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Complexity and challenge in paediatrics: a roadmap for supporting clinical staff and families
  1. Hilary Cass1,
  2. Sarah Barclay2,
  3. Clare Gerada3,
  4. Daniel E Lumsden1,4,
  5. Kaji Sritharan5,6
  1. 1Neurosciences Department, Evelina London Children’s Hospital, London, UK
  2. 2Medical Mediation Foundation, London, UK
  3. 3Hurley Group, London, UK
  4. 4Dept of Women’s and Children’s Health, King’s College London, London, UK
  5. 5Department of Vascular Surgery, Royal Liverpool University Hospital, Liverpool, UK
  6. 6Royal Society of Medicine, London, UK
  1. Correspondence to Dr Hilary Cass, Evelina Children’s Hospital, St Thomas' Hospital, London SE1 7EH, UK; drhilarycass{at}

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There is much that paediatricians love about their job. The attraction of working with children and families, colleagues who are supportive and non-hierarchical, and the diversity of the specialty are all integral to a stimulating and fulfilling career. Yet, despite these positive features, paediatricians are seeing an insidious decline in morale and well-being within the profession.

Most of the current cohort of consultant paediatricians started their careers at a time when competition ratios for entry to the specialty were high. The perception was of a specialty that was tough due to the long hours and high-intensity work, but amply compensated by the rewarding nature of the job. However, between 2015 and 2018, although the calibre of applicants remained high, recruitment to Specialist Trainee 1 in paediatrics fell from 97.5% to close to 80%, with this once-popular specialty having the lowest competition ratio of all the medical specialties.1

Recruitment shortfalls are one manifestation of broader problems in the specialty, with paediatricians now representing around 5% of referrals to the NHS Practitioner Health Programme (PHP), a confidential mental health and addiction service for doctors.2 This is an over-representation compared with other specialties. In addition, the service sees a higher percentage of trainees (70% compared with an average of 54% across all specialties). Neonatologists and intensive care specialists form a significant subset of the paediatric group. Almost all paediatricians presenting to PHP have mental illness as opposed to addiction problems, with the vast majority displaying anxiety, depression and symptoms of burn-out. Most tragically, a small number have committed suicide.

In 2018 two meetings (‘Spotlight on Paediatrics’) were convened to discuss the issues which may have contributed to this worrying trend, and to try and find solutions. This paper describes the format and outputs of the two meetings and provides key insights …

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  • Contributors HC wrote the full manuscript and also led the two ’Spotlight' meetings described herein. SB facilitated parts of both the Spotlight meetings, contributed to the components about conflict and was involved in editing of the text. CG contributed data and background information on mental illness and stress in doctors and was involved in the planning of the first Spotlight meeting. She was also involved in editing of the text. DEL contributed to the section on children with medical complexity and thinking about this aspect of the paper. He was involved in editing of the text. KS facilitated both meetings in her capacity as Associate Dean at RSM and also wrote up the proceedings of the first Spotlight meeting. She was involved in editing of the text.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note Any individuals or organisations interested in joining the planned collaborative should contact the lead author.

  • Patient consent for publication Not required.

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