Doctor rota gaps 'regular and frequent' in Wales
More than two thirds of junior doctors report "regular and frequent" rota gaps, according to a professional body.
The Royal College of Physicians (RCP) in Wales said a third of advertised consultant posts go unfilled and sickness absence is also rising.
Vice president Dr Gareth Llewelyn said it meant increased workloads and was a problem which "needs to be solved".
The Welsh Government said it was investing record levels and had more training places than ever.
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The RCP, which represents 1,300 doctors in Wales, makes 16 recommendations for improvements, saying Welsh hospitals are "understaffed and overstretched".
Between 2007 and 2017 the number of consultant physician posts in Wales rose by 70%, from 409 to 694, however in 2018, a third of advertised posts were unfilled.
On rota gaps, different grades from junior doctors to consultants all reported issues.
More than a third of consultants "act down" to cover these gaps.
70%of medical registrars report frequent rota gaps
63%of junior doctors cover gaps on a weekly or monthly basis
60%of consultant physicians face frequent rota gaps in teams
74%of consultant physicians worked evenings and weekends
'There's probably a lack of junior doctors on the ground'
Dr Melanie Nana is a registrar at Wrexham Maelor Hospital, now starting to specialise in diabetes and endocrinology.
"Each day starts with a ward round and then three times a week I do a clinic and other days I'm either on call or helping on the ward. It's a busy hospital - today we started the ward round at 8.30am and finished it at about 1pm.
"There's no doubt about it, it's extremely busy and there's probably a lack of junior doctors on the ground.
"Our day-to-day job is enjoyable - and we've all entered medicine for that reason - but there's a lot of covering other people's gaps.
"With that comes very busy days and sometimes there isn't the ability to take some of the training opportunities that you might like to do."
She added: "It's reasonably tiring and you don't often finish work on time; it means we all come into medicine to help patients and if you're stretched and rushing and spreading yourself thinly - you don't always feel you're doing the job you'd like to.
"On work-life balance, the rotas are quite tight so it's sometimes quite hard to get time off. But the morale between colleagues to help each other out so you can go to important events still exists."
She studied medicine in Cardiff and hopes to get specialist experience in London. Although Dr Nana is originally from Newcastle she hopes to work back in Wales.
"We're a small country - everyone's really friendly and that drew me back ultimately."
The RCP, which is holding a conference at Ewloe, Deeside, also pointed out:
- The number of students from Wales applying to study medicine in Cardiff and Swansea is rising but progress is still slow and more needs to be done to promote careers in medicine to children from all backgrounds and all parts of Wales.
- Location is by far the biggest factor when junior doctors are considering long-term career options, and it is "vital that more is done to create incentives". This could include more flexible working, enhanced study budgets and one-off grants to help with professional exams.
- The NHS needs to do things differently with recruitment. "Too often, health boards advertise the same old posts with no success," says the RCP. Only 43% of advertised consultant jobs were filled last year in north Wales - health boards need to think differently about how (and who) they are recruiting.
- A lack of detail in the Welsh Government's £100m health and social care transformation plan, launched nearly a year ago, with "little useful information available about where this is being spent".
- After rota gaps, the next biggest concern for doctors is lack of capacity in social care to transfer patients home or into the community. Many of those who are well enough to leave hospital "remain trapped in the system".
A Welsh Government spokeswoman added: "Our national and international marketing campaign This is Wales - Train Work Live is attracting new doctors to Wales.
"We have also commissioned Health Education and Improvement Wales to develop a new workforce strategy for the NHS by the end of next year."