Consultant physicians working with patients - Royal College of ...

2 Specialties Acute internal medicine and general internal medicineCertificate of Completion of Training (CCT) holders tofill consultant posts and supports the case for moretraining numbers in AIM, either as new posts or as postconversions. Despite these problems, AIM has remainedthe fastest growing medical specialty in the past 5 years.A workforce of three acute physicians per acute hospitalis clearly not able to provide all the consultant inputrequired to manage the acute medical intake, and in thissituation there will still be a need for consultantphysicians with specialist interests to be involved in theacute take. Some acute hospitals have, however,demonstrated their intention to employ larger numbersof acute physicians, with groups of six or seven beingappointed. If this trend is followed, then an average of 6acute physicians in each acute hospital would need aworkforce of over 1,300 acute physicians, but the needfor the continued involvement of other physicians in theacute take would be reduced and acute physicianstrained in both AIM and GIM could take part in thelonger-term care of inpatients. This would, however,demand even more training numbers in AIM.In planning workforce requirements, a consultantphysician should be expected to spend an average of 15minutes reviewing each patient after their formalassessment. 1,29 This should allow time for theconsultant on call to assess each new patient, review thecase and relevant documentation and talk to relatives.To this should be added time for opportunist teachingand the assessment of trainees using the ACAT.Time must also be allowed for the review of existingshort-stay patients on the AMU on post-take rounds.Thus in a typical extended working day, the consultanton call should be expected to review no more than 32new patients.Where attendances at the AMU are likely to exceed 32per 24 hours, there should be more than one consultanton duty and the number of consultants involved dailyon the AMU should reflect pro rata the number ofpatients expected to attend. 29 Consultant work programme/specimenjob planThe models recommended in Tables 1 and 2 should beregarded as standard with respect to the activities of aconsultant in acute medicine but may be altered byagreement according to local need.Table 1 Acute physician with no additional special interestActivity Workload per session SessionsDirect patient careAcute medical unit ward rounds or hot review sessionsRapid access clinicsAmbulatory care sessionsInvestigational sessions – eg endoscopyOther specialty sessionsSupporting professional activities (SPAs)Up to 32 new patients per 24 hours6 new or 12 old patientsVariableVariableVariable⎫⎪⎬6.5 sessions in total⎪⎭2.5 sessionsTable 2 Acute physician with a major additional special interest, including general internal medicineActivity Workload per session SessionsDirect patient careAMU ward rounds or hot review sessionsRapid-access clinicsAmbulatory care sessionsSecond specialtySupporting professional activities (SPAs)Up to 32 new patients per 24 hours6 new or 12 old patientsVariable⎫⎪⎬4 sessions in total⎪⎭3.5 sessions2.5 sessionsC○ Royal College of Physicians 2013 23