Hospitals were also employing less highly qualified surgeons from overseas to cut costs and meet waiting-list targets, the RCS said. Of more than 1,000 consultant general surgeons in the United Kingdom and the Irish Republic surveyed by the Association of Surgeons, 71 per cent said they were working more than the 35 recommended "core" hours a week, even before they had fulfilled on-call duties. And 24 per cent said they were working up to 60 hours a week before they completed on-call duties.
The RCS president Barry Jackson said: "My very desperate concern is that because there is this overworking, there will be occasions when the standard of work performed is less than adequate."
He said most surgeons were "extremely competent", but under such pressure, "there is the potential for occasional lapses. If you are tired, there is the temptation to try to get the next operation done more quickly, and if you are trying to do it more quickly you might not do it as well. There is the temptation to leave part of the operation to an assistant and there is the potential for making a technical error."
James Wisheart, heart surgeon at the Bristol Royal Infirmary, last month told a public inquiry into the hospital's record on babies survival rates that he was overworked and under massive pressure in the unit where children died or were left brain-damaged after operations.
Mr Jackson said that workload pressures had been exacerbated by waiting- list targets, changes in training - which meant consultant surgeons spending more time teaching and supervising juniors - and a shortage of hospital consultant posts and students. He said the 2 per cent expansion rate of surgeons was not enough.
Bernard Ribeiro, president of the Association of Surgeons, said the shortage of surgeons had been an "anachronism" for many years. "We have fewer doctors per head of population in this country than in all the other European countries save Albania or Turkey," he said.
The United States has four times the number of surgeons per head in Britain and the rest of Europe two or three times the number. A manpower review has recommended an expansion rate of 4 per cent.
Frank Dobson, the Secretary of State for Health, said yesterday that the problem had been developing for a long time and efforts were being made to increase the number of consultants.
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