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“There is a crisis in the recruitment and retention of emergency department consultants”. These words from the Health Select Committee’s report published yesterday strike me as strong. A crisis. The reasons given in evidence to the committee were not so much the money they are paid, although this wasn’t excluded from the assessment. The reasons given were about job satisfaction, personal fulfilment, professional accomplishment. There was little incentive to specialise in emergency medicine if it meant working with a team that changes all the time, where the rota often has gaps that means covering shifts with no break, and where a patient can move up to 4 times in the first 48 hours, indicating a kind of whirling pace of movement not only of patients but of staff. Should staff in emergency medicine be paid more than other specialisms? This point will be debated in the coming months but the report went out of its way to say that this, while desirable, was not going to be the main incentive for attracting good doctors into A and E. Which raises questions about motivation and incentive. Why do we do what we do? How do we choose what we do if we have a choice at all? Last year, a survey was published which asserted that the level of salary at which significant improvements to our lifestyle made us happier was $50,000 or £32 ½ thousand pounds. For many of us, this might seem like quite a lot of money but it is only £8,000 a year more than the national average in the UK. “Speciality doctors” earn more than this, but what the evidence to the committee revealed was that attracting good doctors and nurses into the vital work of the emergency department depends on things like respect from others, a level of stability in work relationships within which trust can develop, the freedom to make decisions and have some measure of control over your day...