In his letter Dr John Eagles points out that the assertion in our paper that consultant psychiatrists working in more progressive roles (low accumulation of patients, effective delegation, good team working and support, effective gate keeping and low level of direct referrals, time to deal with emergencies) are likely to suffer less from occupational burdens is flawed, since no consideration is given to the number and/or quality of team members. Dr Eagles continues, stating that conclusions and recommendations do not stand up in the absence of these data, since any consultant not in a sufficiently populated, effective team would not survive in a progressive role.
My initial response is to state that we indeed did collect data about the size of the respondent's team. These data weren't included in this paper as submitted to keep the length down to publishable level. In common with many national studies, the original dataset for this project is vast and contains several hundred variables. We are forced to choose not only which to analyse in depth, but must create a subset of those to submit for publication in peer-reviewed journals. I can report, however, that team size was included as a predictor in some of our univariate (the larger the respondent's team, the higher their reported satisfaction level [P<0.05]) and multivariate (the larger the team, the lower the respondent's General Health Questionnaire - version 12 score ([P<0.05], and the less they suffer from depersonalisation [P<0.01]) analyses. My second point concerns Dr Eagles’ interpretation of the findings more generally. I feel that Dr Eagles has rather missed the point of this paper: the progressive model can only ever work where the consultant has a motivated, effective multidisciplinary team. A progressive role, by reference to its defining characteristics, cannot be achieved without it. Further, the more important point here is that a consultant cannot change in isolation: as we point out in the paper, any change of role is potentially dangerous unless carried out as part of a whole-systems approach to change, a restructure, where due consideration is given to ensure that any reduction in workload is not merely passed onto other team members, rendering them liable to stress and burnout.