Sending a thank you to the junior doctors

Today, for the first time, junior doctors went on a full strike. They’ve been backed into a corner by the government. I gave the doctors at the Guy’s and Tommy’s picket line a card and some cakes, and Dr Kitty Mohan was kind enough to retweet my message.

kitty mohan tweet

I’ve said it before, and I’ll say it again: I fear this contract will create many more ex-medics like me, but they may well be ex-medics who, unlike me, would have been better off staying in Medicine, and that’s what makes me sad.

Back when negotiations were still going on, the BMA managed to broker a much better deal than the one that was initially offered by the DDRB. A lot of progress was made on issues such as working consecutive weekends, a limit of 72 hours worked in seven days, pay for all work done, and leave for key life events (like weddings). 90% of the terms and conditions were agreed upon.

However, there are still some major sticking points. The issue of doctor fatigue hasn’t been completely resolved – under the current contract proposal, a shift that finishes at 1.59 am still may not be considered as a night shift, therefore doctors could be denied enough rest time. Also, if a doctor doesn’t receive adequate rest time, financial remuneration is being offered, but money isn’t the same as rest, and money won’t prevent tired doctors from making mistakes.

The issue of what constitutes ‘out of hours’ is also a sticking point. Doctors feel that redefining Saturday as a weekday threatens their private lives, particularly as many full time doctors already work two weekends per month anyway. Redefining Saturday as a weekday is a cheap way of having more junior doctors working on a Saturday, but with morale being so low and doctors feeling that they have been demonised, such measures will only serve to deepen the recruitment and retention crisis.

The financial aspect cannot be ignored. There are deep concerns that certain groups more than others will be financially penalised by the new contract, including part time doctors, doctors with a disability, doctors who are carers, doctors who take time out to do research, and doctors who are required to do significant further study (for example, oral and maxillofacial surgeons are required to do two degrees: medicine and dentistry). The fact that women will be the worst affected is another problem, as female doctors are more likely to need time out or do part time work, due to maternity leave and childcare. The new contract will

The deepest suspicion about this contract however, comes from Jeremy Hunt’s declaration that imposing the contract is necessary in order to combat the ‘weekend effect’. First of all, the existence of the ‘weekend effect’ is unclear, since the authors of that paper themselves said that to believe that excess deaths at the weekend could be prevented would be ‘rash and misleading’. Secondly, there is no provision planned for allied healthcare professionals – a true seven day service could not be delivered by extra doctors alone – there would need to be extra weekend cover from nurses, midwives, physiotherapists, theatre staff, porters and healthcare assistants, to name a few, for patients to be dealt with effectively and safely. There will also need to be significant investment in social care services if more elderly or vulnerable patients are to be discharged at the weekend. None of this has been modelled or apparently even considered by the government. Doctors are very worried that the quality of care will suffer if these things are not put in place.

The bottom line is this: how can you provide seven day services with five day resources, without spreading the workforce more thinly? Junior doctors are facing a severe staffing crisis already, and even a small increase in rota gaps could prove absolutely devastating for both doctor and patient safety.

 

 

15 tips: what to do if you want to quit medicine

don't know what to do

Lately, so many of my old junior doctor colleagues have contacted me to ask for advice about leaving medicine.

It shouldn’t surprise me really, what with the government forging ahead with the imposition of the ridiculous new contract, but it does make me sad that so many of my brilliant, hard-working old colleagues are feeling lost, exhausted, and just plain fed up. 

When I first considered quitting medicine, I found the whole idea deeply distressing, and I felt really alone. I didn’t know what to do or even how to find out more information, as it felt like such a taboo to even talk about my feelings. So, in honour of my old colleagues, and anyone else out there who has doubts, I’ve put together a guide for what you should do if you’ve had it with medicine.

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1. Find some head space

As much as our beloved eportfolios bang on and on about the importance of ‘reflection’, working as a doctor rarely gives you the chance to actually reflect on your life. I got my chance to do this completely by chance – in October 2015, I was called up for jury service, and as all those who have done it before will know, you spend a lot of time waiting around. The hours I spent sitting in a tiny room outside the court with a bunch of strangers forced me to think, and in the end, the inefficiency of the justice system served me well, because five days later, I wrote my resignation letter.

Whether it’s getting away from normal life for a while, or talking to someone who’ll respond to your concerns objectively and not critically, spend some time exploring your doubts and feelings. I highly recommend it.

2. Know that you don’t have to leave medicine outright

I’ve had doubts abut medicine since my first year of medical school, but one of the reasons I held back from doing anything about it was that I genuinely didn’t realise that you could be more than a doctor.

It sounds like such an obvious thing now, but the medical schools rarely tell students how they can diversify their careers. As a medical student, you’re led to believe you’re on a non-stop train to consultancy, but since I started working with Medic Footprints, I’ve discovered that you can get off the train. You might change trains and go via a different route. You might ditch the train for a while and drive a car to the next station, where you get back on again. I’ve met people who have had several career breaks over the course of their lives, doing both medical and non-medical things. For these people, their experiences have enriched their lives and have actually helped them when they have returned to their medical careers. Don’t believe the old-school naysayers who will tell you that career breaks will damage your chance of making it in your chosen field; if you do something interesting that will help you grow as a person, it can only be beneficial.

Check out this blog post about Eurekadoc’s ‘Medicine: Stay or Go?’ event to find some real examples of doctors who still work for the NHS, but have other tricks up their sleeves.

3. Remember who you were

I went out for a drink with an old teacher while I was on jury service. She taught me French at high school and we stayed friends after I left. Whenever I see her, I feel a strong connection to my high school self: the girl who was a brilliant linguist, but didn’t appreciate or realise it at the time; the girl who loved poetry and prose better than covalent bonds and the Krebs cycle; the girl for whom English, French and German held such a fascination, that studying them hardly felt like real work.

My old teacher listened to me so understandingly, and told me of her own search for happiness in life, and suddenly the right thing to do became blindingly obvious to me: I didn’t just like languages – I was madly and irrevocably in love, to the point that life without some linguistic aspect would always feel incomplete.

4. Ask yourself: is it medicine or is it the NHS?

This notion came from an unexpected corner: my parents. Although they have expressed doubt as to the wisdom my leaving the profession, bu they made a very pertinent point: debate is important when you’re making big decisions, and while the medicine referendum was going on in my head, my parents represented the ‘stay’ campaign.

Working for NHS England can make it very difficult to like medicine at times, and it can be really hard to know if it’s medicine itself that is making you unhappy, or whether it’s just the system. Could a hop over the border into Scotland or Wales could make for a different experience? Could a different speciality, part-time work, or a year or two abroad give you that sense of perspective? What about the private sector? It’s a taboo subject I know, but you’d be surprised to know that even junior doctors can find roads into it. The co-founders of Doctify, Drs Stephanie Eltz and Suman Saha, set up their independent health tech platform partly because they felt stagnated in the NHS, and setting up a business has been their way of getting that spark back.

It’s a really hard question to answer, but I guess, if you don’t ask it, you never look into it.

5. Do your homework… in the right way

If you’re like me, you’ve probably spent hours googling thing like ‘alternative careers for doctors’, and seen unhelpful lists of other careers that are vaguely related to medicine. But I stopped when a friend of mine, Dr Evgenia Galinskaya, who is a Dermatology reg turned career coach, told me not to do this. (Her exact words were: “stop googling alternative careers for doctors!”)

You are not limited to those lists. When was the last time you sat down and thought about what you wanted to do? Years of medical school and postgrad training give you a plethora of skills, but it can make medics forget that they have other facets to their personalities. Give yourself the chance to rediscover your natural skills, weaknesses, goals and passions.

6. Evaluate your own health

The GMC estimates that 10-20% of doctors suffer from depression at some stage, but more recent studies suggest that the real figure is much, much higher than this.

Of course, not every doctor who questions their career will be experiencing either mental or physical health issues, but I think the risk of this happening is greater, because changing career just isn’t something we do. As I said before, it’s classically been a bit of a taboo – you work so hard and invest so much personally; leaving could naturally make you feel that a lot of time and effort has been wasted. Then there are the wishes of your family or colleagues, and their investment in your career, plus the horrible, awful guilt many doctors feel about leaving. When all of this was added together, for me, it made the misery so intense that I honestly began to wish I could go to sleep and not wake up again.

Please don’t feel alone if you find yourself struggling. You know what the signs and symptoms are; if you were your own patient, would you be worried? Don’t suffer in silence: contact the Professional Support Unit in your Deanery.

7. Get some careers support

Even if it isn’t emotional support you need, people who are having a career crisis generally could use a little help.

I stumbled across an amazing resource while at a Medic Footprints networking event last September – the Professional Support Unit in the London Deanery provides four to six free career coaching sessions for any doctor in a training programme! I could hardly believe my luck when I was linked up with a coach who wasn’t a doctor, but a writer by profession. She did all sorts of things with me, like personality tests, a CV overhaul, a skills analysis, non-medical interview practice and lots more. As she worked with me, it became clearer to me why medicine wasn’t the right career for me. I cannot recommend this experience highly enough, so get in touch with them.

If you’re not in training, there are also a lot of independent career coaches out there, and having someone sit down with you in this way might be a worthy investment.

I also was lucky enough to find myself a mentor at the Alternative Careers and Wellbeing for Doctor event in October: Dr Gyles Morrison left medicine to become a user experience expert, and his support and advice became a lifeline to me as I felt my way through a strange, new, non-medical world.

8. Explore opportunities to take time out

For you doctors with a specialty training number, it could possible for you to take an ‘Out of Programme Experience’ (OOPE) for a maximum of 3 years. This can be related to training, research, or something completely non-medical altogether. They can be hard to get, but they are definitely worth exploring. I’ve met many medics who have done an OOPE, and many have stepped out of medicine into something completely different, like management consultancy or health policy. I don’t think a single one of them regrets doing it, for the experience has allowed them to learn something totally new. Some don’t return to medicine, but some do, and from my experience, those who do feel empowered to come back on their own terms.

9. Network your socks off

Doctors – especially junior doctors – are not used to the concept on networking. Generally, you know where to find the people you need (even if they’re not always available!) and as jobs in the early years are dished out using some strange algorithm that puts the SJT on a parr with six years of med school, you don’t really need to get out there and meet people in order to find work.

However – and I cannot emphasise this enough – this is not how it works outside medicine. Meeting people and knowing people can mean everything. I’m not talking about nepotism; it’s more about being in a position to take opportunities. How can anyone become your mentor, your new boss or even business partner if they don’t know you exist?

I’ll give you an example: my mentor Gyles walked past a health tech startup’s PR stunt one day, and stopped to ask them questions about what they were doing. He ended up meeting the bosses and they paid him for some UX consultations. Some months later, I met Gyles by networking at the Medic Footprints Alternative Careers and Wellbeing event and he became my mentor. Gyles then asked me to assist the same company in another PR stunt they were doing, and I just went along out of curiosity and to be helpful. In the process of doing this, I got to know them and I guess they saw something in me that they liked, because they called me in for an interview and here I am now, Head of Content and Marketing at Dr Morton’s – the medical helpline.

So there you have it: go to networking events and careers fairs, be curious and keep your eyes and ears open. You never know what you’ll discover one day.

10. Get on LinkedIn

This ties in with networking, and is a must for medics who want to explore new professional territory. Make yourself a profile, put some effort in and make it look good. You can go further by putting up blog posts as well. 

11. Think about when you’ll be in a good position to leave

It’s not a nice subject, but I used up a lot of the money I had saved working as a doctor while I was unemployed. It didn’t feel great – especially when I  was considering unemployment benefits – but I felt it was a necessary investment in myself. I was extremely lucky to have the support of my fiancé as well.

Dr Roger Tackley made headlines when he left his post as a Consultant Anaesthetist to open up his own hair salon. A career change is always a financial burden, but for him, setting up a new business at the same time made it even more challenging. However, he told me that he was so glad he took the plunge, and his advice to anyone who has a passion to do something alongside a medical career is to give it your best shot. He said it’s a good idea to experiment and sample it before swapping careers, and to make sure that you are secure enough to survive if it doesn’t work out.

12. Remember that the door is always open

Dr Lafina Diamandis is a testament to how varied a doctor’s career can be. She took several career breaks to try different things, including setting up her Boutique Property Services in Spain, and founding Eurekadoc, the only UK publishing house dedicated to printing ‘niche’ career guides for doctors. In December 2015, it was she who organised the ‘Medicine: Stay or Go?’ conference. Lafina went in and out of medical practice, and is now returning again to complete her Paediatrics training. So if someone tells you that once you leave, you can never come back, ignore it; it’s simply not true. Check the GMC and BMA websites for more information of how to come back to medicine after a break.

13. Free yourself from guilt

On Dr Sabine Fonderson’s blogpost for doctors switching careers, getting rid of the guilt thing was her number one tip.

I too was racked with this terrible feeling, but Gyles put it this way for me: if you did a degree in history, would you feel guilty about not becoming an historian? Probably not. Yet doctors continue to feel this sense of shame and guilt when they consider leaving medicine. I felt like I was letting everyone down and I felt that I owed the NHS all the money spent on my training.

Do remember, though, that the government subsidises every single degree in this country – medical students might get a bit more, but the difference is not as big as people believe. Also think of all your fees, exam costs, the free overtime you do, the quality improvement projects, the audits, the teaching and everything else you do completely out of your own pocket and your own time. You’ll probably find that the NHS owes you more than you owe it! Also your value is not just monetary – you are more than just a paycheck. The fact that you’re a doctor makes you extremely valuable to other sectors – health policy, for example. People who harangue you for wasting taxpayers’ money are ignorant of these things and therefore not worth listening to. 

Ultimately, you have to do what is right for you. If you are miserable, you and everyone around you will suffer, including your patients.

14. Turn down the volume of negative influences

It can be hard to avoid negativity. When someone close to you expresses a strong aversion to the idea of a career change, it can make it very difficult to make the call. I also had a bad experience with my educational supervisor, who simply told me I was wasting my life. 

People will always have an opinion about what you should do with your life, but I now try to take advice only as it empowers me.

15. Find peer support

The one good thing that has come out of the junior doctor contract dispute is the heightened sense amongst doctors that things need to change. Aside from the Junior Doctor Contract Forum on Facebook, other groups have sprung up, like Tea and Empathy – a group that provides a safe space for doctors to talk to each other about personal issues. Other groups, like Tiko’s GP Group, are aimed more at solving clinical issues. 

I have noticed that more and more senior doctors are willing to talk about the realities of working in medicine than they were before. I’ve been surprised at how, as well as those consultants who have urged me to go back, there are a considerable number who have been open to discussion about other careers, and have helped me – by providing references, for example.

Another benefit of networking is finding that peer support. When I first started discovering the alternative careers sphere, meeting other people who thought differently was just the most inspiring and comforting experience.

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I hope this article has been helpful to you. Just remember, you’re not alone. In medicine, always being in the same environment can make it difficult to see the bigger picture, but take it from me – there are other options out there, and there’s no harm in looking!