A significant number of consultant physician posts are not being filled, a survey has found.
Too few doctors were being trained
A Federation of the Royal College of Physicians of the UK census found over one third of vacancies were unfilled between October 2003 and June 2004.
The federation said future demand for doctors was under-estimated in the past.
As a result too few doctors entered specialist training to fill posts becoming available now.
It takes four to six years for a physician to complete Higher Medical Training and be ready for appointment to a NHS consultant post.
The federation said candidates for consultant posts today entered training at a time when the numbers of places were subject to a national quota.
It said advice from health authorities and NHS Trusts to the Department of Health did not foresee the need for a substantial increase.
Since then NHS Trusts have realised they need many more consultants.
If all last year's advertised posts were filled, there would have been an increase of more than 15% - in reality there was just a 3.6% expansion.
The need for more consultants has been driven by factors such as waiting list targets, and restrictions on working hours imposed by the European Working Time Directive.
Restrictions on entering higher medical training have now been eased and the numbers of Specialist Registrar (higher medical training) posts increased.
But this has exhausted the numbers who have completed the previous stage of training (basic medical training) so that it is now difficult to fill Specialist Registrar posts.
The federation said efforts must be made to try to persuade consultants not to retire.
It also called for posts to be made more attractive, for instance by offering flexible working, which was particularly appealing to the growing numbers of women in medicine.
And it said more non-physician clinicians should be recruited to offer support to consultants.
Dr Rodney Burnham, RCP director of medical workforce when the survey data was collected, said: "There is not just one simple solution, it requires a whole raft of things.
"Certainly we can't fill all the posts at the moment, and in some cases the only alternative is to use a locum which is not very satisfactory.
"It is better than no service, but if a locum only has skills in two areas, rather than four or five, it puts extra pressure on those people with the skills who are already at a trust.
"We certainly need to increase the attractiveness of posts. Consultants are under such pressure, and their senior house officers see them working long hours - sometimes longer than they do.
"They think 'do I want to do that?' - especially as there is alternative work in general practice with the ability to opt out of night calls."
Dr Burnham said the senior doctors also relied heavily on good secretarial back-up.
But he said the new NHS pay package, Agenda for Change, threatened to drive secretaries away from the health service, as they could see their salaries cut by up to £3,000.
A Department of Health spokesperson said its figures showed a vacancy rate of 4.4% for all consultants in March 2004.
"This is a fall from 4.7% in March 2003 and shows that our work to grow the workforce and fill vacancies is succeeding.
"Between September 1997 and June 2004 consultant numbers overall have increased by almost 8,700 (41%), including considerable increases in consultant physicians.
"DH figures do not provide comparable data for all specialties covered by the Royal College of Physicians.
"However, in the specialties we can compare, DH figures show vacancy rates ranging between 0% and 18% (with an average of 3.4%), lower than the average for all consultants.
"In September 2003, there were 14,619 specialist registrars, 1,939 more than in 1999.
"The NHS Plan target for 1,000 additional specialist registrars by 2004 has been met and almost doubled."
Alastair Henderson, of the NHS Employers organisation, said: "It should be recognised that medical workforce planning is notoriously difficult and nobody, including the medical profession, has managed to get it right in the past.
"Numbers of consultants are now increasing as the number of training places increase."
"The NHS and Department of Health take staff shortages seriously and have already carried out a huge amount of work to tackle the issue with good results in many parts of the country."