Addressing the environmental impact of commuting amongst orthopaedic trainees
By Tobi Oputaa and Neil Jainb
aSpecialist Trainee Year 8 Trauma and Orthopaedics
bConsultant Trauma and Orthopaedics Surgeon
If we wish to reach our ambitious goal of achieving the world’s first net zero health service by 2040, we need to address many issues. Even ‘smaller’ issues are important in the view of collectively making multiple marginal gains to achieve one overall large gain.
One such ‘small’ issue is that of trainee commuting. NHS England alone accounts for 40% of public sector emissions in the UK and 4% of this is due to staff commuting. Trainees are in a unique position where they are required to work antisocial hours, frequently change workplace location, and may be required work across large regions of the country, often consisting of hospitals in distant and remote locations. These factors combine to make it difficult for trainees to take advantage of more sustainable commuting options.
In a recent survey completed by 13% of UK Trauma & Orthopaedic Surgical (T&O) trainees, we demonstrated that, when compared to average UK workers, T&O trainees are more likely to commute by car (89% vs 70% p<0.001) travelling more than double the average distance (53 miles vs 23 miles) and thus having a greater environmental impact. Furthermore 75% of trainees reported that they were concerned about the environmental impact of their commute.
We proposed many potential solutions to the trainees surveyed and the most popular of these were as follows:
Rescheduling half day zero sessions - Trainees frequently have half day zero session. These could be rescheduled to ensure that they fall on the same day allowing a full day off and preventing the need to commute to work.
Rescheduling sessions that can be worked remotely - The impact of the COVID pandemic has led to an increase in remote working. Sessions such as regional teaching, research sessions, audit and MDT meetings are frequently worked remotely. These could also be rescheduled to ensure that they fall on the same day, allowing a full day of remote working. An example would be ensuring that all trainees have their half day research session on the same day as half day regional teaching session. Alternatively, instead of halving a weekly half day of regional teaching, this could be converted to a fortnightly full day.
Sub-division of training regions - Many training regions cover very large geographical areas. In the North West for example, the distance between the two furthest hospitals is 108 miles. Since moving house every 6 months is an impractical solution, trainees are required to make decision on where to live to minimise average commute times during their training. We propose that larger regions are either subdivided or trainees are informed of likely locations at the start of their training.
We appreciate that it may be difficult to give long term guarantees on training locations. Circumstances and training needs may change during the course of training and specialist services may only be available at certain hospitals within a region (e.g. spinal surgery or major trauma). However, a trainee could be informed at the start of their training that most of their placements are scheduled to be in a certain part of the region, however this would not be a guarantee and subject to change. Trainees could then make a personal decision on how much weight to afford such information when making decisions on housing.
The recent experiences of two T&O trainees in our region have highlighted this. One completed all but one of their twelve placements in the northern half of a very large region. Whist another completed all but one of theirs in the southern half of the same region. Knowing such information at the start of ST3 when both moved house from out of the region would have been extremely valuable and helpful to both.
The above solutions could all be addressed at a local and regional level by training program organisers and local hospital education leads and administrators. Although considerable work may be required in adjusting job plans for both trainees and trainers, it is easy to see the environmental beneficial of such solutions, which will enable trainees to commute less frequently and over shorted distances. This would also be likely to additionally improve work life balance for trainees, potentially helping to improve overall trainee wellbeing and morale.
While being a move in the right direction, the inevitable increased uptake of electric vehicles will not solve the problem alone. They remain to be another marginal gain. These vehicles are associated with other suitability issues such as the generation of energy used for charging and concerns around sourcing materials required for battery production. It is therefore up to us as a profession, to work towards identifying solutions like those raised above, implementing them wherever possible.