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GMC report highlights pressure on ophthalmologists in training

  • 15 Dec 2021
  • RCOphth news

The annual report into the state of medical training and practice in the UK has illustrated the pressure that ophthalmologists in training continue to face as the pandemic continues, with rates of burnout increasing faster than any other specialty.

Carried out in the summer of 2021, key findings from the General Medical Council’s (GMC)’s annual survey of trainees and trainers in the UK that informed The state of medical education and practice in the UK are:

  • Ophthalmologists in training are happy overall with their training experience, rating their quality of supervision, teaching and experience higher than most other specialties.
  • Burnout is a significant concern. Ophthalmology trainees saw the biggest increase in those at risk of burnout, up from 5% in 2019 to 13% in 2021.
  • The disruption to training during the pandemic is likely to be a key reason for rising levels of burnout. Half (50%) of ophthalmology trainees felt they hadn’t been able to compensate for missed training opportunities through transferable skills or given opportunities to backfill competencies (53%) missed due to the pandemic. Although similar to other surgery-based programmes, these figures are well above the average for other trainees.
  • A rising proportion (23%) of all doctors say they are planning to leave the profession, with 7% having taken “hard steps” to leave – up from 4% in 2020. Since the pandemic, doctors have however reported improved team working and knowledge sharing.

Commenting on today’s GMC report, Sunil Mamtora, Chair of RCOphth’s Ophthalmologists in Training Group said:

“Ophthalmologists in training have gone above and beyond during the pandemic, often at the expense of their wellbeing and training. The focus now needs to be to focus on making up for lost time and putting training as the top priority.

We hear from Ophthalmologists in training that there is huge variation between regions and even within regions about how Covid-19 precautions are being implemented. This hits the numbers of cases booked into both theatres and clinics, with some trainees still not accessing the surgical training they need. It is vital that trainees reach the end of their training with the competency, capability and confidence to be consultants”.

Some of the key themes from the report are summarised below.

Positive overall training experience, despite need for stronger organisational support

Between 85-90% of ophthalmology trainees rated their quality of experience, teaching and supervision as good or very good – higher than the average across all specialties.

This is despite the fact that both ophthalmology trainees and trainers were less likely than other specialties to say they had a supportive working environment. 73% of ophthalmology trainees said their trust or board was fully supportive – compared to the 78% average. Likewise, 18% of ophthalmology trainers did not feel valued by their trust or board, a worrying figure compared to the 14% average.

Greater efforts must be made by NHS organisations in the four nations to understand and address these discrepancies.

Disruption to training continues to bear a heavy toll

Almost a fifth (19%) of ophthalmology trainees disagreed that they were on track to meet their curriculum competencies – almost double the 10% average. Half (50%) felt they hadn’t been able to compensate for missed training opportunities through transferable skills – again well above the 31% average, but similar to other surgery-based programmes. Likewise, over half (53%) of ophthalmology trainees felt they had not been given opportunities to backfill competencies missed due to the pandemic.

These concerning statistics reflect data we have collected too. In an RCOphth survey of ophthalmologists in training in 2020, over two thirds (72%) said they did not achieve all their training objectives in their most recent placement, with over half (55%) of these citing lack of surgical opportunities. A significant proportion (29%) of those not achieving their training objectives felt further placement would be required.

It is absolutely imperative that we continue to properly train the next generation of ophthalmologists. The College has collated key information on trainee progression during the pandemic on our website. We are also working hard to ensure that the independent sector provides opportunities for surgical training, where these are not available in NHS organisations.

As the NHS gears up to tackle a possible increase in COVID-19 cases due to the Omicron variant, it is crucial too to reiterate the message that  the RCOphth  published last winter on trainee redeployment. Any redeployment must be done in a planned and considered way, and only where absolutely necessary. Every effort must be made to ensure that time for dedicated ophthalmology teaching is retained and that regular contact with trainees is maintained to support their wellbeing.

Retention of doctors a major challenge in the workforce crisis

A rising proportion (23%) of doctors say they are planning to leave the profession, with 7% having taken “hard steps” to leave – up from 4% in 2020. Rising stress and burnout may be factors – since 2019, the proportion of doctors at risk of burnout has risen from 10% to 17% and those who took time off work due to stress was also 17% in 2021, having been 10% in 2019.

It is vital that as part of tackling our workforce crisis, the NHS and policymakers take action to improve both retention and recruitment of our medical workforce, as well as the wider multi-disciplinary team needed to deliver care. The RCOphth outlined the actions needed for the ophthalmology workforce in more detail in our response to a recent Health Education England call for evidence.

On a more positive note, the experience of working through the pandemic and delivering patient care appears to have had some positive effects for doctors. 43% now report they are satisfied in their day-to-work, up from 32% in 2019. Some improvements seen during the pandemic have also been retained, with 60% seeing improvements in knowledge sharing and team working.