How we can improve retention in our demanding yet rewarding profession

In preparing for our careers campaign, Russell notes that we must be clear about the challenges of a career in paediatrics, and focused on keeping it as the best career in medicine.

Since taking on this role I’ve written quite a bit about the future of our profession. As the evenings draw in and the politics seems to draw out endlessly, our future has been in my mind more than ever as we prepare to launch our new careers campaign in October.

We know we need to work harder to recruit doctors into paediatrics. What is less clear, to me at least, is how to get the messages right when our profession is under significant strain, and when retention is as big a challenge as recruitment.

I wrote a few weeks ago about Brexit and my anxiety about the corrosion of trust in public life. This has been on my mind in the context of our campaign. Trust, honesty, caring for each other: these values matter in a profession like ours, and I’ve been clear that our ‘pitch’ to the next generation can’t ignore the reality that it’s not an easy time to be in paediatrics and healthcare. 

In our efforts to improve recruitment we must ensure that we are clear with potential ‘recruits’ about these challenges. 

Our most vital role is to ensure you have the support and the resources to do a job that, even at the best of times, is tough and demanding.

In preparing for the campaign we asked you about some of the biggest challenges facing paediatrics. Unsurprisingly, more than half (58%) said workforce and rota gaps, followed by burnout (35%) and then work / life balance (34%). These issues are systemic and reflect an NHS that is stretched, stressed, and under-resourced. You also told us about other challenges like emotional strain, safeguarding and the duration of training.

I’m listening, and so is the College. Our most vital role is to ensure you have the support and the resources to do a job that, even at the best of times, is tough and demanding. But we know that it is this wonderful and rewarding challenge of working with children and young people that leads people into our profession. 

A lot of my focus as President has been to raise the importance and priority of children and young people’s health – I’m convinced we can make the most difference for you on the ground by getting more money and priority for child health services. 

Together we’re making important progress. Our workforce census and our surveys on rota compliance and vacancies help us make the case about unacceptable gaps and staff shortages at the frontline. We introduced the Trainee Charter and we successfully made the case for paediatrics to be included on the shortage occupation list. We launched the Paediatrics 2040 project to scope and shape the future of our profession. 

In England we now have children and young people as a national priority in the NHS for the first time in 15 years, and some increases in resources will flow from this. We’ve set up an Ambassadors programme that is working to establish a network of members to advocate locally for children, young people and the broader child health workforce. In Scotland we secured an increase in paediatric training places on the basis of workforce demand modelling. It is at this system level that we can collectively make a real difference.

If I’m honest, I am hesitant to write in too much detail about what we can do at an individual level because I’ve yet to meet a doctor for whom resilience is the primary problem. However, it is worth restating that we exist for you, and we’ve developed some practical resources that cover career development, wellbeing, mentoring, and less than full time training.

Paediatrics has an incredible story to tell, but not every chapter is easy - and we need to be brave about saying that out loud.

I want to finish with a few thoughts about light and shade. As part of the focus groups for the recruitment campaign, a few of you were asked to talk about some moments that stayed with you during your career in paediatrics.

Of a patient with safeguarding issues, a colleague said:

No family members came to visit her on her birthday so we (the med students) and the rest of the paediatrics department held a birthday party for her on the ward. She almost seemed to have been adopted by the department.

Most of us will relate to this story and understand why it stayed with our colleague. It is not an easy profession, but many of the most enlivening and formative moments come amid challenging times in difficult circumstances. It is undeniable though that we make a difference. 

I think it’s vital that we talk openly about the good days and the bad days, especially when we’re recruiting new trainees. Paediatrics has an incredible story to tell, but not every chapter is easy - and we need to be brave about saying that out loud. 

I believe more strongly now than ever in the immense value of paediatrics and child health. I know first hand that despite the many hurdles, there are few more inspiring and diverse choices for doctors who want to make a difference. I promise to work with you at every level to make things easier for those of you who’ve already made the choice.