It’s a gas, gas, gas

A system that actively removes anaesthetic gas mixtures from operating theatres and any other areas fitted with nitrous oxide terminal units.
“Anaesthetic Gas Scavenging” by giginger is licensed under CC BY-NC 2.0

Anaesthetists, on the whole, have a chip on their shoulder. We are the single largest hospital specialty in the NHS and, in our own view, we pretty much run the place. Try having surgery without an anaesthetist, or a baby or a critical illness or a chronic pain issue or an intravenous dialysis line or.. I could go on, but you get the point. In essence, we (yes we, I worked as an NHS anaesthetist for ten years) provide the physiological bedrock upon which all other specialties have to stand to perform their work.

And yet we are invisible. Shouty, needy surgeons hog the limelight for their work – and sometimes for ours too. Surgeons: At the Edge of Life, Brain Doctors, Baby Surgeons – it’s all about them, them, them.

We gasmen* occasionally edge into view but we’re mainly silently wielding a mask. Once the patient is conveniently asleep, it is generally assumed that the only thing left for us to do is the crossword. Our hero is Guy Secretan from Green Wing, played by lovely, lovely Stephen Mangan. He is the only anaesthetist on UK television that I can immediately bring to mind. And Green Wing finished fifteen years ago. Plus he’s not even real.

Today, for once, anaesthetists are headline news. The Independent has revealed that hundreds of them have no jobs to go to, after spending this last year on the front line looking after Covid-19 patients.

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On the face of it, this looks awful. Hundreds of young doctors who have stepped up during the pandemic are being cast aside without a second thought, now that they are no longer needed. Is it actually as brutal as that?

To understand the situation, you need to know where the bottlenecks are. These hundreds are doctors-in-training. A degree in medicine is really just the start – a ticket to the game, if you like. It is only when you get out of medical school that you start training for the job you will eventually do (orthopaedic surgeon, dermatologist, psychiatrist, whatever). These doctors have spent four years on the first stage of their specialist training in anaesthesia and are looking to move up to the next level. This year, there are more of them than there are higher training places available – 697 more, to be exact. It’s a huge discrepancy.

Why is that? There are a number of reasons but the biggest one is a chronic mismatch of supply to demand. Training doctors is incredibly expensive and the number of available higher training places is fixed (by Health Education England, part of the Department of Health). That fixed number of training places is the bottleneck.

On one side of this bottleneck, we have hundreds of young doctors who want to train as anaesthetists but can’t. On the other side, we have a speciality desperately in need of more qualified staff but unable to find them. The Royal College of Anaesthetists has given clear warnings that the profession is universally undermanned in England. It’s crazy.

As things stand, one million surgical procedures per year will have to be delayed because we simply do not have enough anaesthetists. This is not going to help us clear the biggest backlog of care that the NHS has ever recorded. In the meantime, 697 doctors who are mad keen to help can only watch and wait for another year and another recruitment cycle.

For the last year, these doctors have worked at the coal face of the Covid crisis, at significant risk to their physical and mental health. Now, they discover they have virtually no job prospects. It is understandable that this feels like a ‘slap in the face’. The result is likely to be a whole generation of anaesthetic trainees who feel over-used, under-valued and may leave the profession altogether, leaving it in more desperate need than ever.

It seems the chip on our shoulders is going nowhere.

*gasman: broadly-acceptable colloquial term for someone qualified in the specialty of anaesthesia. Gender neutral.

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