Medical workforce in the future
Dr Paul Myres, Chair of the Academy of Medical Royal Colleges Wales
The Wales Academy chair, Dr Paul Myres, was asked to speak for 3 minutes at the recent Bevan Commission International Conference as part of a panel about the future of the medical workforce in Wales.
Will there still be a need for doctors in the future? Yes, certainly
Will there be more doctors in the future?
Hopefully. Patients are asking for more time with doctors to understand better about their own health and illnesses and to make the right decisions for them about managing their health issues. Most Royal medical Colleges are telling us there are insufficient numbers to maintain a safe and efficient service. There needs to be the right balance between generalists and super specialists. In order to maintain efficiency and ensure sustainability, we have to recognise that doctors are expensive items and some of what they do can be done by others.
What can doctors uniquely do?
Doctors undertake a long generalist training as under graduates and at least three years, often much longer to gain specialist expertise. They have a widespread understanding of how the human body works, how it interacts with the environment, what can go wrong and how it can be put right (or not). In particular doctors weigh up complex information, handle uncertainty, manage clinical risk and make diagnostic formulations. They are competent clinical decision makers, adept in applying modern technology (most of the time) and many provide leadership to clinical teams.
Will they need new skills?
Doctors will adapt to changing circumstances and the needs of both the public and the service itself. Doctors will work more in teams and will need to demonstrate leadership capability if they are to retain senior positions. They will need to be competent with IT , responsive to new technology and increasingly know how to use artificial intelligence (AI). They will need to be confident in evidence informed medicine and stop using treatments that are of low value to patients. They will need to understand basic population health and concentrate more on achieving outcomes relevant and acceptable to patients and clinicians. They will need to understand genomics and be proficient in personalised medicine. They must learn to let go of some power , share responsibility and decision making with patients and be comfortable focussing on what is important to individual patients. They will need to be more honest that not all health problems have medical solutions and be prepared to work in a social model for care and wellbeing.
Medical trainees are dissatisfied. They feel undervalued and are working in non family friendly ways. They often don’t feel part of a team and many don’t feel they are using their professional skills. Yes, routine tasks are inevitable but to retain our keen young doctors, there need to be opportunities for them to have their intellectual curiosity stimulated and satisfied. Senior doctors must take some responsibility for this and ensure the training environment offers a good and safe experience. Clinicians should care for each other as well as their patients but the system should also be seen to care for its staff as much as for the individuals being cared for.
Doctors will be core members of multidisciplinary teams using their diagnostic, technical and clinical decision making skills to provide care that is responsive to what is important to individuals, informed by evidence, supported by technology and makes best use of resources.