Consultant staffing and career prospects in gastroenterology for England and Wales. Royal College of Physicians Committee for Gastroenterology and Clinical Services Committee of the British Society of Gastroenterology.

In the three years since the last report on career prospects in medical gastroenterology in England and Wales' the need for more specialist gastroenterologists has become increasingly evi- dent. In part this is because of an increased demand for endoscopy2; and in particular the development of laparoscopic cholecystectomy which has expanded requirements for endoscopic retrograde cholangiopancreatography (ERCP). Five years ago it was suggested that ERCP would be limited to larger centres; now it is required in every district general hospital of average size. In addition liver transplantation is becoming a routine procedure and Newcastle is soon to be added to the five centres already offering this surgical solution to liver failure and end stage liver disorders. Hepatologists are required, not only for the development of transplant centres, but also throughout the country for the accurate assessment of patients with liver disease. Finally, specialist gastroenterologists are playing a major role in developing the services for artificial nutritional support.3 Recently pub- lished evidence shows that gastroenterologists are undertaking more service sessions than con- sultants in other general medical specialities45 and, on average, work well above scheduled hours. Thus there is strong evidence to support a further expansion in consultant staffing for gastroenterology.