Snapshot of UK consultant physicians 2023

Every year the Royal College of Physicians (RCP) conducts a census on behalf of the RCP, the Royal College of Physicians of Edinburgh (RCPE) and the Royal College of Physicians and Surgeons of Glasgow (RCPSG) covering a range of issues.

Today, the three royal colleges have published the latest findings about UK consultant physicians’ working lives. 

The RCP sent a survey to all the consultant and SAS physicians that it was able to contact via email between November 2023 and January 2024. In total, 22,253 physicians were contacted. The overall response rate was 16.6%. Some demographic data is held on the whole cohort and further data is obtained from the Joint Royal College of Physicians Training Board on doctors in higher specialty training. 

More details on the methodology can be found here.

Key findings

• There continue to be consultant physician vacancies: 59% of UK consultant physicians reported that they have at least one consultant vacancy in their department.
• Consultant physicians are frequently seeing gaps in the trainee rota: 62% reported daily or weekly trainee rota gaps when on acute duty over the past year.
• Consultant rota gaps are impacting patient care: 69% felt that consultant physician rota gaps were having a negative impact on patient care, with reduced access to outpatient care, increased length of stay, the care of inpatients out of hours and delays in diagnosis the most commonly cited impacts.
• Rota gaps are impacting consultant physicians’ ability to supervise and train others: when asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to supervise and train others, 32% said a lot, 41% said to some extent, 16% said a little and 12% said no impact.
• Consultant physicians continue to manage significant workloads: almost a fifth (18%) said they almost never feel in control of their workload. Only 36% said they feel in control of their workload most of the time or almost always.
• Consultant physicians continue to work beyond their job plans, with over half of respondents (52%) saying that their job plan does not adequately reflect all of the work that they do, compared to 48% who said that it did. On average, full-time consultant physicians are contracted to work 11 programmed activities (PAs) but work 12 PAs, while those who work less than full time are contracted to work 8 PAs but work 8.5.
• Unmanageable workloads are impacting the training and supervision of doctors: The top three things that were squeezed out of a week when things get too busy were continuing professional development, quality improvement activity and education, training and supervision of doctors (of all grades, including appraisals).
• Consultant physicians feel stressed at work: 14% of UK consultant physician respondents said they were very stressed at work. 55% said they were somewhat stressed at work.
• Better IT, reduced clinical workload and a bigger workforce would most improve work satisfaction: when asked what top three things would improve work satisfaction, improved IT systems reduced clinical workload and increased workforce/fewer gaps were most commonly cited.
• Less-than-full-time and flexible working continues to grow: just under a third (32%) of UK physician consultants said they work either flexibly or less than full time. This breaks down into 46% of female consultants and 21% of male consultants. The majority of men working less than full time are over 60 years of age.
• Most UK consultant physicians undertake educational and clinical supervision, but the time allocated is not always sufficient: 85% said they undertook educational or clinical supervision. Of those, 94% said they supervised doctors in training, 41% said they supervised doctors not in a training post and 41% said other health professional. 61% said they had time in their job plan to undertake this supervision, and while 65% of those said the time was adequate, 35% said it was not.

Who makes up the UK consultant physician workforce?

Based on the RCP dataset of 22,253 physicians: 

• 48% describe their ethnicity as White British/English/Welsh/Scottish/Northern Irish, 30% as Asian/Asian British, 3% as Black/Black British, 2% as mixed ethnicity, 3% as White Irish, 10% as White other and 4% as other.
• Women made up 41% of the consultant physician workforce in 2023. On current trends, women will make up 46% of the consultant physician workforce by 2027.
• 85% work in England, 8% in Scotland, 4% in Wales, and 3% in Northern Ireland.
• 55% of UK consultants are under 50 years of age, 40% are over 50-64 years, and 5% over 65 years.

Based on the 3,666 survey responses from practising NHS consultants:

• Most physician consultants are employed by the NHS (82%). 3% are on a joint NHS contract (for example, a hospice) and 2% have a non-NHS employer (industry, or local council).
• 7% are on a joint NHS/academic contract with the majority NHS funded and a further 7% are on a joint NHS/academic contract with the majority academia funded (e.g. a university with an honorary NHS post).

Who makes up the UK higher specialty trainee workforce?

• There were 7,004 physicians in higher specialty training and registered with the JRCPTB in January 2024
• 40% describe their ethnicity as White British/English/Welsh/Scottish/Northern Irish, 34% as Asian/Asian British, 5% as Black/Black British, 4% as mixed ethnicity, 3% as White Irish, 6% as White other and 8% as other. The ethnicity of 754 HSTs is unknown.
• Women made up 51% of higher specialty trainees in 2023 (3,607), the same as in 2022. There have been more women than men in training since 2013.

The following sections are based on 3,666 survey responses, where NHS consultant physicians responded to at least part of the survey. More details about survey responses to each section and question can obtained from medicalworkforce.unit@rcp.ac.uk.

Vacancies and rota gaps

• 59% of UK consultant physicians reported they have at least one consultant vacancy in their department.
• 69% felt that consultant rota gaps were having a negative impact on patient care: reduced access to outpatient care, increased length of stay, the care of inpatients out of hours and delays in diagnosis were cited as impacts.
• 62% reported daily or weekly trainee rota gaps when on acute duty over the past year.
• 74% felt that trainee rota gaps had a negative impact on patient care, with the care of inpatients out of hours, increased length of stay and assessment of patients in the emergency departments the most commonly cited impacts.
• When asked whether rota gaps at consultant or trainee level were having a negative impact on their own job satisfaction, 30% said a lot, 44% said to some extent and 16% said a little. 10% said there was no impact.
• When asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to improve clinical services, 43% said a lot, 36% said to some extent, 12% said a little and 9% said there was no impact.
• When asked whether rota gaps at consultant or trainee level were having a negative impact on their ability to supervise and train others, 32% said a lot, 41% said to some extent, 16% said a little and 12% said no impact.
• 17% reported another health professional being appointed in place of a consultant.

Workload

• Almost a fifth (18%) said they almost never feel in control of their workload. 36% said they feel in control of their workload most of the time or almost always.
• 39% of consultant physicians said they had an excessive workload almost all or most of the time and 33% said they worked excessive hours.
• UK consultant physicians on full-time contracts work one PA more than they are contracted to (median). Those on less-than-full-time contracts work on average half a PA more than they are contracted to (median). On average, full-time consultant physicians contracted to work 11 PAs work 12 PAs, while those who work less than full time are contracted to work 8 PAs but work 8.5.          

Wellbeing at work

• 14% of UK consultant physician respondents said that they were very stressed at work. 55% said they were somewhat stressed. 15% said neither, 15% said they were not stressed and 0.6% said they were not sure.
• 24% of consultant physicians said that they felt emotionally drained almost all or most of the time and 32% said they felt tired when getting up in the morning almost or all of the time. 18% said they felt less enthusiastic and 15% said they felt less interested almost all or most of the time.
• 47% reported decreased enjoyment in their job over the last year.
• When asked to choose up to three things most negatively affecting wellbeing at work, clinical workload, poorly functioning IT equipment and staff vacancies in their team were the most commonly cited, followed by lack of administrative support and lack of capacity in social care to discharge patients in a timely manner.
• When asked what would make the biggest difference to their wellbeing at work, the top three factors were well-functioning IT equipment followed by reduced staff vacancies and reduced clinical workload.

Job satisfaction

• 81% of UK consultant physicians said that they always or often found their work satisfying in their specialty.
• 62% of UK consultant physicians said that they always or often found their work satisfying in their education and training role.
• 49% of UK consultant physicians said that they always or often found their work satisfying in their leadership role.
• 43% of UK consultant physicians said that they always or often found their work satisfying in their medical research role.
• 35% of UK consultant physicians said that they always or often found their work satisfying in general internal medicine (GIM).
• When asked what top three things would improve work satisfaction, improved IT systems reduced clinical workload and increased workforce/fewer gaps were most commonly cited. 

Flexible working

• 30% of UK physician consultant respondents said that they were contracted to work less than full time (<10 PAs a week) (LTFT).
• If we also take flexible working into account, just under a third (32%) of UK physician consultants said that they either work flexibly or LTFT. This breaks down into 46% of female consultants and 21% of male consultants.
• 27% of higher specialty trainees (HSTs) said that they worked LTFT. 40% of HSTs who were women said they worked flexibly or LTFT compared to 14% of HSTs who were men.
• 49% of female consultant respondents aged 35–44 said that they work LTFT compared with 8% of male consultants in that age bracket.
• Over the age of 60, working LTFT working is commonplace with 45% of those between 60–65 working LTFT and 66% of those over 65 years. Men working LTFT are most likely to be over the age of 60.

Job planning

• 79% of respondents said their job plan is reviewed and agreed every year.
• 37% of respondents said that their department undertakes group job planning and 63% said that their department did not.
• Over half of respondents (52%) said their job plan does not adequately reflect all of the work that they do, compared to 48% who said it did.
• Of those who said that their workload was more than was contracted/job planned, patient administration, direct patient-facing clinical workload and education, training and supervision of doctors (of all grades, including appraisals) were the most commonly reported things that weren’t adequately reflected.
• The top three things that were squeezed out of a week when things get too busy were continuing professional development, quality improvement activity and education, training, and supervision of other doctors.

Clinical and education supervision

• 85% said they undertook educational and clinical supervision. Of those, 94% said that they supervised doctors in training, 41% said doctors not in a training post and 41% said other health professional.
• Of those supervising another health professional, over half (53%) supervised a clinical nurse specialist, 34% an advanced clinical practitioner, 23% a pharmacist, 22% a physician associate and 18% an allied health professional; 10% said other.
• 61% said they had time in their job plan to undertake this supervision – 39% did not. Of those 61%, 65% said the time was adequate – 35% said it was not.

Types of work undertaken

• 80% said they provide care for hospital inpatients.
• 42% said they see acute unselected admissions or look after general medicine patients.
• 30% said they delivered care on a same day emergency care unit (SDEC).
  • Of those delivering care on a SDEC, 43% said they delivered care there weekly, 36% monthly, 12% daily and 10% once or twice a year.
• 43% said they participated in the specialty out-of-hours on call only.
• 9% said both specialty on call and acute unselected take/receiving combined.
• 4% said both specialty on call and acute unselected take/receiving but not combined.
• 15% said they participated in the acute unselected take/receiving.
• 29% said neither.

Remote working 

• 83% of UK consultant physicians said that they undertake some work remotely.

Virtual wards/hospital@home

• 10% of respondents said they worked on a virtual ward/hospital@home.
• Of those respondents working on virtual wards (10%), 43% said they delivered care on a hospital@home/virtual ward weekly, 27% said monthly and 21% said daily. 9% said once or twice a year.
• When asked how many patients are under your care on a hospital@home/virtual ward on average, 31% said up to 5, 25% said 5–10, 14% said 10–15, 10% said 15–20 and 20% said more than 20.

Leadership roles

• 45% said they were working in a leadership role. Of those, most were working as a clinical director or clinical lead (34%), in an education or training leadership role (24%) or as a specialty lead in their organisation (20%).
• Of those working in an education or training leadership role, 39% said they were training programme director, 19% were local training lead and 6% were director of medical education or equivalent; 27% said ‘other’.
• Over half (51%) said that their trust/health board did not allow time in their job plan to undertake a leadership role outside of the organisation, for example being an examiner, college tutor, or to attend society meetings.
• 37% said their leadership role had a positive impact on their wellbeing. 35% said their wellbeing was unaffected by their leadership role and 28% said that it had a negative wellbeing impact. 

Feeling valued

• 80% of UK consultant physicians said they felt valued by patients, 76% said they felt valued by medical colleagues, 72% by non-medical colleagues, 61% by their clinical line manager and 34% by their trust/hospital management.  

CPD, sickness and annual leave

• The majority (83%) said that they took time away for continuing professional development (CPD), taking an average of 4.9 days. Over half (55%) said that this was funded in full by their organisation. Of those who did not have CPD funded by their organisation, 82% said that it was self-funded.
• 37% said they took days off work due to unexpected illness in 2023. 35% of those who took days off reported this being due to COVID.
• 35% of UK consultant physicians didn’t take their full annual leave allocation for the past year. Of those who didn’t take the full allocation, the main reasons were being unable to find cover for the clinical service they provide (38%), being too busy to organise cover (36%) or unable to take time away from non-clinical roles (29%). 18% said ‘other’, 3% said they did not feel that they needed all of their annual leave and the same percentage (3%) said that they were unable to afford a holiday.
• Consultant physicians reported being contacted during their annual leave about work – 47% said they were contacted about clinical issues and 40% said they were contacted about non-clinical issues.
• 49% said of respondents said they wanted to work fewer PAs in future.
• 37% said they wanted to work the same number of PAs, 7% said the same with a different pattern, 4% said they wanted to work more and 4% said they didn’t know.

Retirement 

• The average age for planned/intended age at full retirement was 62.8 years on average.
• When asked whether their planned/intended age of retirement for full retirement had changed over the past year, 60% said no, 28% said yes to an earlier age and 12% said yes to an older age.

Who are the respondents? 

• 24,863 consultant physicians are on the GMC specialist register
• 22,253 make up our dataset of practising consultants (including locums)
• 7,004 higher specialty trainees (data provided by JRCPTB)

The 2023 census survey was sent to 22,253 physicians:

• 3,689 physicians responded to at least some of the survey.
• 3,666 practising NHS consultants responded.