The state of the consultant geriatrician workforce: An analysis of the RCP census

Foreword

The BGS has long advocated for a better staffed healthcare workforce to care for the needs of the UK’s rapidly ageing population. Workforce pressures are nothing new and it is well known that the NHS is experiencing severe staff shortages. As a result, healthcare workers report feeling exhausted. These challenges are exacerbated by the failure to resolve long-standing industrial disputes. There is a long way to go to solve these problems. Concerted action is needed to recruit more healthcare professionals into the specialty of geriatric medicine, especially to rural and coastal areas where the populations are likely to age faster, and to retain and support existing staff. 

This report analyses data from the UK 2022 census of consultant physicians conducted by the Royal College of Physicians (RCP) on behalf of the RCP London, the Royal College of Physicians of Edinburgh (RCPE), and the Royal College of Physicians and Surgeons of Glasgow (RCPSG). The census was published in 2023, using data that was collected in 2022. The BGS would like to express thanks to the RCP who work to conduct this annual census. The data is a valuable resource that allows us to keep track of the current state of the consultant workforce caring for the older population. Of course, consultant geriatricians are just a small part of the multidisciplinary workforce that provide healthcare to older people. The BGS will continue to seek data on the wider workforce in our endeavour to represent the whole multidisciplinary team. Our recent report, The state of the older people’s healthcare workforce: A report from the BGS membership survey, captures some of this evidence from our wider membership but more high level data is needed.¹

Nine months on from the publication of The Case for More Geriatricians: Strengthening the workforce to care for an ageing population,³ the new census data highlights that there is still a long way to go to meet our calls and make up for the shortfall in consultant geriatricians. The current shortage is only expected to worsen, with just under a half of geriatricians expected to retire in the next decade and more people needing healthcare in their later years. The report also highlights that there is an uneven geographical distribution of geriatricians in the UK, with urban areas typically being better served despite the ageing population more likely to be found in rural and coastal areas. On the ground, most geriatricians report substantial staff shortages and do not feel in control of their workload. These frustrations echo the findings of our recent membership survey which painted a bleak picture of the wider workforce and highlighted that staff shortages have a big impact on mental and emotional wellbeing of healthcare professionals.¹

Despite frustrations, most consultant geriatricians are happy with the specialty of geriatric medicine, and we know many of our members find their roles rewarding. This sentiment needs to be captured in a recruitment drive, starting to build increased training numbers. We are excited by our own upcoming #ChooseGeriatrics BGS campaign which will promote the specialty to medical students and the wider multidisciplinary team, making the case for the older people’s healthcare workforce. More information on this campaign will be publicised soon and we would value support from BGS members and others.

As the biggest users of the health and social care system, older people’s needs must be at the centre of workforce planning. The upcoming general election is a vital opportunity for political parties to consider the needs of an ageing population and the workforce supporting it. Health policies must address current staff shortages and put geriatricians where they are needed most. This is vital so that, across the country, older people can receive high-quality, personalised care, now and in the future. 

Professor Adam Gordon
BGS President

Dr Amit Arora
BGS Vice President for Workforce  

Key messages

• For the first time since 2016, geriatric medicine is the biggest medical specialty. 
• There are 2,328 consultant geriatricians in the UK. For every 697 individuals aged 85 and over in the UK, there is one consultant geriatrician. This does not meet the UK-wide target of one consultant geriatrician per every 500 people aged 85 and over that the BGS recommends. At least 1,786 additional geriatricians are needed by 2030 to make up for this shortfall. If including intended retirement plans, this number increases to 2,566.
• There is an uneven distribution of geriatricians across the country, with urban areas, particularly London, typically being better served. This is despite non-metropolitan areas being more likely to have ageing populations.
• More female consultant geriatricians work less than full time or flexibly than their male counterparts. 
• A higher proportion of consultant geriatricians care for patients on virtual wards compared to other specialties.
• More consultant geriatricians have a work commitment to Acute Internal Medicine and General Internal Medicine compared to other specialties.
• Most consultant geriatricians do not feel in control of their workload.
• Most consultant geriatricians reported a substantial level of rota gaps and vacancies in their department, and this appears to be a bigger problem than other specialties. The majority of geriatricians felt this impacted patient care.
• Leadership roles significantly contribute to job satisfaction, but this is often not recognised in appraisals.
• Just under half (44%) of consultant geriatricians will reach their intended retirement age in the next ten years, equating to 1,025 consultants who will need to be replaced.

About the respondents

Data from the General Medical Council indicates there were 2,328 registered consultant NHS physicians in the UK in 2022 whose main specialty was geriatric medicine, with 657 responding to the RCP census survey (31% response rate). Based on self-reported data collected by the BGS, an estimated 1,767 of these are members of the BGS. Of the RCP census respondents, 525 were based in England, 16 in Northern Ireland, 87 in Scotland, and 29 in Wales (see Figure 1a & 1b). This report analyses some of the data at a country level. However, the low level of responses from Northern Ireland and Wales may be too small to draw meaningful conclusions regarding country trends. For the first time since the 2015-16 census, geriatric medicine was the biggest specialty, with 160 more consultants than cardiology, the next biggest specialty. This is a changing trend as cardiology has been the biggest specialty since 2016-17, with geriatric medicine coming in second. Since 2021, there has been an increase of 378 consultant geriatricians included in the census data.

The consultant geriatrician population has a higher proportion of women working in the specialty compared to the overall consultant workforce. Just under half (47%) of consultant geriatricians were female and 53% were male, compared to 41% of females in the overall consultant workforce and only 18% of consultant cardiologists being female. Most consultant geriatricians were aged between 40 and 54 (56%). This is consistent with the average age of all consultants. The next biggest age groups were those over the age of 60 (15%) and those between the ages of 35 and 39 (10%) (see Figure 2).

Ethnicity and citizenship

Most consultant geriatricians identify as white, with 53% noting they were white English, Welsh, Scottish, Northern Irish or British. The second biggest ethnicity was Asian or Asian British (29%). A small proportion (3%) of consultant geriatricians identify as Black or Black British, consistent with the wider consultant workforce (see Figure 3). Compared to consultant cardiologists, geriatrics appears to be slightly more inclusive of the Black population, with only 1% identifying as Black or Black British in the specialty of cardiology. The 2021 census of England and Wales shows that 81.7% of residents identify as white, 9.3% identify as Asian, and 2.5% identify as Black.⁶ In Scotland, the 2011 census illustrates that 96% identify as white, 2.7% identify as Asian, and 0.7% identify as African Caribbean or Black.⁷

Over a quarter (31%) of consultant geriatricians qualified outside of the UK, which is consistent with all consultants, with 32% of all consultants having graduated overseas. Most geriatricians qualified in England, followed by Scotland, India, Pakistan, Northern Ireland, Wales, Italy, Ireland, Greece and Germany. Most consultant geriatricians (95%) were UK citizens, compared to 93% of all consultants.

How many consultant geriatricians are there and where are they based?

In The case for more geriatricians: Strengthening the workforce to care for an ageing population, the BGS not only highlighted the overall shortage of geriatricians in the country, but also noted that the ratio of geriatricians to older people is uneven across the country.² While quantitatively comparing the number of geriatricians in different locations may not take into account the uniqueness of some areas, for example, smaller populations in rural and remote locations, it allows for a top level understanding of where geriatricians are based in the UK. To meet the needs of the older population, the BGS has advocated for a UK-wide target of one consultant geriatrician per every 500 people aged 85 and over.²

Data from the RCP census indicated that there were 2,328 substantive consultant geriatricians in the UK in 2022, with an estimated number of 2,019 full time equivalent (FTE) consultant geriatricians. That means, comparing population estimates^8,9,10 to the total headcount of geriatricians (not FTE roles), there is one consultant geriatrician per 697 people aged 85 and over in the UK. This is not meeting BGS’s suggested target. Geographical variation means that some areas are better served than others. Wessex is the least served region with 1,257 individuals aged 85 and over per geriatrician. The RCP data shows that 38% of Wessex consists of rural and hubtown populations (towns with populations between 10,000 and 30,000), and it also has a coastal population.¹¹ In contrast, London is the best served area, with one consultant geriatrician per 428 individuals aged 85 and over. The Chief Medical Officer’s Annual Report 2023 highlighted that urban areas are not where the growth in older people is occurring, with more non-metropolitan areas experiencing a growth in this population group.¹² A proportion of older people move away from urban areas before they reach older age and therefore, rural, semi-rural and coastal areas have growing older populations. This indicates that a particular focus is needed to increase the numbers of geriatricians in these rural and coastal areas, to meet current and future demands. However, the data also indicates that not all rural areas are less well served, with West Scotland having relatively more geriatricians than some other areas, despite having a rural and hubtown population of 53%. More analysis is needed to examine the potential reasons behind this variation. A full breakdown of each region can be found in Table 1 (see Appendix).

Last year, the BGS highlighted that an additional 1,218 consultant geriatricians were needed to level up to the national benchmark of one consultant geriatrician per 500 people aged 85 and over based on census data from 2021 and an additional 1,846 needed by 2030.² The new RCP census data indicates that the new number of consultant geriatricians that would have been needed for 2022 was at least 917. By 2030, it is estimated that at least 1,786 additional geriatricians are needed (starting from the total headcount of geriatricians in 2022), not taking into account retirement. It is important to note that these figures are for the total headcount of consultant geriatricians in the UK, inclusive of part-time consultants. This reinforces our calls for government to urgently act on recruitment, retention, training and support as outlined in The case for more geriatricians: Strengthening the workforce to care for an ageing population.⁵

Working arrangements

The majority of consultant geriatricians - 85% - work for the NHS; 9% work academically (with or without an NHS contract); 2% work jointly for the NHS and another organisation; and 5% work for other organisations. Other organisations included local authorities, charities, hospices, and HM Forces. In comparison to all consultants, it was more common for geriatricians to work for the NHS and less common for them to work academically. Amongst all consultants, 78% worked for the NHS and 15% worked academically. Consistent with all consultants, 31% of consultant geriatricians work less than full time or flexibly comprise. Of the female geriatricians, 47% work less than full than full time or flexibly whilst 14% of male geriatricians work this way.

The majority of consultant geriatricians (94%) provided care for hospital inpatients, which is higher than the average for all consultants at 79%. A higher proportion of geriatricians also delivered care for patients on virtual wards, with 19% delivering care in this way compared to 9% of all consultants. Of those, 49% work on a virtual ward weekly, 24% work on them daily, 21% work on them monthly, and 7% once or twice a year.

Most consultant geriatricians (98%) have a Certificate of Completion of Training (CCT) in Geriatric medicine and a further CCT in Acute Internal Medicine (AIM) or General Internal Medicine (GIM). This is significantly higher than the average of all consultants, with 62% on average having a CCT in AIM and GIM, and 50% of consultant cardiologists. As a result, 71% of consultant geriatricians had a work commitment to AIM or GIM which is considerably higher than the average of 45% for all consultants and 24% of consultant cardiologists. Additionally, 59% of consultant geriatricians reported that they participated in the acute medical take, which is higher than the average of all consultants at 35% and consultant cardiologists at 11%.

Most consultant geriatricians (82%) participate in out of hours on call work, with 34% participating in specialty only calls and 23% participating in the acute take only. This is slightly higher than average, with 72% of all consultants participating in out of hours on call work. Consultant geriatricians tend to partake in less specialty-only out of hours work compared to other specialties. Most consultant geriatricians (84%) routinely work some hours above their contracted Programmed Activities (PAs). The majority of respondents (64%) reported that their patient-facing clinical workload was a contributing factor to working above contracted hours, most (56%) also highlighted that their administrative clinical workload played a role, and just under half (45%) highlighted vacancies and covering for colleagues was a factor. This is similar to other specialties. However, most consultants spend more overtime on administration duties and geriatricians spend more overtime on patient-facing activities. This is probably a result of geriatricians spending more time on the acute medical take. Over half of consultant geriatricians would like to work fewer PAs in the future, consistent with the wider consultant workforce’s views.

Reflective of the whole consultant workforce, just under half of consultant geriatricians (43%) did not take their full leave entitlement in the last year. Of those, 55% had 10-20% of their leave remaining. The primary reason why leave was not taken was due to an inability to find cover for clinical service, followed by consultants being too busy to organise cover and being unable to take time from non-clinical roles.  Nearly half - 42% - were contacted by work about clinical matters while on leave, and 38% were contacted by work about non-clinical matters while on leave. The majority of consultant geriatricians took Continuing Professional Development (CPD), or study leave in the last year, with the majority taking 3-5 days, which is similar to the average.  

Most consultant geriatricians felt that they were supported to work from home, with 75% reporting sufficient equipment to effectively work remotely. The majority of consultants (86%) have remote working IT equipment provided by their workplace and 78% also reported using personal electronic devices to do work. The type of work most done remotely was CPD (78%), followed by administration related to patient care (61%), education (47%), and appraisals (42%).

Job satisfaction and wellbeing

Consistent with the wider consultant workforce, the majority of consultant geriatricians do not feel in control of their workload, with only 35% feeling they can manage the expected amount of work. However, a stark comparison can be made to consultants who mainly work in general internal medicine, with 52% of them feeling in control of their workload. Of the geriatricians, 42% of male consultants and 28% of female consultants felt in control of their workloads. A significantly lower proportion of consultants from Northern Ireland felt in control of their workload, at 7%, compared to other UK nations, which ranged from 31 to 37%. The age group which felt the least in control of their workloads were the 40–49 year olds. Just under half of geriatricians felt that they worked excessive hours, consistent with the wider consultant workforce.

Just under a quarter (23%) of consultant geriatricians felt that they were at risk of burnout, which is slightly higher than the average of all consultants at 19% and consultant cardiologists at 17%. The burnout percentage is higher in the male workforce, at 25%, compared to the female workforce, at 21%. Northern Ireland had a slightly higher percentage of consultant geriatricians at risk of burning out (27%) compared to other nations, which ranged from 19% to 25%.

Most consultant geriatricians are happy with the specialty, with 83% saying they are always or often satisfied with geriatric medicine. For those taking on commitments in general internal medicine, only 44% were satisfied with this. Most consultant geriatricians (75%) felt they were valued by their colleagues, and 79% felt they were valued by their patients. Additionally, 84% of geriatricians would recommend their organisation to outside consultants and trainees, 85% would recommend to a SAS doctor, and 80% would recommend to their friends and relatives as a patient.