Shift work for specialist registrars in acute medicine: more questions than solutions.

Trainees' hours are under review once again, due to the changes incurred by the latest pay deal and the likely enforcement of the European Working Time Directive. Until now, specialist registrars (SpRs) training in general internal medicine (GIM) have been accustomed to residential on-call rotas or partial shift schemes as a means of covering emergency work. Some NHS trusts have suggested that GIM SpRs should now work full shifts to meet the restrictions of European Working Time Directive. This article outlines the views of the Royal College of Physicians' Trainees Committee on the potential impact of full shift work for GIM SpRs on medical services. Impaired continuity of inpatient care and reduced staffing levels for outpatient services were felt to be the most serious possible consequences. Some short-term solutions are suggested, but in the long term, increased numbers of both consultants and SpRs will be vital to maintain and improve standards in acute medicine.