Blog spot – should consultants be excused night shifts once they’re 50?

The old adage that ‘none of us are getting younger’, is a lamentable fact of life for all of us.

While no one has yet managed to prevent ageing, those with careers in more sedate lines of work are better placed to continue in these roles comfortably for longer.

Medicine, with its incredible demands and sometimes near impossible asks, is not one of these professions, and this is perhaps doubly true of those areas of medicine at the sharpest ends of the profession, such as emergency medicine.

The high intensity of working in emergency departments, particularly its emphasis on irregular and antisocial working hours, can take its toll, physically and mentally on those practising it.

With every year that passes, that toll can be harder to bear.

A 2016 clinical review into the health consequences of shift work, published in the BMJ in 2016, showed varying levels of association between shift work and health issues such as a type 2 diabetes, coronary heart disease, stroke and cancer.

‘We can’t all carry on indefinitely [and] what I could do at 30, I’m not sure I could do at 50.’

Such was BMA armed forces committee chair and consultant anaesthetist Glynn Evans’ candid admission to members gathered at the BMA annual representative meeting in Brighton today, to debate consultant working patterns.

The debate, which included a proposal for the association to call into question the reasonableness of expecting consultants over the age of 50 to work resident night shifts, cut to the heart of a number of core issues currently affecting the health service, including working pressures and recruitment and retention of staff.

‘[Older] age could bring experience … additional expertise,’ said Colonel Evans. ‘But rest assured it also brings diminished psychomotor skills and at 3am in the morning, my bio rhythms are not just zero, they are heavily into the negative.

‘How long do you expect me to do this for? Is it till I’m 65 or till I’m 70? Is it until the point where I myself need resuscitating when I arrive at the cardiac arrest [unit]. Is it to the point where I need a walking stick to get around the hospital in a hurry?’

The debate around consultants’ working hours was put forward by London emergency medicine consultant Simon Walsh.

He insisted that his intention was not to simply give older consultants an easier life in the workplace, but to safeguard the sustainability of his branch of practice.

‘Sadly, one of the many factors leading to many [doctors] leaving emergency medicine and other acute specialties, is the high proportion of anti-social hours worked,’ he said.

‘We need to be able to reassure those considering careers in these exciting frontline specialties that they don’t have to give up the rest of their life: successful relationships, family life, hobbies and a reasonable sleeping pattern, if they want a career that involves routinely managing emergencies.

‘This isn’t about giving older consultants an easy life; this is about preventing the collapse of acute, frontline specialties… in the most pressurised parts of our NHS.’

Workforce recommendations published in 2010 by the Royal College of Emergency Medicine, lend support to Dr Walsh’s position, stating that consultants over 50 should no longer serve on night shifts, and that all emergency departments should give consultants over 55 the option of withdrawing from the on-call rota.

While acknowledging the demands posed by shift work, support for the idea of exempting those over 50 was not without its detractors.

Foundation year 1 doctor Rebecca Acres said that preventing consultants over 50 working on-call shifts would inevitably impact upon junior staff, by limiting the number of senior, experienced clinicians at night.

‘Who is going to be the most senior support when I have patients dying at opposite ends of the hospital, half a mile apart at 3am? There are not enough medical seniors.’

Academic clinical fellow in public health Lucy-Jane Davis warned that a policy designed to support older doctors could unintentionally stigmatise them among the wider workforce.

‘This policy potentially marks older doctors out as being less able and less competent, and that is not right,’ she said.

‘Some people will want and need to come off a full-shift rota at the age of 45… some people will very happily stay on, working into their 50s and 60s.

‘That is what we should be striving for; to support individuals, not to introduce a blanket, arbitrary age where people stop doing things.’

The ARM ultimately took a compromise decision on the proposals around shift work for consultants, taking the over-50 cut-off as a reference, meaning that it is taken into consideration but does not become BMA policy. At the same time, doctors endorsed calls for age to be taken into account in future contract negotiations and lobbying on workforce planning.

Emergency medicine specialty trainee 2 Jessica Fairfield summarised things from a position everyone could agree on.

‘The reality is working in emergency medicine is gruelling, and can make you sick.

‘The role of a trade union, which is what we are, is to protect its members, and preventable, chronic illness is one of the things I want to be most protected from.’