How many trainees are needed in general surgery? A computer model to facilitate planning.

As a consequence of the reduction in junior doctors' hours, the intention to shorten training and the freedom of Trusts to appoint additional consultants, the requirement for trained surgeons has increased sharply. Whether this consultant expansion will be sustained, so as to reach the target of one general surgeon to 30,000 population, is uncertain. To improve the planning of the number of trainees in this unstable environment, a computer model has been established for the numbers of higher surgical trainees (HSTs) and consultants. Using a series of scenarios the model demonstrates that the existing number of HST posts, with a six-year duration of training, cannot deliver the intended 1767 consultant posts until about 2016. The target can be reached in 2009 by shortening HST to five years or by the conversion of visiting registrar posts to career HST; both measures combined can achieve the target by 2006. Thus urgent action is needed to increase the output of HSTs in general surgery. In view of the uncertain demand for additional consultants, the number of trainees, in each year of HST, should be monitored frequently. The number entering training may then be adjusted appropriately.