Crippled before the race begins: how the med students are feeling

UPDATE – SEPTEMBER 2023: I don’t want to delete this article as it’s a part of my story, but I must tell you that I cannot continue to endorse Medic Footprints as a company, following their decision to pursue the highly unethical Multi-Level Marketing business model, in the form of ‘Travel Doctorpreneurs’. As a marketing professional for the last 8 years, I passionately advocate against getting involved in MLM schemes (otherwise known as Network Marketing). As well as the financial risk, the ethical risk is huge, and I am deeply saddened, and more disappointed than I can express, that a company I once respected has involved itself in such exploitative practices. Medic Footprints may still be useful to you in terms of their resources, but I would strongly advise my readership to steer well clear of Travel Doctorprenuers, or indeed any other MLM scheme.

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Hello all, I wrote this yesterday after I went to Birmingham medical school for the day to represent Medic Footprints at a national conference hosted by BAMSoc (Birmingham Academic Medicine Society). As well as academic presentations and poster displays, there was also a focus on career development and mentoring. One of their committee members, Lauren Quinn, was telling me how they were inspired by the Medic Footprints ACW (Alternative Careers and Wellbeing for doctors) conference last October, and wanted to bring something of it to their own university. It was pretty interesting to hear what current med students have to say about their medical careers…

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I’m sitting on a train on my way back to London from Birmingham New Street, and thinking about the experiences I’ve just had at the BAMSoc conference.

I was there with fellow Medic Footprints team member Dr Jogisha Kukadia, an orthopaedic registrar who’s taking a break from the classical training path and locuming while she does other things and tries to figure out what she wants to do – such a common story now. I was unsurprised to see the recent government statistics confirming that only half of FY2s continue into speciality/GP training – there seem to be more reasons to leave than to stay these days.

Anyway, it was a very interesting day. I used to wonder whether it was ‘too soon’ to be discussing alternative careers with medical students – after all, they haven’t even started yet – but then we’ve had a few medical students come to events over the years, and indeed many of the doctors in our network started their journey while at medical school. As Jogisha said, it’s never too early to set an example and ‘sow the seeds’, as it were.

The general feeling from many of the medical students we spoke to is that they are really feeling the strain of what’s going on in the NHS, and questioning the future of their careers. Already they’re planning F3 years and thinking about leaving, and a couple of them were even thinking about quitting medical school before finishing. I felt keenly for one student who came up to me and told me how a friend ‘couldn’t bear the thought of doing the clinical years, but felt she couldn’t speak to anyone about it ’. And there was another who found medical school was eating into every aspect of life, and becoming so stressful, that hobbies and interests were no longer fun. I remember feeling these things at medical school. I thought I was alone, but in reality I think that a lot of people probably felt that way – we all just hid it very well.

A really lovely moment today was when three final year students came to us and told us how ‘refreshing’ our talk was. It was actually brilliant to meet them, because they seemed so impressed with the ethos of Medic Footprints, and so amazed that this whole world of possibilities existed. I’ve got used to it now, but I mustn’t forget that, just a short time ago, I too was ignorant of any path but the well trodden one of continuous, relentless training until consultancy. We spoke for a long time about various things – dealing with the guilt of leaving, having little to no access to alternative careers information at medical school, the tendency of medicine to make everyone conform to one ideal, like robots rather than thinking, feeling , individual human beings.

We told them numerous stories about doctors were know who have done things differently, like Gyles Morrisson, Evgenia Galinskaya, Stephanie Eltz, Sandeep Bansal and many more. They seemed so shocked – the expression on their faces must have been exactly as mine was the first time I went to the ACW.

They told us how they felt they were losing who they really were. On their first day at medical school, they were told by a lecturer that ‘half of them would be GPs’. This is, of course, the government target that the med schools are clearly pushing, but it made the students feel as if they had no autonomy over their careers and were just there to do as they were told. They told us about the Situational Judgement Test, and how even the exam itself was designed to imply that, though work-life balance was important, work was the ultimate priority.

When did medicine become like this? It’s a vocation, to be sure, but that doesn’t mean it should come at the price of your happiness and enjoyment of life. We are breeding a generation of miserable doctors, shuffling onto the wards to do their duty rather than loving their job. What good is that? Who does that benefit? Certainly not the patient, for whichever way you put it, an unhappy doctor is never going to be as effective a clinician as a well-rested, emotionally supported doctor who is happy with their life.

It was also absolutely fascinating to hear a talk by Peter Minnis, who is training to be a doctor in the Royal Navy. Jogisha and I looked at each other in astonishment when he told us how much they earn. Not only are school fees paid for, but they are also salaried while they are at medical school! Think of that! To be paid for studying! It seemed unreal. And then the fact that, as a naval FY2, you could earn £56k! Madness! That’s more than double the normal FY2 salary! And just when Jogisha and I were thinking it was probably a man’s world, he told us that about 50% of naval doctors were female! Apologies for the overuse of exclamation marks, but my mouth literally dropped open during this talk.

Peter then went on to describe the other benefits of being a navy, army or RAF doctor: the camaraderie, the great social life, the sense of belonging, the problem solving, the autonomy, the hands-on approach in which skills like wound closure, intubation and other aspects of advanced trauma life support were taught routinely – all of these things were exactly what I imagined life would be like when I applied for medical school, and I was so disappointed when it was not. Junior doctors nowadays are massively deskilled because their exposure to all this practical stuff is so minimised. I couldn’t believe this way of doctoring still existed in the armed forces! Clearly, the medical students didn’t know either, as some of them sounded annoyed that they had never been given this option before.

In the navy, you are also, by default, obliged to step out of medicine every so often, as you are a naval officer first and a doctor second. You are expected to muck in and assist with the other jobs to be done on the ship, and you travel the world while you do it, so the very nature of the job protects you from that dangerously unhealthy state in which medicine becomes omnipresent and all-encompassing. Of course, there is a risk involved – you may pay for it all with your own life, and I don’t pretend that doing such a job easy, with the long missions away from home and the ethical implications of the job. But you could argue the NHS has its own risks – the rates of physician suicide are that much higher than the average person, and both mental and physical health problems are growing increasingly common. I would die a thousand deaths before going back to being the mundane, bitter shell of a person I became as a doctor.

Someone asked me if I would still recommend medicine as a career. That’s a tricky one. I recently turned down an opportunity to speak at an event that was aimed at helping college students to get into medicine. I couldn’t do it – given my background, I couldn’t reconcile myself to the cause. Having said that, a medical degree is a valuable one, and medicine itself is a wonderful profession if you remove all the inane obligations thrown at you by the system.

I think I would still recommend it, I just don’t think it’s right that medicine should be done full time. When I say full time, I mean it in a junior doctor’s terms, where every hour of every day is spent either working clinically, working at home on projects, papers or portfolios, or worrying about work. I think cultivating interests outside of medicine should be encouraged and applauded, because it is simply unhealthy and unwise to do this kind of work without respite and relief.

What struck me most today was not so much that these students were already disillusioned before even beginning their careers. It was that they were so disempowered. So often we heard from those who were unable to share their fears for fear of censure, ignorant of the many forms a medical career can take, and pressured to ‘complete’ their training as fast as possible. These are the reasons why medicine can feel like a prison. Without a way to address these issues, what happened to me will happen to them – they will get to a point where they just can’t do it anymore and quit. I hope that we can make a difference by intervening sooner, and showing them that you truly can achieve a balance between medicine and life. I hope we can also show them that it’s OK to ask questions and have doubts, and that their wonderful, high-functioning individuality is their greatest asset, not something that should be stamped out of them.