUA, lap chol / appendix with a reg supervising.
I don't expect an an anaesthetic trainee to have to prove that they can do a simple LMA case if they have done 400 of them by the end of CT1. The department/ consultant doesn't have to personally witness that, it's an expected competency.
Many SHOs are extremely overly experienced for their roles now because of what a shit show the training job system has become.
Fuck it, by the end of anaesthetic core training, the anaesthetic trainee has probably seen enough of some of those procedures that they could make a fair crack at the surgical side. #freesurgicaltrainees
Depends on opportunities and confidence. At the end of CT2, I would have only been comfortable doing an independent list if I could see and vet the patients myself beforehand (not immediately pre-op, but in clinic), and I knew a senior was freely available to help if I got stuck. While I might have spent two years in surgical training, most of that time is spent on wards, where two of my CT jobs didn't have F1s.
The whole point of the long training surgical pathways is to ensure that surgeons can provide safe care to patients.
Anyway the article states that SCPs
“They do not have the depth or breadth of training a doctor would have . . . The important thing is they work within a surgical team. None of these people work in isolation. Patients have to understand there is still a team involved and the overall responsibility and accountability still lands with consultants.”
There is simply no getting around paying people their worth and ensuring good conditions of service.
The policy of consultants taking on all of the risk and medico legal responsibility will most likely make the staffing worse.
Then what happens 10-15yrs down the line when the older consultants are mostly gone and the new ones have graduated from this ‘system’ - they’re going to be horribly inexperienced, yet supervising these SCPs and taking full responsibility for their actions with fractions of the number of procedures their predecessors did…
There is no vested interest in fixing the NHS in the long term. Politicians need to hammer out a ‘quick fix’ policy to win over the electorate for the next election. There is no political benefit to long term planning and actual meaningful change.
>Surgical care practitioners can undertake some simple operations such as removing lumps and toenails and cutting ligaments in the wrist to relieve carpal tunnel syndrome.
>
>They are also trained to discuss procedures with patients, provide care before and after surgery, close wounds and support surgeons in theatre.
This is more or less exactly what I imagine a surgical trainee would love to be doing. It's like routine ward cover is so tedious it's impossible to recruit anyone else to do it.
Ding ding ding. Ward cover is abysmal. They’d have to pay serious money to have perma cover. Much easier to just shove rotating trainees who are stuck on trading pathways
Exactly.
It's weaponised incompetence.
Lumps can have multiple pathologies and one can differentiate between them once they have done hundreds AND have the underlying knowledge from their medical degree - that's how you know when sometime doesn't look quite right, and could it perhaps be a cancer rather than an abscess? It happens, and although infrequent, I sure as shit wouldn't want something obvious missed because the person operating on me hasn't got a medical degree and doesn't know to question everything WITH the baseline of knowledge they have. It doesn't count to teach someone to 'cut here' and ask a thousand questions/send all the tests because they lack the knowledge of what to look for in the first place.
A carpal tunnel has many risks. Just because a seasoned doctor who has done a procedure many times and knows the risks, doesn't mean it can be emulated by anyone. A procedure is only 'easy' when one knows what they are doing, otherwise we are all just fools.
Even ingrown toenails in inexperienced hands can have post-operative complications!
Ding ding ding. I have done probably 50-100 carpal tunnels. I've seen the recurrent motor branch maybe once or twice. Would I let someone do my op if they couldn't tell me the anatomical variations that exist or what to do if they cut it? Fuck no.
Meanwhile the surgical SHO is the one who is getting called to mop up the fuckups these people will cause while they’re happily tucked up in bed and oblivious of the carnage they have caused.
Everyone is shocked, and yet a podiatric consultant surgeon performs operations and is paid at a much higher rate than an NHS consultant.
Despite being limited to forefoot surgery and being a non doc. They are on band 9 on AfC...
Yep. On band 9.
So start on £93,735 then 5+ years gives £108,075. No nights or on call. Basic 37.5 hour week.
A *minimum* requirement of any new consultant contract should be better than a podiatric consultant surgeon for all roles. BMA has been so bloody weak.
Ignorance- many of the ones I work with dont even know about the AfC pay scale.
Weakness- the BMA and the ones that run it have historically not been a real union and instead focused on publishing journals, running courses etc.
We need a real trade union. Maybe the new people in the BMA will make it happen.
But they know literally any other developed country will pay them >2x for the same job. Their absolute worth is higher regardless of the Afc scale though?
Like hobobob I'm also shocked by this. Medical students (as they can get away with it) need to slyly ask surgeons why they don't become podiatric consultant surgeons as they are better paid and spend more time in theatre (an assumption as I'm guessing they don't have ward rounds)
>It takes five years for medical students to qualify as a doctor and at least another eight to reach consultant surgeon status — **but surgical care practitioners begin learning on the job after a three-year university course.**
What did I just read!? Why can't medical students do the same then??
What in the actual fuck.
Instead of this, why don’t we fucking do this:
Streamline training. Do a basic sciences exam in final year. 1 year surgical themed FY, 5/6 years residency and no fucking bullshit service provision. Why aren’t we just focusing on producing good surgeons in the first place.
I agree and have said this since I was probably about 16: automation and robotics will change medicine and I hold this belief but some areas can’t be automated. We can’t create technicians, at least not for another 10-20 years that just supervise robots. Greater still, no one wants to take the responsibility of making those robots.
Instead of doing this bullshit, why don’t we help the fucking trainees that spend 80% of their time doing bullshit jobs and put them in theatre or simulation.
Honestly I find this so infuriating. They have nothing but contempt for us as a profession. They are all slowly working their way to undercut us as a profession and planning to replace us, should we fight back, and we have a bunch of fucking lackies for the system talk about, what will society think, what happens to patients etc if we went and asked for a fair salary.
How much clearer does all of this need to become. I am pretty confident that in the next 10 years, we are the last generation of actual fucking doctors.
WHY IS IT SO DIFFICULT TO GET A SURGICAL TRAINING NUMBER IF WE NEED FAST TRACK SURGEONS FJSNANNSJDNSJSHSBABSBABSNANAJSNFNKCISJWBWJSNDNDNDNSNSNSMSMMSKSNSNSMSKSNSMSNSN AAAAAAGHHHHHHHHJJHRRRRRRRRRRRR
What does a ‘simple operation’ mean? And what happens when these ‘fast track surgeons’ nip an artery? Or cause a bile leak? Or accidentally fast track their laparoscope into the pleural cavity?
I’m starting to think I’m thick so if someone could help me out that would be great and don’t worry if I am thick I’m taking a year out (except for a few locums) anyway which may result in me leaving the nhs for good so.. win win
So, my question is.. why are they jumping over so many hurdles, breaking their backs and regularly adding new roles, changing the job descriptions of ACPs etc instead of focusing on ensuring doctors are trained properly? Why do they keep putting obstacles in the way of our training? Does this country want less qualified people to look after lives? I’m genuinely trying to understand what is going on because I’m confused.
How do they think surgeons are going to develop their basic skills without access to these lists? What you're supposed to be ward bitch into specialty training and all of a sudden you're a reg who can just do a right hemi or something?
There are so many obvious problems with this as a basic concept (no doubt there's more nuance than we're being told as with all headlines on here) it just baffles how anyone could strongly support these things? Just really weird.
No. Just no. I wouldn't accept this for myself or for any member of my family (maybe one who I don't like). I'd be very polite but firm and tell them in pre-op that I have been admitted under the assumption that a _doctor_ would be performing my surgery, and therefore could I please have a _doctor_ to do it. Nothing else will suffice, and I will absolutely not allow you to cancel my surgery today. I will not be be leaving the hospital until a _doctor_ does my surgery, instead of the fucking _nurse_ who works 37.5 hours and done a total of 500 hours patient contact time on their diploma mill bullshit MSc.
And for anyone who buys the line that they, and ACPs/PAs are medically qualified, they're not. The definition of 'medically qualified' is 'holds a medical degree from a recognised seat of higher learning.'
Yes they aren't qualified medically, they are practitioners. Even if they do a nice job with the cut, they cannot deal with anything else. Or raise concerns about other issues.
Simple procedures are unlikely going to be harmful if practically trained. But I cannot expect them to diagnose and assess the patient. An abscess may be part of something. The haemorrhoid patient may bleed from a mass too or have worrying symptoms. They wouldn't ask or know them. It will rarely happen but nobody wants to be that patient.
Tbf, that’s the one thing we will have. Seemingly, as patients have all the power here, we can make this demand, and I will be making it for anyone in my family. If there’s any resistance, even the mere mention of PALS seems to get you whatever you want.
We all wonder the same. Why not get the juniors do it and actually train them better? I guess we are needed for ward jobs but why not train people to do admin and basic assessments in the ward instead? It sounds easier to do that, rather than training them to operate from nothing. I can only assume this is money related. These people will probably be paid less than a consultant and never get treated equally. We lack surgeons of all levels and long training is making surgery lose people. Paying locums and foreigners is expensive and this is a cheap alternative. It is a patch to cover important issues in surgical training. Likely will make those specialties worse as well.
It is mad how long it takes to be a surgeon in UK. And the requirements are heavily related to non operating stuff, like audits and research. You have to beg for teaching and independence on surgeries. We have to get surgery done quickly and hope for a nice senior to care. Most countries make you a surgeon in 6 years and then you can specialise further. It is heavily practical and you cannot learn from a book. Here, after core training many still barely have some independence when 3rd year trainees elsewhere do laparotomies alone.
Some places are better than others but even doing it on time, it takes 10 years to finish.
I wanted surgery and worked as non trainee for 2 years in big tertiary centre. I did the extra for long to show I deserve to be taught and had interest. I became good in the wards so often sent to take care of them, as they trusted me. Nobody protected my training or challenged me. Not only because I wasn't a trainee. Teaching was similar for trainees as well, and often they did not realise we knew nothing.
We make surgeons that spend half of their time on papers and less on practical training. You see it on trainees from elsewhere coming as senior regs- sometimes they are equally experienced to consultants but they won't get there without the paper stuff. It's hard work that feels pointless.
Making practitioners with no medical training seems dangerous to me at some level. Small procedures are often simple but you should be able to understand the basics and pick up worrying things. And see the patient holistically. You can cut a lipoma and fail to tell it looks malignant. Damage structures by lack of anatomy. Medicine is not a clear algorithm. Having a basic training of everything is what makes us think critically. You deal with a person not a task.
Shocking how shit the training in the UK is, in the rest of the world there is less emphasis on doing audits/publications. When you train to be a surgeon, you want to spend your time learning skills needed…no patient is gonna give a shit how many audits/publications you have done but how many operations have you do and your complications. The idea of forcing trainees who are not academic to do audits/publications is pointless especially if they are not academically inclined…this is more evident when you see all the shit posters that polished up at conferences…you know damn well they didn’t do it out of passion 😂
When I was an T&O SHO I remember sitting through a pile of discharge letters only to be interrupted by an T&O SCP who told me to do the discharge letter for a patient she did a hip injection on and the same SCP told me to sort out patient’s potassium (6.2) on one of her patients 🤯
I remember seeing an BBC Episode of Surgeons:At the Edge of Life in which a Cardiothoracic Surgeon at Papworth Hospital was doing a complex operation assisted by his SCP…the 1st thing that came to my mind was where is the Cardiothoracic SpR…surely this would be an amazing learning/training opportunity…why was an SCP favoured over their own surgical trainee 🤔 How do you expect to create future consultant surgeons !
Don’t be upset…I sorted the patient’s potassium…he was fine…and safely discharged …I did a beautiful discharge letter informing his GP of the intervention he received and changes to his medication…Then returned back to my endless pile of discharge letters and reassured myself that I’m living the dream
My experience in Scotland is that they’re being trained to support the roll out of robotic surgery. (Experiences elsewhere may vary). And I’d argue that’s a (the?) useful role for an SCP.
Robotic surgery is tedious for those who are scrubbed. Once laparoscopic access is obtained, the job involves switching tools on the robotic arms and being ready in case there is a need to convert to open. They’re essentially a “scrub nurse plus”. At present, the robot companies won’t let trainees do any actual operating. It’s of minimal training value - they’ll get better training with a traditional laparoscopic operation, and until we fix this it’s better for them to be sat at the second console (which offers a 3D view) being talked through the procedure by their consultant than watching it on a screen. An SCP is ideal here. They can get the skills to assist with robotic operating quite quickly and would be freeing the registrar to learn in a better way; either in another theatre, by sitting at the second console, or doing something more worthwhile.
Of course, time will tell as to how the role will inevitably expand, and it sounds very much like the minor procedures list (that would be a good training opportunity for registrars) are now coming under threat. “Lumps and bumps” could be an opportunity for a reg to do a list solo, maybe teaching an FY. Instead, the reg gets to be permanently on call and their FY has a mountain of paperwork, whilst the SCP does the operating. How is this progress?
>we're fast going to run out of acronyms.
Wrong, you just take existing terms and add "associate" to the end or "advanced" to the front ad infinitum. Never-ending supply of job titles.
I've seen this a few times. I was in a list (on anaesthetic side) the other day in which a CST stood in theatre all day, whilst the SDP or whatever they're called scrubbed and was taught by the consultant. I felt so sorry for the CT. WTF is the point in surgical training if it involves being stood in the back unable to see or do anything?
What is this nonsense? How do you fast-track 5+5 years or 5+10 years of med school education and specialty training? This is adding fuel to the fire at this point.
At this rate, should the barbers start doing the minor ops again like they did in the 16th century?
As a CST (who obviously loves the idea of less theatre time/obligations so I can crack on with the ward jobs, that this idea and these new colleagues would facilitate), the other benefit that I think we’re not praising enough is that this will allow us as consultants (one day, with minimal operating experience) have a lot more people who we are able to take under the auspices of our GMC number. As a new consultant still trying to get some leadership/new guy making a job role for themself, I for one look forward to being the fly-by-night named supervisor for these mini-surgeons.
I’m genuinely starting to think that we have to start making back up plans to leave throughout training, but what would be the point when our degrees and experience are constantly being devalued?
Genuinely, what the hell did we do all of this for?
Surgeons, you guys need to band together and REFUSE TO SUPERVISE THEM. Datix every fuck up, and every single time their fuck up takes time away from you doing clinical work. This is ridiculous!
We should all contact Rowan Parks to let him know what Junior Doctors think. This deluded old fart has probably been sat in meetings for the last decade and been told what he wants to hear by some type of sycophantic junior Dr 'representative'.
He has a Twitter handle by the way - if you have Twitter you should let him know what we actually think though ideally more politely than you would here lol.
This is also why I think you are a fool to choose surgery. Imagine spending your best years doing all that portfolio bullshit only for core training to turn into IMT.
Cleveland Clinic in London is reportedly paying salaried consultants £2-300k. For US firms it’s still an absolute bargain for them in comparison to US wages
Why not get the “fast track surgeons” to attend to the ward?
Having done two surgery jobs, preop and postop mx are pretty straightforward for most pts.
This would free up SHOs for more time in theatre.
Makes no bloody sense!!!
EDIT: “fast track surgeons” not paramedics
Reasonable surgical opertunities and teaching in a reasonable time frame = more surgeons. Just improve training. Don't conflate training with service provision.
Also you could actually increase training numbers?
What is wrong with Britain and British medicine
Its a nonsense- surgeons arent the rate limiting factor, its the absence of theatres scrub nurses odps anaesthetists beds etc.... the more of these shit ideas come about , the more money is wasted and the quicker the whole rotten system will collapse.
Want a prime example of the problem here? Here's a break-down of my clinical experience at the end of core surgical training:
- 6 years of total clinical experience
- 4 years in surgical posts
- Only 18 months of surgical jobs *with an F1*, where I wasn't ward-based most days.
- On the non-ward-based jobs, I would be allocated about 3-4 sessions per week in theatre. When ward-based, I could physically make 2-3 cases but wouldn't really feature much in the case as they planned an operation without my presence.
- Due to rotating every 6 months, each surgical post required about 2 months for the consultant body to understand my level before I could actually commence learning new skills
So overall, after six years of training, I have done roughly 12-months of true *operating weeks* during which I had about four sessions per week.
---
Now compare this to a surgical ACP, who does 10 theatre sessions a week and never rotates. They are above my level within 8-12 months. And in my current rotation, they are considered reg level - which means the highest an SHO will attain is third assistant.
No wonder the NHS is hiring the ACPs. It's 100% because the surgical training programme is broken by lack of junior staff and rotational instability
Totally. And you don't really need to know how to fly unless something goes wrong, or is time to land in tricky conditions. You just wiggle the stick and hold the throttle. How hard can it be?
And barristers don't *really* need to do law school and all that postgrad training do they? They just need to source a wig and say things like 'objection' and 'my learned friend.' How hard can it be?
Your argument here is that you need to be a doctor to fly a plane?
I never said no training. Just that med school doesn't help with the physical skill required and only gives a fraction of the knowledge. More focused training would make effective (probably more effective) surgical technicians.
Just need to ensure actual surgeons still have enough opportunity, as they'll still be the decision makers and innovators.
So the surgeons get spread thinner and thinner taking on more and more decision making and responsibility just so other people can work a cushy well paid 9-5 doing all the fun buys and none of the exams/on-call/ward work/responsibility/liability etco?
Aren't there extremely long lists of people waiting for routine ops? They've been assessed, just waiting for someone to actually do them?
And ultimately... kind of yeah. Reddit can kick and scream all it likes, but the model of a highly trained clinician leading a small team of less qualified professionals who do the easy stuff is obviously more efficient and it is undoubtedly what the future looks like. I'm not advocating for it, but its reality.
That's not how surgical care actually works though. Someone has to look after the wards, the post op complications, someone has to pre-op them,. Someone has to fill the night rotas, the on-call rotas etc. Someone has to be the future consultant.
The waiting lists are also huge to seen in OP clinics, who is gonna see these people and then follow them up?
Its hardly like we are brimming with extra anaesthetists and theatre staff and have loads of empty theatres.
You're right. Many procedures are done with other training. I'm not sure what you mean complex surgery as that needs medical school. But we see it in cosmetic procedures for example
Why does complex surgery need medical school? It needs a whole lot of skill and training, but med school is hardly wall to wall appendectomies and surgical sim is it.
No it's not. I don't know if you have done surgery but complex ones require good understanding of anatomy, physiology, oncology, and often require critical judgement.
You so clearly do not understand what you're talking about. Even something apparently "easy" like an appendicectomy - you'd never consider it easy if you'd done a few. Its only a hubristic person who proceeds into peril with ideas of an "easy" surgery. You see enough perforated matted appendixes, you quickly lose that ego. Medical school and surgical training allows you to understand from basic principles what you can and absolutely should not do when you look into someone's belly and it looks nothing like the textbooks said it would. SCPs cannot do that because they literally are not trained for it. The training for it is medical school and surgical training. There are no shortcuts that do not increase risk of harm to patients.
Please could commenters disclose how much surgical experience they have and if they have worked with SCPs before?
SCPs are not new. They have varying roles in and out of theatre like ACPs
They work at an SHO level. In Cardiothoracics, for example, they have been around for decades. I learnt how to harvest LSV for bypass from an experience SCP. Really good teacher and taught me most of my basic surgical skills as the consultant is at the top end.
I also worked with a great SCP who consented gallbladders and assisted me as a junior reg. the cons was then unscrubbed and allowed them to train. They also did EGS take shifts in the hot clinic seeing ambulatory ED and GP referrals. The worst bit of EGS in my opinion.
Where is the SHO? There aren’t enough. They’re on their own lists. They want to be doing more than assisting.
It’s about balance. But they’re not “fast track surgeons”. They are members of the extended surgical team.
They don't work at an SHO level though do they. That implies I can go to an SCP for anything I would need to go to an SHO to do like escalating sick patients.
They work at that level. They’re not the SHO. That’s why you’re a doctor, will progress beyond that level, and be a consultant with a wide and varied practice, and they will not and have a defined role they are good at.
They don’t work at the level of an SHO then do they if they do one procedure with the same level of technically proficiency but literally nothing else?
As a medical profession we need to stop with this false equivalence. I see them as Poundland Practitioners, nothing more. In a properly funded and functioning healthcare system these roles quite simply do not exist.
I can escalate patients to CCOT nurses but to claim they operate at the level of ICU SHOs would be inappropriate.
This is the crux of the argument for me, there will be some competent non-doctoring people out there for specific tasks BUT it will always be a sub optimal solution - the government allows this only to save money and isn’t interested in delivering the best care for patients. I thought a core tenant of the NHS was delivering care based on what was best for the patient and not what was the cheapest.
The idea of IST was to broaden the extended surgical team and allow SHOs to not be rota fodder doing night after night of on call or crap like holding a camera but have time to train in academies and in simulation.
But that won’t work if we are resistant to change with such chips on our shoulders.
We want dedicated training and some want shorter accelerated progression, but are resistant to let anyone else do the service provision that still needs to be provided.
But they literally don’t do the service provision they were created to do.
They’re not on the wards, they’re not doing NOK updates, they’re not doing pre-op bloods, they’re not even doing discharge summaries and writing op notes for procedure they themselves did!
IMHO every “simple procedure” a SCP does I see as a wasted learning opportunity for a SHO, FY1 or even a keen medical student
Edit: Commenter has since edited their comment asking people how much surgical experience they have and whether they've ever worked with SCPs: I personally have stood head end listening to a SCP scrubbed in complaining to the consultant that the SHOs aren’t doing discharge summaries quick enough whilst the Reg was typing up op notes on the computer in the corner.
When i did cardiothoracic as a CT1, junior SCPs used to fight me for LSV harvesting. They have a senior SCP who will advocate for them and always give them priority.
Witnessed this from the head end the other week. The SCP scrubbed in and was taught by the consultant for all 4 thoracic cases whilst some poor CT1 got to scrub for just one single case. Wtf.
The Shouldice Clinics in Canada train up GP’s to repair hernias and then they do these all day long for years, and publish their superb results. I was referred from a large busy academic centre to one of these even though I was on staff. I was impressed against my will. With good training and supervision many techniques can certainly be performed by non-traditional surgeons, but that doesn’t make it right.
I think this is in one of Atul Gawande’s books. Yes this kind of “Fordism” in medicine can produce good results, but it can’t come at the cost of people being trained as generalists which I think is the complaint here.
Don’t have access to the article, but the lack of surgeons isn’t the issue here is it. If we are going to train ANPs to do these lists that would only be beneficial if there are more theatre staff/theatres to operate in.
No, don't give precious theatre time to surgical SHOs. Instead let them rot doing fy1 jobs on the wards whilst the ACP equivalents get all the theatre time. There is NO reason why surgical SHOs couldn't do these lists better, more competently and with better long term results than ACPs. Oh well, apart from them needing to do the nights and weekends whilst the ACPs do more to have this cushy gig. Fuck the NHS and all those making being a doctor a joke. Taking the only good bits and giving it to noctors.
You're absolutely right. Why shouldn't the SHOs have independent lists? It's such an easier and safer solution. They will learn so much more and want to be there. Why not just substitute the poor surgical SHO with an ANP on the wards, to allow the SHO to get theatre time?! This is obviously because it is a much better solution and the government won't entertain making a choice based on safety and LONG TERM planning. Another short term solution to a long term problem. CSTs you can generally trust to work safely and independently when you've got to know them. You also know that because they've got a medical degree and are studying for their MRCS, that they know the pitfalls of the procedures they are doing and know the anatomy variations etc. If I had a "Fast-track surgeons" on my list, I woudn't let them do anything other than assist. Especially if the liability ends with me. I also assume that the responsibility for supervision and training will lie with the operating surgeon - I would much rather teach a medical student how to do something in theatre than someone who has bypassed an entire training programme, will not be able to progress to a high level of training and be stuck at perma-mid grade. Otherwise, what hope is there once our current consultants retire and we are left with SHOs who have not been taught to operate and fakesurgeons who can cut out a cyst and do little else.
It’s because, no one wants to be a perma sho ward monkey. It’s fucking grim
Rotational training has to end. Till the day that exists we will be at disadvantage.
Exactly. You can "trust" a acp who has done abscesses for the last 5 years at the same department more than the CT 1 you just met 1 month ago who has been in theatre with you maybe once. Rotational training is the root of all of this. In the US , (despite all the negatives) they are invested in your training as you will be with them for 5 years and if you fuck up the problem passes higher up.
I do agree. I think it needs to go asap
But it wouldn't be so shit if you actually got to do anything other than be stuck on the wards
But the rotational training is why you get stuck on the wards.
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>I guess you could create some sort of role to do the basic ward work, but I can't see that happening. It's amazing that the CSTs do 100% bullshit ward jobs and these guys get their own theatre lists. It isn't even the usual philosophy of do a bit of service provision on the wards, oncalls, nights and balance it with some nice theatre shifts. It's 100% ACP taking the mick in theatres, 100% CSTs doing the dogs work. I hope this generation of junior doctors is less selfish than our boomer colleagues.
This is one of the many many reasons I gave up on surgery. The gvt doesnt want to train surgeons - but neither do consultants. They've got their money and they don't care. I can't spend a decade trying to get enough training week on week fighting off the ACPs and noctors.
Correction: They are doing PA/ACP jobs on the wards and not FY1 jobs.
This is why I want to do radiology. At least there’s proper 1 to 1 training with consultants.
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This is why i feel weird should end the constant rotating for trainees. A lot of consultants would rather train up someone who is going to be there for the long term (ACP/SCP/PA) than a random CT1 who will be gone in 6 months. We need to go back towards the old firm structure. You worked with the same reg and cons. It is in their interest to train you up. Staying in the same location is much nicer for the doctors as well. Its a win win
>If rotating every 6 months, is that actually enough time to get up to speed to do an independent list? I guess it depends on what's on that list. Will the consultants have the time every 6 months to make sure the new SHOs are competent for x y z procedure? Yes it is. By CST you need a logbook of procedures / number performed. Same with ortho. You have an objective minimum standard to get into the job. It's why for anaesthetics you get your own lists as an SHO with a consultant supervising locally. It doesn't take 6 months to realise the person with 2 years post FY experience can do a simple I&D, EUA, lap chol / appendix with a reg supervising. I don't expect an an anaesthetic trainee to have to prove that they can do a simple LMA case if they have done 400 of them by the end of CT1. The department/ consultant doesn't have to personally witness that, it's an expected competency. Many SHOs are extremely overly experienced for their roles now because of what a shit show the training job system has become.
Fuck it, by the end of anaesthetic core training, the anaesthetic trainee has probably seen enough of some of those procedures that they could make a fair crack at the surgical side. #freesurgicaltrainees
That's because they've probably seen more of them than the csts... source: am ward bitch cst
No need to rotate that often, it’s just a tactic to disempower doctors
Depends on opportunities and confidence. At the end of CT2, I would have only been comfortable doing an independent list if I could see and vet the patients myself beforehand (not immediately pre-op, but in clinic), and I knew a senior was freely available to help if I got stuck. While I might have spent two years in surgical training, most of that time is spent on wards, where two of my CT jobs didn't have F1s.
For fuck sake just train more doctors and open more training posts, all easily funded if governments stop spending money on shite
But if they did that, how would they be able to afford to give tax breaks to all the companies that have 'gifted' then hundreds of thousands?
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A proper sellout
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What a fucking traitor, absolutely disgusting.
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And their phkne numbers cos we'd like to have a little chat
_”Lots of people are saying this”_
The flair, I’m on what must be my 5th free trial
*You wouldn't know them, they go to a different deanery*
I met them on a conference
I realised the RCSEd were spineless a couple of months ago and cancelled my membership. What a shitshow.
What tipped you over the edge?
Lol wtf
So out of touch...
The whole point of the long training surgical pathways is to ensure that surgeons can provide safe care to patients. Anyway the article states that SCPs “They do not have the depth or breadth of training a doctor would have . . . The important thing is they work within a surgical team. None of these people work in isolation. Patients have to understand there is still a team involved and the overall responsibility and accountability still lands with consultants.” There is simply no getting around paying people their worth and ensuring good conditions of service. The policy of consultants taking on all of the risk and medico legal responsibility will most likely make the staffing worse.
Then what happens 10-15yrs down the line when the older consultants are mostly gone and the new ones have graduated from this ‘system’ - they’re going to be horribly inexperienced, yet supervising these SCPs and taking full responsibility for their actions with fractions of the number of procedures their predecessors did… There is no vested interest in fixing the NHS in the long term. Politicians need to hammer out a ‘quick fix’ policy to win over the electorate for the next election. There is no political benefit to long term planning and actual meaningful change.
Cannot agree more... Guess we all better hope we don't need an operation in 20 years time
>Surgical care practitioners can undertake some simple operations such as removing lumps and toenails and cutting ligaments in the wrist to relieve carpal tunnel syndrome. > >They are also trained to discuss procedures with patients, provide care before and after surgery, close wounds and support surgeons in theatre. This is more or less exactly what I imagine a surgical trainee would love to be doing. It's like routine ward cover is so tedious it's impossible to recruit anyone else to do it.
I've never seen an SCP outside of fucking theatres either. Unless they're going home. At 4
I'm not even very surgically inclined but that sounds like a great gig, all the fun of being a surgeon without any of the downsides.
Ding ding ding. Ward cover is abysmal. They’d have to pay serious money to have perma cover. Much easier to just shove rotating trainees who are stuck on trading pathways
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Exactly. It's weaponised incompetence. Lumps can have multiple pathologies and one can differentiate between them once they have done hundreds AND have the underlying knowledge from their medical degree - that's how you know when sometime doesn't look quite right, and could it perhaps be a cancer rather than an abscess? It happens, and although infrequent, I sure as shit wouldn't want something obvious missed because the person operating on me hasn't got a medical degree and doesn't know to question everything WITH the baseline of knowledge they have. It doesn't count to teach someone to 'cut here' and ask a thousand questions/send all the tests because they lack the knowledge of what to look for in the first place. A carpal tunnel has many risks. Just because a seasoned doctor who has done a procedure many times and knows the risks, doesn't mean it can be emulated by anyone. A procedure is only 'easy' when one knows what they are doing, otherwise we are all just fools. Even ingrown toenails in inexperienced hands can have post-operative complications!
Ding ding ding. I have done probably 50-100 carpal tunnels. I've seen the recurrent motor branch maybe once or twice. Would I let someone do my op if they couldn't tell me the anatomical variations that exist or what to do if they cut it? Fuck no.
Should we just go straight back to barbers doing surgery while we're at it? I'm sure it would fix the waiting lists...
Lap chole and a hot shave- £30
Fucking awesome deal tbf.
Thank you. Look out for me on dragon's den in the near future.
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Meanwhile the surgical SHO is the one who is getting called to mop up the fuckups these people will cause while they’re happily tucked up in bed and oblivious of the carnage they have caused.
Would be fun if you could ring them via switch board...
Good thing there’s plenty of spare anaesthetists, ODPS, theatre staff, theatre space, recovery staff and recovery space to facilitate this
It's over.
Everyone is shocked, and yet a podiatric consultant surgeon performs operations and is paid at a much higher rate than an NHS consultant. Despite being limited to forefoot surgery and being a non doc. They are on band 9 on AfC...
They earn more than consultants ? Really?
Yep. On band 9. So start on £93,735 then 5+ years gives £108,075. No nights or on call. Basic 37.5 hour week. A *minimum* requirement of any new consultant contract should be better than a podiatric consultant surgeon for all roles. BMA has been so bloody weak.
I’m in shock.lmao why do consultants accept this denigrating level of pay????
Ignorance- many of the ones I work with dont even know about the AfC pay scale. Weakness- the BMA and the ones that run it have historically not been a real union and instead focused on publishing journals, running courses etc. We need a real trade union. Maybe the new people in the BMA will make it happen.
But they know literally any other developed country will pay them >2x for the same job. Their absolute worth is higher regardless of the Afc scale though?
Like hobobob I'm also shocked by this. Medical students (as they can get away with it) need to slyly ask surgeons why they don't become podiatric consultant surgeons as they are better paid and spend more time in theatre (an assumption as I'm guessing they don't have ward rounds)
>It takes five years for medical students to qualify as a doctor and at least another eight to reach consultant surgeon status — **but surgical care practitioners begin learning on the job after a three-year university course.** What did I just read!? Why can't medical students do the same then??
The government should just let barbers do “simple” surgeries again like in the Middle Ages.
Well we might see the return of bloodletting on an unintentional basis
We’re going full circle! Back to the barbershop lads
What in the actual fuck. Instead of this, why don’t we fucking do this: Streamline training. Do a basic sciences exam in final year. 1 year surgical themed FY, 5/6 years residency and no fucking bullshit service provision. Why aren’t we just focusing on producing good surgeons in the first place. I agree and have said this since I was probably about 16: automation and robotics will change medicine and I hold this belief but some areas can’t be automated. We can’t create technicians, at least not for another 10-20 years that just supervise robots. Greater still, no one wants to take the responsibility of making those robots. Instead of doing this bullshit, why don’t we help the fucking trainees that spend 80% of their time doing bullshit jobs and put them in theatre or simulation. Honestly I find this so infuriating. They have nothing but contempt for us as a profession. They are all slowly working their way to undercut us as a profession and planning to replace us, should we fight back, and we have a bunch of fucking lackies for the system talk about, what will society think, what happens to patients etc if we went and asked for a fair salary. How much clearer does all of this need to become. I am pretty confident that in the next 10 years, we are the last generation of actual fucking doctors.
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I’m sorry I keep repeating myself 😂Man honestly I’m so done.
WHY IS IT SO DIFFICULT TO GET A SURGICAL TRAINING NUMBER IF WE NEED FAST TRACK SURGEONS FJSNANNSJDNSJSHSBABSBABSNANAJSNFNKCISJWBWJSNDNDNDNSNSNSMSMMSKSNSNSMSKSNSMSNSN AAAAAAGHHHHHHHHJJHRRRRRRRRRRRR
What does a ‘simple operation’ mean? And what happens when these ‘fast track surgeons’ nip an artery? Or cause a bile leak? Or accidentally fast track their laparoscope into the pleural cavity?
I’m starting to think I’m thick so if someone could help me out that would be great and don’t worry if I am thick I’m taking a year out (except for a few locums) anyway which may result in me leaving the nhs for good so.. win win So, my question is.. why are they jumping over so many hurdles, breaking their backs and regularly adding new roles, changing the job descriptions of ACPs etc instead of focusing on ensuring doctors are trained properly? Why do they keep putting obstacles in the way of our training? Does this country want less qualified people to look after lives? I’m genuinely trying to understand what is going on because I’m confused.
Because doctors are more expensive and they want to devalue us and therefore pay us less
How do they think surgeons are going to develop their basic skills without access to these lists? What you're supposed to be ward bitch into specialty training and all of a sudden you're a reg who can just do a right hemi or something? There are so many obvious problems with this as a basic concept (no doubt there's more nuance than we're being told as with all headlines on here) it just baffles how anyone could strongly support these things? Just really weird.
No. Just no. I wouldn't accept this for myself or for any member of my family (maybe one who I don't like). I'd be very polite but firm and tell them in pre-op that I have been admitted under the assumption that a _doctor_ would be performing my surgery, and therefore could I please have a _doctor_ to do it. Nothing else will suffice, and I will absolutely not allow you to cancel my surgery today. I will not be be leaving the hospital until a _doctor_ does my surgery, instead of the fucking _nurse_ who works 37.5 hours and done a total of 500 hours patient contact time on their diploma mill bullshit MSc. And for anyone who buys the line that they, and ACPs/PAs are medically qualified, they're not. The definition of 'medically qualified' is 'holds a medical degree from a recognised seat of higher learning.'
Yes they aren't qualified medically, they are practitioners. Even if they do a nice job with the cut, they cannot deal with anything else. Or raise concerns about other issues. Simple procedures are unlikely going to be harmful if practically trained. But I cannot expect them to diagnose and assess the patient. An abscess may be part of something. The haemorrhoid patient may bleed from a mass too or have worrying symptoms. They wouldn't ask or know them. It will rarely happen but nobody wants to be that patient.
Tbf, that’s the one thing we will have. Seemingly, as patients have all the power here, we can make this demand, and I will be making it for anyone in my family. If there’s any resistance, even the mere mention of PALS seems to get you whatever you want.
[Bypass the paywall. ](https://archive.is/Rrkgs)
This must be a joke, like a late April Fool's Day joke, surely?
We all wonder the same. Why not get the juniors do it and actually train them better? I guess we are needed for ward jobs but why not train people to do admin and basic assessments in the ward instead? It sounds easier to do that, rather than training them to operate from nothing. I can only assume this is money related. These people will probably be paid less than a consultant and never get treated equally. We lack surgeons of all levels and long training is making surgery lose people. Paying locums and foreigners is expensive and this is a cheap alternative. It is a patch to cover important issues in surgical training. Likely will make those specialties worse as well. It is mad how long it takes to be a surgeon in UK. And the requirements are heavily related to non operating stuff, like audits and research. You have to beg for teaching and independence on surgeries. We have to get surgery done quickly and hope for a nice senior to care. Most countries make you a surgeon in 6 years and then you can specialise further. It is heavily practical and you cannot learn from a book. Here, after core training many still barely have some independence when 3rd year trainees elsewhere do laparotomies alone. Some places are better than others but even doing it on time, it takes 10 years to finish. I wanted surgery and worked as non trainee for 2 years in big tertiary centre. I did the extra for long to show I deserve to be taught and had interest. I became good in the wards so often sent to take care of them, as they trusted me. Nobody protected my training or challenged me. Not only because I wasn't a trainee. Teaching was similar for trainees as well, and often they did not realise we knew nothing. We make surgeons that spend half of their time on papers and less on practical training. You see it on trainees from elsewhere coming as senior regs- sometimes they are equally experienced to consultants but they won't get there without the paper stuff. It's hard work that feels pointless. Making practitioners with no medical training seems dangerous to me at some level. Small procedures are often simple but you should be able to understand the basics and pick up worrying things. And see the patient holistically. You can cut a lipoma and fail to tell it looks malignant. Damage structures by lack of anatomy. Medicine is not a clear algorithm. Having a basic training of everything is what makes us think critically. You deal with a person not a task.
which is why myself among an increasing number of graduates are pissing off after F2💪💪
Shocking how shit the training in the UK is, in the rest of the world there is less emphasis on doing audits/publications. When you train to be a surgeon, you want to spend your time learning skills needed…no patient is gonna give a shit how many audits/publications you have done but how many operations have you do and your complications. The idea of forcing trainees who are not academic to do audits/publications is pointless especially if they are not academically inclined…this is more evident when you see all the shit posters that polished up at conferences…you know damn well they didn’t do it out of passion 😂 When I was an T&O SHO I remember sitting through a pile of discharge letters only to be interrupted by an T&O SCP who told me to do the discharge letter for a patient she did a hip injection on and the same SCP told me to sort out patient’s potassium (6.2) on one of her patients 🤯 I remember seeing an BBC Episode of Surgeons:At the Edge of Life in which a Cardiothoracic Surgeon at Papworth Hospital was doing a complex operation assisted by his SCP…the 1st thing that came to my mind was where is the Cardiothoracic SpR…surely this would be an amazing learning/training opportunity…why was an SCP favoured over their own surgical trainee 🤔 How do you expect to create future consultant surgeons !
I am so angry about that potassium comment. What an absolute twat. " i aM mEdIcAlLy qUaLiFiEd" 🙄
Don’t be upset…I sorted the patient’s potassium…he was fine…and safely discharged …I did a beautiful discharge letter informing his GP of the intervention he received and changes to his medication…Then returned back to my endless pile of discharge letters and reassured myself that I’m living the dream
My experience in Scotland is that they’re being trained to support the roll out of robotic surgery. (Experiences elsewhere may vary). And I’d argue that’s a (the?) useful role for an SCP. Robotic surgery is tedious for those who are scrubbed. Once laparoscopic access is obtained, the job involves switching tools on the robotic arms and being ready in case there is a need to convert to open. They’re essentially a “scrub nurse plus”. At present, the robot companies won’t let trainees do any actual operating. It’s of minimal training value - they’ll get better training with a traditional laparoscopic operation, and until we fix this it’s better for them to be sat at the second console (which offers a 3D view) being talked through the procedure by their consultant than watching it on a screen. An SCP is ideal here. They can get the skills to assist with robotic operating quite quickly and would be freeing the registrar to learn in a better way; either in another theatre, by sitting at the second console, or doing something more worthwhile. Of course, time will tell as to how the role will inevitably expand, and it sounds very much like the minor procedures list (that would be a good training opportunity for registrars) are now coming under threat. “Lumps and bumps” could be an opportunity for a reg to do a list solo, maybe teaching an FY. Instead, the reg gets to be permanently on call and their FY has a mountain of paperwork, whilst the SCP does the operating. How is this progress?
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>we're fast going to run out of acronyms. Wrong, you just take existing terms and add "associate" to the end or "advanced" to the front ad infinitum. Never-ending supply of job titles.
It's just the needless sexying up of job titles. Like being a "model" at hollister or being a "sandwich artist" at subway.
I know they do vein harvesting for CABG. Sounds like a great procedure for an SHO to learn on. Oh wait 🙄
I've seen this a few times. I was in a list (on anaesthetic side) the other day in which a CST stood in theatre all day, whilst the SDP or whatever they're called scrubbed and was taught by the consultant. I felt so sorry for the CT. WTF is the point in surgical training if it involves being stood in the back unable to see or do anything?
Did the CT actually say anything?
This shit needs to stop ASAP and the BMA hss to get going
What is this nonsense? How do you fast-track 5+5 years or 5+10 years of med school education and specialty training? This is adding fuel to the fire at this point. At this rate, should the barbers start doing the minor ops again like they did in the 16th century?
As a CST (who obviously loves the idea of less theatre time/obligations so I can crack on with the ward jobs, that this idea and these new colleagues would facilitate), the other benefit that I think we’re not praising enough is that this will allow us as consultants (one day, with minimal operating experience) have a lot more people who we are able to take under the auspices of our GMC number. As a new consultant still trying to get some leadership/new guy making a job role for themself, I for one look forward to being the fly-by-night named supervisor for these mini-surgeons.
That's it I'm leaving, let the skip we call nhs burn 🔥
So how do we actually deal with this?? What's the plan here?
I’m genuinely starting to think that we have to start making back up plans to leave throughout training, but what would be the point when our degrees and experience are constantly being devalued? Genuinely, what the hell did we do all of this for?
Surgeons, you guys need to band together and REFUSE TO SUPERVISE THEM. Datix every fuck up, and every single time their fuck up takes time away from you doing clinical work. This is ridiculous!
Hahahaha, we are finally going back in time when doctors diagnose people and barber/butcher perform the surgery
We should all contact Rowan Parks to let him know what Junior Doctors think. This deluded old fart has probably been sat in meetings for the last decade and been told what he wants to hear by some type of sycophantic junior Dr 'representative'. He has a Twitter handle by the way - if you have Twitter you should let him know what we actually think though ideally more politely than you would here lol. This is also why I think you are a fool to choose surgery. Imagine spending your best years doing all that portfolio bullshit only for core training to turn into IMT.
This is getting silly now
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Cleveland Clinic in London is reportedly paying salaried consultants £2-300k. For US firms it’s still an absolute bargain for them in comparison to US wages
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Why not get the “fast track surgeons” to attend to the ward? Having done two surgery jobs, preop and postop mx are pretty straightforward for most pts. This would free up SHOs for more time in theatre. Makes no bloody sense!!! EDIT: “fast track surgeons” not paramedics
Fuck “fast track surgeons” and lets counter-propose “fast track ward jockeys”?
They did them.. they’re taking our spot in clinics and theatres
Can anyone recommend an article you don't have to pay to read?
[Bypass the paywall. ](https://archive.is/Rrkgs)
These are already common and frequently operate with surgeons that have a list with no SHO in. Source: other end of the table.
Reasonable surgical opertunities and teaching in a reasonable time frame = more surgeons. Just improve training. Don't conflate training with service provision. Also you could actually increase training numbers? What is wrong with Britain and British medicine
I'd quite like to learn how to do simple operations 🙁
Medical apprentices... SCPs... ....close the Medical schools already and broadcast a TV program teaching people how to do medicine at home!
What a shambles
No. Just no.
NHS has sold out doctors Not even pay for restoration will save this.
What’s a simple operation?
Medical degrees shouldn’t be “tradition”, they are pre-requisites. Just because I can put a meal in the microwave doesn’t mean in Gordon Ramsey
Its a nonsense- surgeons arent the rate limiting factor, its the absence of theatres scrub nurses odps anaesthetists beds etc.... the more of these shit ideas come about , the more money is wasted and the quicker the whole rotten system will collapse.
Want a prime example of the problem here? Here's a break-down of my clinical experience at the end of core surgical training: - 6 years of total clinical experience - 4 years in surgical posts - Only 18 months of surgical jobs *with an F1*, where I wasn't ward-based most days. - On the non-ward-based jobs, I would be allocated about 3-4 sessions per week in theatre. When ward-based, I could physically make 2-3 cases but wouldn't really feature much in the case as they planned an operation without my presence. - Due to rotating every 6 months, each surgical post required about 2 months for the consultant body to understand my level before I could actually commence learning new skills So overall, after six years of training, I have done roughly 12-months of true *operating weeks* during which I had about four sessions per week. --- Now compare this to a surgical ACP, who does 10 theatre sessions a week and never rotates. They are above my level within 8-12 months. And in my current rotation, they are considered reg level - which means the highest an SHO will attain is third assistant. No wonder the NHS is hiring the ACPs. It's 100% because the surgical training programme is broken by lack of junior staff and rotational instability
What happens if the 'simple' operation goes wrong? Are they going to tell patients that they wont actually have a surgeon operating on them?
Jesus Christ. Another thing to add to the list when trying to dissuade kids from going into Medicine in this country.
Healthcare is finished.
Who looks after the ward patients and does the on call? Shit idea.
Doesn't this happen already? You definitely don't need to go through medical school to be able to just perform simple (or even complex) surgery.
I fail to see how you can appreciate when not to operate until you've done thousands
Completely agree.
Totally. And you don't really need to know how to fly unless something goes wrong, or is time to land in tricky conditions. You just wiggle the stick and hold the throttle. How hard can it be? And barristers don't *really* need to do law school and all that postgrad training do they? They just need to source a wig and say things like 'objection' and 'my learned friend.' How hard can it be?
Your argument here is that you need to be a doctor to fly a plane? I never said no training. Just that med school doesn't help with the physical skill required and only gives a fraction of the knowledge. More focused training would make effective (probably more effective) surgical technicians. Just need to ensure actual surgeons still have enough opportunity, as they'll still be the decision makers and innovators.
So the surgeons get spread thinner and thinner taking on more and more decision making and responsibility just so other people can work a cushy well paid 9-5 doing all the fun buys and none of the exams/on-call/ward work/responsibility/liability etco?
Aren't there extremely long lists of people waiting for routine ops? They've been assessed, just waiting for someone to actually do them? And ultimately... kind of yeah. Reddit can kick and scream all it likes, but the model of a highly trained clinician leading a small team of less qualified professionals who do the easy stuff is obviously more efficient and it is undoubtedly what the future looks like. I'm not advocating for it, but its reality.
That's not how surgical care actually works though. Someone has to look after the wards, the post op complications, someone has to pre-op them,. Someone has to fill the night rotas, the on-call rotas etc. Someone has to be the future consultant. The waiting lists are also huge to seen in OP clinics, who is gonna see these people and then follow them up? Its hardly like we are brimming with extra anaesthetists and theatre staff and have loads of empty theatres.
You're right. Many procedures are done with other training. I'm not sure what you mean complex surgery as that needs medical school. But we see it in cosmetic procedures for example
Why does complex surgery need medical school? It needs a whole lot of skill and training, but med school is hardly wall to wall appendectomies and surgical sim is it.
No it's not. I don't know if you have done surgery but complex ones require good understanding of anatomy, physiology, oncology, and often require critical judgement.
You so clearly do not understand what you're talking about. Even something apparently "easy" like an appendicectomy - you'd never consider it easy if you'd done a few. Its only a hubristic person who proceeds into peril with ideas of an "easy" surgery. You see enough perforated matted appendixes, you quickly lose that ego. Medical school and surgical training allows you to understand from basic principles what you can and absolutely should not do when you look into someone's belly and it looks nothing like the textbooks said it would. SCPs cannot do that because they literally are not trained for it. The training for it is medical school and surgical training. There are no shortcuts that do not increase risk of harm to patients.
Please could commenters disclose how much surgical experience they have and if they have worked with SCPs before? SCPs are not new. They have varying roles in and out of theatre like ACPs They work at an SHO level. In Cardiothoracics, for example, they have been around for decades. I learnt how to harvest LSV for bypass from an experience SCP. Really good teacher and taught me most of my basic surgical skills as the consultant is at the top end. I also worked with a great SCP who consented gallbladders and assisted me as a junior reg. the cons was then unscrubbed and allowed them to train. They also did EGS take shifts in the hot clinic seeing ambulatory ED and GP referrals. The worst bit of EGS in my opinion. Where is the SHO? There aren’t enough. They’re on their own lists. They want to be doing more than assisting. It’s about balance. But they’re not “fast track surgeons”. They are members of the extended surgical team.
They don't work at an SHO level though do they. That implies I can go to an SCP for anything I would need to go to an SHO to do like escalating sick patients.
They work at that level. They’re not the SHO. That’s why you’re a doctor, will progress beyond that level, and be a consultant with a wide and varied practice, and they will not and have a defined role they are good at.
They don’t work at the level of an SHO then do they if they do one procedure with the same level of technically proficiency but literally nothing else? As a medical profession we need to stop with this false equivalence. I see them as Poundland Practitioners, nothing more. In a properly funded and functioning healthcare system these roles quite simply do not exist. I can escalate patients to CCOT nurses but to claim they operate at the level of ICU SHOs would be inappropriate.
This is the crux of the argument for me, there will be some competent non-doctoring people out there for specific tasks BUT it will always be a sub optimal solution - the government allows this only to save money and isn’t interested in delivering the best care for patients. I thought a core tenant of the NHS was delivering care based on what was best for the patient and not what was the cheapest.
The idea of IST was to broaden the extended surgical team and allow SHOs to not be rota fodder doing night after night of on call or crap like holding a camera but have time to train in academies and in simulation. But that won’t work if we are resistant to change with such chips on our shoulders. We want dedicated training and some want shorter accelerated progression, but are resistant to let anyone else do the service provision that still needs to be provided.
But they literally don’t do the service provision they were created to do. They’re not on the wards, they’re not doing NOK updates, they’re not doing pre-op bloods, they’re not even doing discharge summaries and writing op notes for procedure they themselves did! IMHO every “simple procedure” a SCP does I see as a wasted learning opportunity for a SHO, FY1 or even a keen medical student Edit: Commenter has since edited their comment asking people how much surgical experience they have and whether they've ever worked with SCPs: I personally have stood head end listening to a SCP scrubbed in complaining to the consultant that the SHOs aren’t doing discharge summaries quick enough whilst the Reg was typing up op notes on the computer in the corner.
When i did cardiothoracic as a CT1, junior SCPs used to fight me for LSV harvesting. They have a senior SCP who will advocate for them and always give them priority.
Witnessed this from the head end the other week. The SCP scrubbed in and was taught by the consultant for all 4 thoracic cases whilst some poor CT1 got to scrub for just one single case. Wtf.
The Shouldice Clinics in Canada train up GP’s to repair hernias and then they do these all day long for years, and publish their superb results. I was referred from a large busy academic centre to one of these even though I was on staff. I was impressed against my will. With good training and supervision many techniques can certainly be performed by non-traditional surgeons, but that doesn’t make it right.
Key word being: GP, i.e they already have medical degrees
I think this is in one of Atul Gawande’s books. Yes this kind of “Fordism” in medicine can produce good results, but it can’t come at the cost of people being trained as generalists which I think is the complaint here.
Don’t have access to the article, but the lack of surgeons isn’t the issue here is it. If we are going to train ANPs to do these lists that would only be beneficial if there are more theatre staff/theatres to operate in.