Is Polyamory Possible When it Comes to Specialty Applications?

Can you really be committed to more than one specialty?

NHS England recently released some fascinating (and slightly eyebrow-raising) stats about CT1/ST1 applications for 2024. So, what’s going on? We now know that out of 26,036 doctors, a solid 57.4% (14,951) took the “one and done” approach—submitting just a single application (e.g., Core Psychiatry Training CT1).

But the real fun begins with the remaining 42.6% who couldn’t settle on just one option. 5354 doctors hedged their bets with two applications. Then there's the extreme end of the spectrum: the 3 brave souls who managed to submit 16 applications. Yes, 16. That’s practically a full-time job in itself, never mind the actual doctoring.

As soon as these numbers dropped, so did the jokes:
“Can you really be committed to a speciality if you’ve applied to 9 different ones?”

But let’s be real for a second. Behind the jokes, we might be missing something important. In a landscape where the bottlenecks are tightening, the academic requirements are inflating fast, and some doctors are demoralised by perpetually remaining at SHO level, who can blame them for trying everything to progress in their careers? Applying to multiple specialities isn’t necessarily a lack of commitment; it’s a commitment to progression, advancing their careers, and not being stuck in “SHO Limbo” forever.

The truth is, doctors are playing a game where the goalposts keep moving. Today it’s a PhD requirement; tomorrow it’ll be clinical trial experience while juggling three surgeries. So, for those watching their dream speciality slip further away each year, casting a wide net of applications makes sense. It’s a survival tactic.

And here’s the silver lining for those seeing the ratio’s increase in their desired speciality: despite the fierce competition ratios, multiple applications are padding the stats. So, while the competition is undeniably tough, it may not be as apocalyptic as it seems when some candidates are applying to every speciality under the sun, hoping for a match somewhere.

£11 Billion Later, The Unified NHS Platform Hits the Dust: For Now…

For years, we had high hopes for a unified NHS IT platform. The idea? A massive system where all patient data would be stored in one place, accessible across trusts and departments. No more lost referrals, no more guessing the medication. It was poised to be the world’s largest civilian computer system—until it wasn’t.

After 10 years, endless delays, and a cool £11.4 billion (yes, billion with a "B") of taxpayers money, the National Programme for IT has been officially... unplugged.

From the start, the project was about as clear as a hospital discharge summary. A vague vision paired with trusts wary of losing control over their systems meant the "one-size-fits-all" dream fizzled out. It turns out that unifying the NHS's patchwork of IT platforms is a task so enormous, that even £11 billion couldn’t make it work.

So, here we are, still chasing that IT utopia while patients try to recall their medical history for the fifth time. At least we can all unite in a collective sigh over the lost billions.

A Case of Mistaken Identity

How lanyards and name badges can create confusion…

We’ve all seen it: your average anaesthetist, effortlessly identifiable from a distance thanks to the ubiquitous ‘drug label lanyard’ draped around their neck. It's practically part of the uniform. In fact, legend has it that if you ever get lost in a hospital, just look for the lanyard, and you’ll find an anaesthetist next to a syringe of propofol.

But it got the OnCall team thinking – how important is the humble lanyard within the NHS? Could the wrong choice of neck accessory cause confusion, or worse, chaos among staff and patients?

Picture this: an emergency medicine doctor walking around with a ‘drug label lanyard.’ To the untrained eye, they could easily be mistaken for an anaesthetist. “Not a big deal”, you might say. But when you consider the potential implications, things start to get a little murkier. This simple case of mistaken identity raises a broader question: just how easy is it to manipulate our professional image in a hospital setting?

Now, imagine someone really pushing the boundaries – a non-doctor sporting a ‘Core Surgical Trainee’ lanyard. That’s no longer a harmless mix-up; that’s straight-up role misrepresentation. It could lead to patients and colleagues placing trust in someone who isn’t qualified to offer the care they appear to be representing. The consequences? Let’s just say they’re not covered by a humorous anecdote.

Hospital lanyards, once a tool for quickly identifying roles and responsibilities, can easily be co-opted by the bold (or mischievous) to present a false front. And the effects aren’t benign. Misrepresentation leads to a breakdown in trust, confusion among teams, and, ultimately, could jeopardise patient care.

As doctors, we’re the gatekeepers of this sacred hospital hierarchy, and we have a duty to call out lanyard-related (and other) identity violations.

So, next time you see someone flaunting a lanyard that doesn’t quite match their role, think twice. And if you’re the one reaching for that anaesthetist’s prized ‘drug label lanyard’, make sure you’re prepared to back it up with some serious pharmacology know-how or a closed-eye venflon insertion.

“Had the most bizarre encounter ever with a reg who picked up the phone and answered ‘Hello Cardiology Reg Dr X MBBS, MD, MRCP’ - sorry but who on earth lists off their qualifications answering a bleep“

“Have a patient who won’t stop talking. Interrupt them. Don’t feel bad about it as you have a job to do. Building rapport is essential, but if it’s impeding your ability to provide safe management, it takes second place”

“Can we settle the true ABC of anaesthesia - Airway, Bagel, Coffee or Always Bring Charger?”

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Struggling to get paid for locum shifts? You’re not alone! The process varies from region to region and can be maddeningly slow. In some areas, you first have to send a timesheet, copy in your line manager, and wait for medical staffing to acknowledge it (after you chase them down, of course). Then, prepare yourself for a potentially two-month wait to actually see the money. And just when you think it’s sorted, you might get an email on payday saying, “Oops, short-staffed—next cycle!” 3 months to be paid for one shift…

No other profession would tolerate this—why do we? It’s frustrating, but you’re not powerless: consider holding off on extra shifts until payment is sorted, or shift to an agency that guarantees timely pay. “Sorry I would be able to cover this, but as my last shift has not been paid, I will have to decline”