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Recruitment of Transplant Surgeons

Mr Hany Riad

Consultant Transplant Surgeon, Manchester Royal Infirmary

'I like the name of the conference 'Keeping Pace with Change' because not many people find it easy to keep pace with change, but it is important for us to look forward and consider changes in the service we run. I was asked to speak about the recruitment of transplant surgeons, to see if there is a problem and if so what that might be'.

Across roughly 22 units we have between 75 and 80 surgeons. So, to dwell a little on the pattern of work, of those 22 units some are performing just kidney transplants, some kidney and lung transplants and some kidney and pancreas transplants. There are some of course that perform all three. Between these units we have not quite reached the 2000 transplants a year figure – this figure includes all ages of patients and so you are not talking about a huge figure of transplants per surgeon, per year about 25 per surgeon. When we consider other transplants; pancreas alone for instance, there are 9 units across the UK with around 40 surgeons doing 100 transplants a year. This is a different technique as is paediatric transplantation. You can’t just say that because I do transplants I can do a paediatric transplant. To do a transplant in a 15 or 16 year old is one thing, it is something quite different to perform a transplant on a 10kg child.

So is there a problem? I say there are sufficient surgeons, but not all units are the same size and they all service a different size population, but you also need to make provision for training and back-up and you have to consider the infrastructure that supports an efficient transplant service. The big beast we are all working against is the European Working Time Directive (EWTD) which says that nobody should work more than 40 hours a week and this makes it difficult for trainee surgeons to get adequate exposure to transplant operations.

Is there a crisis in surgeon recruitment? We held a meeting in London in June last year (2004) which was attended by trainee surgeons, nephrologists, reps from the DOH, BRS, the Renal Association, the NKF and the London Modernization Agency. Ali Bakran from Liverpool did survey all transplant units and so we can assume his figures are more accurate than mine. His figures reflect a total 94 consultant transplant surgeons in post; 12 of these posts were filled by a locum surgeon. There are 9 UK units in need of surgeons and the per unit number of trainees ranged from 0 – 11.

David Mayer, a liver transplant surgeon suggested that ‘bigger is better’ and that we should perhaps concentrate on having bigger units which would then attract more trainees and this too would address the EWTD. If we had just 8 transplant centres performing the 2000 transplants a year then surgeons would work on 23 grafts each, so this does work out and it keeps surgeon expertise in place. Also remember that access surgery is also done by transplant surgeons and this is another area we can look at.

It is up to surgeons like me to encourage and recommend transplant surgery to the junior doctors, just as we were guided by our mentors. It is not always a very sociable career to choose; long hours (often at night), low potential financial reward, retrieving organs from units 50 miles away etc.

Another speaker at this conference was John Shaw of Plymouth who did not use a PowerPoint presentation preferring to talk from the heart. He spoke of the benefits of the smaller units which are more ‘patient centred’ in their approach saying that if you look after 50 patients you know so much better. But you do need the same structure in place for a larger unit as for a smaller unit and this is where cost effectiveness becomes an issue. There is a view that, long term, the current system is unsustainable. Just what a sustainable model is nobody knows just yet, but there are people working on it. We should not be talking about a crisis in recruitment, rather how to retain interest in it.

So, I do not think the current situation for recruitment is too bad and we mustn’t just flood the market with hundreds of trainees who will have no jobs at the end of their training. You too need to be involved in the shaping of your transplant service to make sure it is a sustainable one. Yes, currently you know your surgeons, you know your physicians and the set up and this is comforting but is it sustainable?’

Question 1: Is it necessary for the transplant surgeon to be exclusively transplant surgeons or could they be vascular surgeons and have more job satisfaction?

Mr Riad: They could but you need to be careful when you combine two intensive special areas. It becomes a problem when you combine two rotas; one for transplant surgery and one for elective surgery. But this is not to say this wouldn’t work.

Question 2: Evan Harris MP: My question concerns suitable applicants. What level of suitably trained applicants are there applying for these posts and how much competition is there for SPR training programme posts? Is this variable year on year or is there a trend?

Mr Riad: I am not aware of these figures at the moment but we will be soon be advertising for a consultant in Manchester. I do know that 10 years on we have more applicants for places than places available for SPR specialist registrars in surgery. I would say the future is bright as I believe more young people are interested in transplantation than ever before.