Estimating the future UK consultant physician workforce in relation to projected demand on the National Health Service: a modelling study.

Background: The National Health Service (NHS) is facing one of the most challenging periods in its 75-year history. Currently there is a shortage of consultant physicians (senior physicians who have completed specialty training), contributing to a stagnation in productivity alongside increasing demand driven by demographic change. We created a model to predict the future number of NHS consultant physicians, to identify interventions to meet future demand. Methods: A Markovian approach was used to construct a state transition model, which predicts the number of whole time equivalent (WTE) consultant physicians over the next 25-years starting from 2023. Model states are stages of medical training from medical school to consultant using data from the UK Medical Education Database. Annual transition probabilities were calculated by reviewing the destination of people at each stage of training over consecutive years. With these probabilities, numbers were calculated that progress to a consultant physician post and compared to expected demand predictions. Findings: The model predicts an approximate 11,000 WTE consultant physician shortfall by 2048 based on high demand predictions. Increasing medical student places to 17,000 per year by 2031, along with increasing retention during physician training through increased training posts, reduced the high demand shortfall to around 5000 WTE. However, increased rates of less than full time working and planned reductions in the intake of overseas doctors would both negatively impact WTE numbers and increase the shortfall from 11,000 to approximately 13,000 and 15,500 respectively by 2048. Interpretation: Without urgent intervention there will be a substantial shortfall in the number of UK consultant physicians by 2048. Increased medical school places will not meet the demand soon enough or by itself. Increasing training positions will be key to meeting demand, with a continued intake of overseas doctors to stabilise the NHS in the short term. Funding: The study was commissioned by the Royal College of Physicians London.