At least 35% more orthopaedic surgeons are needed to ensure consultant based service

Editor—Collins’s editorial on surgical training and service highlights major concerns for the adequacy of training and supervision of surgeons in the new “Calman environment.”¹ His findings in general surgery echo those I reported recently from a survey of supervision levels in orthopaedic surgery.²

In a questionnaire survey of fellows of the British Orthopaedic Association (comprising virtually all consultant orthopaedic surgeons in the United Kingdom) 849 (69%) of 1230 fellows responded. The survey indicated the widespread practice of delegating workload to unsupervised junior staff. In 284 (37.2%) of 763 surgeons’ practices the situation could—at least theoretically—arise that patients are assessed preoperatively, operated on, and followed up without being seen by the consultant. This study took account only of elective work: I strongly suspect that the figures for the supervision of trauma would be even more disquieting.

The figures suggest that we need at least 35% more orthopaedic surgeons at once, simply to ensure a true consultant based service with time for adequate supervision of trainees, and this does not take account of any increase in numbers of patients or clinical workload.