The UK needs 10,000 dermatology academics

by reestheskin on 30/10/2016

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No, it doesn’t: pure clickbait. But how many does it need? The headline was taken from a comment by Eric Schmidt, the former CEO of Google, that the ‘UK needs 10,000 computer science academics’, When I saw the headline, I initially read it as saying the UK needed another 10,000 computer science graduates. Oops. He means staff, not students.

But then I wondered, as I often have, how many academics in medicine we need, and how we might go about working out what the number should be. And I should add, I am sceptical we can know how many doctors we need, only those untouched by reality like Jeremy Hunt, know answers to question like that. But there are some numbers that are relevant, even if I cannot match Enrico Fermi’s ability to perform back of the envelope calculations (how many piano teachers are there in New York?).

Depending on how you parse the data, skin disease is said to be the commonest reason to visit a GP in the UK. Estimates suggest there are 15 million visits to GPs with a skin problem each year. In many countries all these patients would go direct to an office dermatologist (this distinction is important, but marginal to my argument here).

Each year about one million people with skin disease are referred from primary care to secondary care. New to follow up ratios are falling — being forced down without any clinical reason because of money — but assume 1 to 1.5. In terms of visits, the ratio is much higher, because we have to include surgery and phototherapy, so the ratio of new to follow up is much higher, at a guess 1:4. This would mean 4 million visits. This seems frighteningly high.

There are around 70,000 GPs on the register, and around 600 consultant dermatologists in the UK. GP recruitment problems are well known, and estimates are that close to one third of all dermatologist posts are vacant (‘no suitable candidates’). There are juniors (sic) on top, and other miscellaneous doctors too. In terms of new patients, I see 26 per week, and I am clinically part time, so around 1000 per year, plus some on call work, which is light. If we divide the 1,000,000 new referrals by 400 consultants, we get each consultant seeing around 2,500. But if we add in juniors, staff grades and locus, the numbers *feel* about right.

If we were to look at academic staffing, we have about 30-35 clinical academics in dermatology in the UK. They spend their time between clinical practice, research and teaching. Most UK students are taught for most of their time by people who are not ‘academics’ or at least by people without what in most subjects and in most advanced countries would be recognised as an academic apprenticeship. Skin biology or skin science is notable by its almost complete absence in many — possibly the majority— of medical schools. If we argue — and I would — that those who run and organise teaching in higher education need to view this task as a *professional* task, we are running with say 15 FTE providing the undergraduate teaching  resource  that underpins clinical practice and early training / education. Note: my argument is about undergraduate education, and not specialist training; and I believe that teaching is not a ‘bolt-on’ activity at the undergraduate level (if you don’t agree with this view,  I suggest you could largely dispense with university medical schools).

There is a simple way to frame any answer to my question. Do you think it is possible to produce and maintain a culture of learning and clinical expertise given the numbers above?