Which way to vote? My 5 main dilemmas…

junior contract

I feel like the doctors of this country have had some big decisions thrust upon them in the last couple of weeks. It’s unfair really – just as our country is plunged into uncertainty, the fate of our profession lies at our feet before we even have the chance to process what just happened. New contract – yes or no?

Right now I’m wondering whether I even should vote, given that I’m no longer practising as a doctor, and yet I feel compelled not to waste this chance to contribute to something that will affect so many of my relatives and friends. That’s a choice to make on its own.

And if I do indeed decide to vote, the real choice begins, and the considerations are far from simple.

1. The sheer complexity of Medicine

Part of the problem is that the working life of doctors is incredibly complicated.

Be honest, how many of you really read our old contracts before you signed them? How many of you, like me, didn’t even see a contract at all? In the three hospitals I worked in in my brief time as a medic, I signed just one set of papers.

The only time I actually read the old contract and contacted the BMA was when Queen’s Hospital tried to take the doctors’ Mess away while I was Mess President – at that point I read the terms and conditions word for word, and pulled out everything pertaining to the availability of food and overnight accommodation.

So deciding how the new Ts&Cs will affect day to day working life in the NHS is proving damn near impossible.

2. The LTFT dilemma

Judging by the conversations on Facebook, less than full time training is proving to be a real bone of contention, with many people confused about wording. If we, with our advanced degrees, can’t figure out what it all means, how on earth are payroll going to make sure you’re paid correctly?

In general actually, the wording of the new terms and conditions is poor, to the point where Justice for Health is actually challenging the writing itself.

3. The elephant in the room: pay

In all honesty, I rarely used to query payment issues when I was a doctor – the process of sorting it out was so flipping complicated that I often decided it wasn’t worth it. I also felt like a bad person for talking about money.

Now that I’m removed from Medicine, I can talk about money without feeling guilty or greedy, and I can say with conviction that doctors in this country are shoddily paid for what they do.  This new contract might be cost-neutral, but it does not change that fact. I know doctors in general don’t want to be paid more than they get now though, so that’s probably not a consideration. What I’m saying to doctors is this: you should be.

4. Working hours

I do worry that the new ‘Guardian’ for working hours will turn out to be just as complex. Call me cynical, but accurately tracking and safeguarding doctor working hours is going to be a big job – it will either have to be paid for, or done badly on the cheap. My bet is on the latter.

Say nothing of the fact that LTFT is defined as 40 hours a week; I’m sorry, but in the real world, 40 hours is a full time job. Calling it part time is a very clever way of making ‘full time’ hours ridiculous, and fooling part time trainees into thinking they have a good deal. Does the £1500 supplement make up for that? Well, I don’t mid telling you that, under the old contract, I worked as an LTFT for 40 hours a week, and received just under £20k p.a. pre-tax. Having the supplement would have made my salary marginally less insulting.

5. Brexit

Understandably, for many doctors, our current political mess is making the issue seem even more complicated. Many believe that we’re in enough turmoil as a country as it is, therefore a ‘no’ vote would be unwise. Rachel Clarke has said that no one will care about junior doctors in the fallout of the EU referendum.

What I would say, though, is that politics will always change, and one way or another, our international situation will eventually settle down. In ten years, these politicians will be a distant memory, whilst doctors will still be very much working. The PR and Research teams in my office are predicting massive overhauls in the NHS independent of the referendum, so it’s not really a reason to vote yes.

So, what to do…?

The last consideration on my mind – and it’s not a justifiable reason at all, so I haven’t included it on my list – is the thought of that pesky little fool, Jeremy Hunt, claiming that one reason he’d make a good PM is his ‘ability to negotiate’. If this contract is voted in, I have no doubt he’ll gloat over it and take credit for the whole thing.

It’s not a reason to vote no. But my God, it’s intolerable.

I still don’t know how to vote, or whether to vote at all; but what I do hope is that doctors will vote based on their true convictions, and not because they’re afraid of losing public opinion or of Brexit.

Whatever happens, this is my final message to doctors voting in this referendum: don’t let fear hold you back from fighting for what you believe is right.


What we could have done

The last couple of weeks at work have been busy in the run up to the company’s big biannual meeting with our shareholders, who are largely doctors themselves. It was a beautifully sunny day at a nice river-side venue, and there present were a mixture of GPs, GPSIs and specialist Consultants from a range of backgrounds.

The day kicked off with a case-based quiz about thyroid disease from endocrinologist Dr V. It was an unexpected kick-back to med school tutorials, and I was mortified to realise how much I seem to have forgotten… It didn’t help that my last rotation was Orthopaedics! The existence of things like sick euthyroid syndrome and postpartum thyroiditis seems to have escaped me somehow… My only comfort was that some of the doctors struggled too!

The other medical talk was an update on menopause from one of the gynaecologists, Dr K. Did you know that the number of hot flushes a women has is directly related to memory loss? Fascinating. It’s nice to be connected to the medical world in this way. I know it’s silly, but the idea of falling behind and being totally out of the loop in a few years troubles me. Is this what people who do a normal degree feel like? If they do a History degree and go into an unrelated career, do they worry about forgetting the dates of battles or the names of Kings? Does a Physics PhD who now works in web development ever get anxious that they might miss the latest developments at CERN? Perhaps. I don’t know. Maybe it’s a doctor thing.

I hadn’t had the opportunity to meet many of the company’s affiliated doctors before, so it was great to finally do so. As well as talking about medical life, we chatted about the external skills and interests. They seemed very impressed with my presentation about Digital Marketing and SEO, and some of them also had experience of that world themselves.

“I have my own website and I wish my Marketing manager understood Medicine! They just don’t get it!”

“My Marketing manager used to get annoyed with my lack of social media presence, and advised me to go on a Twitter course. I refused to go, but now I have more followers than she does and I tease her about sending her on that course now!”

“Well done on your presentation! What you’ve done is prove that doctors can pick up new skills very quickly if they put their minds to it!”

I met GP Dr A, who told me about all the different things he’d done over his career.

“Don’t go through life so focused on becoming an expert in something that you block out everything else. The successes I’ve had in my life haven’t happened because I’m an expert – they happened because I experimented, tasted different careers, learned about new concepts, and met different people. I’ve got further with a bit of knowledge and a lot of networking, than with a lot of knowledge and sitting in my office all day.”

I chatted to Dr S, another GP who like me, trained at Bristol.

“I think every doctor has moments in their career when they consider leaving, it’s just that some of us do something about it and some of us stick it out. I’m not sorry I stayed, because I’ve got to a place in my life now where it suits me and I can manage my career, but I can understand why you’ve made the leap.”

Later, I was with another group of doctors and we got onto the topic of the junior contract dispute, the Whatsapp message leak and the general state of affairs in the medical profession currently. Their perspective was interesting.

One of the doctors had a patient, who apparently had never worked a day in their lives, and had condemned the junior doctors for ‘complaining’ about their working conditions and dismissed the issue by saying ‘isn’t it what they signed up for?’

Obviously this statement annoyed all of us, and the reaction to this from the doctors was this: to get into medical school you have to be a lot of things- bright, hard-working, talented, tenacious, caring, energetic – and if they really wanted to make a lot of money and buy fancy cars or big houses, those students could go into business or finance. They could put in the same long hours a doctor puts in, and deal with similar levels of stress, but get paid a whole lot more for it, and probably experience more of life through travel and networking opportunities. They would quite likely be treated better too, with basics like food and drink provided if they work late.

So why don’t they do that? Why don’t they drop everything and become investment bankers? Well, it’s because they care. They want to make a difference in life. They want to help people.

OK, so some people *asians like me* do it to please their parents, but I don’t think I’m alone in saying I certainly wouldn’t have done it if that was the only reason. Even before I considered medical school, I appreciated and approved of the idea of doing something with my life that could ultimately make someone else’s life better. Whatever the influences around me at the time, I would not have studied medicine if I had not believed that it was fundamentally a fantastic thing to do.

So isn’t is paradoxical that our society ultimately punishes the people who chose to be selfless? Is that not something we should be proud of? Something we should reward? The saddest thing is, that reward wouldn’t need to be financial. What would best serve the caring is making it possible for them to continue their mission – in short, to give them the kindness, compassion and respect that they want so much to give to others.