Results of CT3 Equivalent Survey

Sent to College Tutors, Regional Anaesthesia Advisors, Deputy Regional Anaesthesia Advisors, Clinical Directors, Heads of Schools, Deanery representatives and Training Programme Directors

This is a joint communication from the Royal College of Anaesthetists, the Association of Anaesthetists and the British Medical Association.
 
We are writing to you as you have important roles in the employment and training of anaesthetic doctors undertaking CT3 equivalent posts, many of whom took part in a survey run jointly by our three organisations.
 
We would like to thank you for your efforts in supporting these anaesthetists, many of whom were extremely disappointed not to be able to secure ST3 training posts in the penultimate and final recruitment rounds at this level. We are grateful for the efforts you have gone to locally to create and recruit to posts that keep them within the anaesthetic family and allow them to continue to progress clinically with the aim of obtaining future ST4 training posts.
 
In July 2021 we jointly published common standards for CT3 equivalent posts, stressing that posts advertised as CT3 equivalent should aim for equity of clinical, educational and employment standards with formal ST3 posts. Between November and December 2021, we conducted a survey of anaesthetists undertaking such posts and had 183 respondents. We published a statement of the high level results and now wanted to write to you directly with further detail.
 
We asked respondents about their experiences in a CT3 equivalent post compared with that of an anaesthetist in training in a formally-recognised training post at ST3 level. Where we specify ‘trainee’ below we refer to those colleagues in a formally-recognised training post at ST3 level.
 
Of the 183 respondents:

• 65% are in posts that were advertised as CT3 equivalent and 78% applied with the intention of achieving CT3 competencies
• 49% say they are confident, and 30% partly confident, that the post will help them achieve this
• 68% said the post met their expectations, with 11% saying it exceeded them
• 17% stated their current post fell below expectations
• 55% stated they would recommend the post to a colleague.

In terms of working arrangements:  

• 95% have an educational supervisor
• 85% have access to study leave; 46% say it is equivalent to that of a trainee
• 65% have access to study budget; 15% receive the same funding as a trainee
• 75% work the same hours as a trainee
• 58% have the same educational opportunities as a trainee. 

In terms of pay: 

• In England:
  • 15% had a salary drop with their post
  • 31% stayed the same
  • 22% increased equivalent to a trainee
  • 14% had an increase not commensurate with a trainee.
• In Scotland, Wales and Northern Ireland:
  • 39% had a pay rise in line with a trainee
  • 15% had a less generous pay rise
  • 33% said their pay stayed the same
  • 12% had a pay decrease.

 Looking more closely at those in England who suffered a drop in take-home pay (i.e after deductions), this averaged a reduction of £400–500 per month. This was more likely to be seen in those in Trusts and Health Boards using the 2002 contract pay scale, rather than those mirroring the terms of the 2016 contract. Respondents who reported these significant drops in take home pay were also more likely to report having less equitable access to study leave and study budget. They were also more negative in their feelings towards their future in anaesthetics, and more likely to be considering leaving the UK or the speciality than those being paid in line with ST3 colleagues.
 
In terms of onward careers:

• the majority of those responding to the survey intend to pursue Higher Training:
  • 15% have a post
  • 52% will apply at next round
  • 23% will apply at a future round.
• 58% feel less positive than they felt a year ago about obtaining an ST4 post
• more than 60% feel negative or somewhat negative about life and about their future in anaesthesia.

Responses were received from 17 Schools of Anaesthesia around the UK.
 
Respondents from Schools that scored highly for “confident will achieve CT3 competencies” and “would recommend post to colleagues” also shared positive free text comments, including “fantastic supportive department, the post has been flexible and [they] are trying to meet all the requirements I have” and “[I have] equal treatment as a trainee… [the] requirements [are] well outlined for the position.”
 
In those Schools where respondents gave less positive responses in these domains, comments more typically included “[It is] difficult to get training opportunities, as trainees are prioritised” and “[my work is] mainly ICU work, little theatre time [I am] treated very differently to trainees.”
 
There was evidence from the free text comments that many of the respondents do not feel clear about what is expected by the RCoA to demonstrate CT3 equivalence, and that they continue to have anxiety about securing ST4 posts if the ratio of applicants to posts funded by the statutory education bodies continues to be high. Many comments were made about the pressures of trying to achieve the clinical and non-clinical capabilities required from the curriculum, honour their service provision commitments, and undertake additional activities to make their next application for higher training sufficiently competitive.
 
Our organisations will act to address these concerns in a number of ways, including:

• ensuring the content on the RCoA website is kept updated so that College tutors, clinical directors and anaesthetists in CT3 equivalent posts can see clearly what they need to do to demonstrate CT3 equivalence
• we will publish updated guidance on flexibility in training, so that anaesthetists in non-training posts can evidence their progress against the 2021 curriculum and have up to 12 months of training in addition to their CT3 equivalent post count towards the future award of a CCT in Anaesthesia
• production of educational content and events targeted at this cohort of anaesthetists.

 We would ask that at a local level, you reach out to anyone in your department who is in a CT3 equivalent post, or otherwise working to achieve CT3 equivalent capabilities, and:

• ensure they have the opportunity to assess how much they have been able to achieve the clinical and non-clinical capabilities they need and have an action plan to address any deficiencies
• ensure they have the same access to educational opportunities, such as teaching sessions, as trainees
• wherever possible, and where you have the ability within your trust or health board to influence this, ensure their access to study leave and their salary are commensurate with that of a trainee
• continue your excellent pastoral support of these doctors including enquiries about how they are feeling and coping and their access to support in work and at home
• signpost them to our organisations where you feel we can offer them specific support, for example the BMA if they are subject to issues with pay and conditions.

 We thank you for everything you are doing to support the careers of the doctors in this important group. As you will be well aware, nationally there is a limited number of formally-recognised training posts at ST3 level, and those in CT3 equivalent posts are able to continue their training thanks to your enthusiasm and innovation.  We want to support you and these doctors so please get in touch with the RCoA training department (training@rcoa.ac.uk) if you have specific questions, or suggestions which will enable us to do that more effectively.

Dr Fiona Donald, President, Royal College of Anaesthetists
Dr Mike Nathanson, President, Association of Anaesthetists
Dr Mike Kemp, Co-chair, UK Junior Doctors Committee, British Medical Association