Between 10% and 20% of medical professor and senior lecturer posts and 20% of lecturer posts in the United Kingdom are vacant, according to a recent survey by the Council of Heads of Medical Schools and Deans of UK Faculties of Medicine.
The authors point out that this is particularly worrying in that medical education is currently expanding rapidly and so even more clinical academics are needed.
Independent advice obtained by the council suggested that an acceptable level of staff turnover was of the order of 5% to 7.5% A rate of over 10% indicated a serious retention and recruitment problem.
The situation is more acute in England, where four new medical schools are opening, with a planned increase of 60% in annual intake of undergraduates. Also, nearly 40% of clinical academic staff are employed in London medical schools.
UK medical institutions were asked to provide data on the source of funding, clinical specialty group, and academic grade for all full time clinical and academic staff employed in medical and dental schools on 1 October 2000. All responded, and the results showed that funding and staffing varied widely between specialties. Most unfilled posts were in general medicine and surgery, but there were also large numbers in anaesthetics, pathology, and psychiatry.
The council thinks that the number of vacancies is an underestimate of the true situation, as in many universities information was not available on the number of clinical academic posts discontinued for financial or academic reasons. In such cases NHS staff often take on the teaching, but this is not officially recognised. Furthermore, in many universities a vacancy does not exist until a post has been reconfirmed and funding assured.
The survey also found that around half the unfilled posts were vacant for more than six months and that the number of applicants for professorial appointments was “worryingly small.” One institution said that in the last two years only one candidate had been available for each of seven professorial appointments in the medical school and commented: “It is unhealthy for the academic strength of medicine to rely on single candidate shortlists for advertised appointments.”
Sources of funding also varied widely, making it difficult to compare institutions as no two medical schools had the same funding profile. Currently it is the Department for Education and Skills that is responsible for funding undergraduate medical training, and the survey showed some consistent patterns. Higher Education Funding Councils generally paid for the most professorial posts, while the NHS funded most of the senior lecturer and lecturer posts.
The survey's key messages are this reliance on NHS funding and the converse, the dependence of the NHS on the universities for clinical services and care of patients provided by academics, which have resulted in an increase in the pressure on academics to meet their commitments to two employers by delivering teaching and research as well as services.
The new medical schools will rely heavily on NHS clinicians to provide the clinical teaching to their undergraduate students, but they will also need a core of clinical academics in all disciplines for academic leadership and research. One of the new schools indicated that it would need to recruit up to 20 clinical academics, including clinical lecturers. Another, Leicester Warwick Medical School, which is rapidly expanding, has estimated that it will need 30-40 new clinical academic appointments over the complete range of clinical specialties over the next five years.
Professor David Gordon, dean of medicine at Manchester University, told the BMJ that the current situation had arisen for two main reasons. Firstly, it was difficult to ensure that academics were fully trained and competent clinicians as well as being good researchers and teachers. Secondly, the uncertainty of a career in academic medicine made it an unpopular choice among younger doctors. He asked: “At a time when higher training is becoming more ordered, how do you fit in something that is ‘different’?” He continued: “Doctors wishing to go into academic medicine have to follow the general rules, and so, sadly, they are anxious about going down a different route.”
Dr Colin Smith, chairman of the BMA's Medical Academic Staff Committee, added that competing workloads were another disincentive. He said: “Most academics are working more than 64 hours a week, half of this time for the NHS and half for the university.” He hoped that the introduction of the joint appraisal process for consultants would aid recognition of the workload problems.
He also welcomed the extra funding from the Department of Health for the clinician scientist programme, but added: “Much more still needs to be done to develop a clear career pathway for all academic clinicians.” This programme was launched last April to offer a more structured career path to clinical academics. The scheme gives access to academic mentoring and flexible development of an academic career, together with specialist clinical training.
However, entry to the scheme is competitive, and most applicants are expected to already have a PhD. The scheme is funded through the Department of Health, the Higher Education Funding Council for England, and research councils and medical charities. The Department of Health has also agreed to fund eight extra posts a year for five years.
The BMA, in conjunction with the Royal College of Physicians, has also put pressure on the government to develop a senior lecturer programme. Dr Smith said that so far the government had been “sympathetic.” He also said that the government would not commit itself to any extra funding for academic medicine until it had received a proposal from the Council of Heads of Medical Schools.
In the survey's conclusion the council recommended that there be discussions between the Higher Education Statistics Agency, the higher education funding councils, and the Department of Health to improve collection of data on clinical academics and clinical academic posts. Professor Gordon said: “This will highlight the gaps and so may be useful in helping us devise ways to overcome the current problem.”
The report is accessible at www.chms.ac.uk/chms.pdf 
Figure.
KIRSTY WIGGLESWORTH/PA
Dr Colin Smith: “Most academics are working more than 64 hours a week[00d3]