Fellows of the @RCPLondon are sometimes invited to serve on appointment advisory committees (AAC) for consultants. This is a pleasure and an honour, and one often comes away learning about how other hospitals handle common problems in acute care.

Not infrequently I am contacted to assist AACs somewhere in the area. These are posts for @acutemedicine consultants.

Of the most recent panels I have agreed to assist, the majority was cancelled due to a lack of applicants. This is quite unsettling.

On one occasion there were four vacancies, for which there were initially three applicants. As the date for interview approached, one after the other pulled out until there were none left.

How do hospitals cope if they can't recruit acute physicians?

The @RCPLondon found some time ago that many consultant posts go unfilled. The only specialty affected more significantly than acute medicine was geriatric medicine. ~50% non-fill rate. https://www.rcplondon.ac.uk/projects/outputs/focus-physicians-2018-19-census-uk-consultants-and-higher-specialty-trainees

An added snag: acute medicine posts can be filled by consultants who have a certificate of completion of training (CCT) in general internal medicine. This has been the case for years and many consultants currently in post trained in a subspecialty before ending up in AIM.

I think this actually augments the problem. Despite the option of appointing GIM CCT holders, the appointment rates are atrocious. This means that we are not training enough doctors to become acute physicians by whichever training route!

Not being close to the centres of power I am not sure what @NHS_HealthEdEng @acutemedicine @NHSEngland are doing about this, but the current situation does not strike me as sustainable.

The current situation has been allowed to develop despite an increasing emphasis on generalism, setting central targets on acute care, the strong evidence base that AMU-based acute care is safer and more effective than the alternative.

Break acute medicine and hospitals will struggle. Sadly I am aware of hospitals where this has happened, and it is not a pretty sight. Acute medicine is the engine room of the hospital, helps meet ED targets, prevents unnecessary inpatient episodes by utilising other pathways...

AMUs are also amazing teaching environments, as long as we create space and time. Many acute physicians I know are closely involved with postgraduate training, supervision and procedural skills teaching.

In recent years acute physicians have been at the forefront of developing ambulatory emergency care (AEC). This has radically altered the acute care landscape, because people can avoid admission without getting lost in the system.

Emergency medicine has only caught up recently.

It is now called #SDEC (same day emergency care) and has branched out into other specialties, but acute medicine got there first.