The forgotten six thousand (guest blog)

confusedmedic

One of the benefits of writing this blog is that it’s given me the chance to meet other medics who have decided to do different things with their lives. I’m so pleased to introduce this guest blog by theconfusedmedic, a fourth year medical student who has currently interrupted  her studies to pursue other things outside medicine. She currently working as a junior medical writer for a medical communications company and would like to explore medical writing as a career option. She plans to return to medical school in the next year or so to complete her MBBS but beyond that, she’d like to do something outside of practising clinical medicine.

A medical student’s view on the junior doctor contract dispute

Last year, a post on Reddit went viral and this heartbreakingly candid photo of a doctor grieving over one of his patients was shown to the world.

Evidently, the reality of being a doctor is tough. It’s draining, both emotionally and physically. They sacrifice so much of their time and self to help others. The reward can be great; doctors make a huge difference in people’s lives. However, if it goes wrong, they have to pick themselves up and do it all again for the next patient that comes through their door.

The junior doctor contract debate that has come to light over the last several months has angered and frustrated thousands of doctors around the country. The changes to the contract have been widely rejected and deemed unsafe for both doctors and patients. Yet, despite the strikes and protests, news broke recently that the contract was going to be imposed anyway.

The whole medical profession is up in arms yet again, and rightly so. The definition of the word ‘contract’ is: “A written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” The key word here is agreement. At no point has anyone agreed and accepted this contract. So why has the government suddenly decided they are going to force it on thousands of employees?

Besides the 50-odd thousand junior doctors in England, there is a significant cohort of people who were never really considered or consulted on the matter of a contract that would dictate their future – they are the 6,000 medical students in England whose voices were overlooked by the government. Six thousand people who will leave medical school and have a job contract enforced upon them that they didn’t agree to.

Amongst my friends and fellow medical students, the general consensus is one of outrage, disappointment, and uncertainty. Outrage at the audacity of the government to go ahead and impose a contract widely condemned as unsafe and unfair; disappointment at the lack of meaningful responses from the government; and uncertainty over what this means for the future of training.

I asked some of my friends for their personal views on the matter and what it would mean for them. Will they complete their foundation training in the UK then leave? Will they apply to do foundation in Wales/Scotland? Would they leave medicine altogether after graduation/somewhere down the line? Or will they stay in the NHS and fight this thing until the bitter end?

The responses were mixed. Some are considering and preparing for alternatives: Wales and Scotland; taking an F3 abroad and playing it by ear; taking the USLMEs. Some are looking for ways out of medicine altogether (I only have to look down my Facebook feed to see events pop up for ‘Alternative Careers in Medicine’ and the like, to know people are considering their options). Some don’t have much choice in the matter of whether to stay or go – the financial investment and ties to family and friends are too strong to consider leaving. And why should they have to?

One common thread amongst medical students is a desire to fight this contract for a better future for themselves, every other medical student that will follow them, and the patients of the NHS. A friend made a good point about how governments will always change and politicians are always attempting to make big reforms; we just have to fight them and stick it out. It took a lot of brave people to keep the NHS running thus far, and it will need a lot more brave people to do the same now.

However, I know for me personally, I don’t know if I could do it. Prior to this contract saga, I had my own personal doubts over a career in medicine anyway and it is looking even more unlikely that I will practice as a doctor. I actually find it quite sad to say because at one point that was what I wanted to do. Unfortunately somewhere along the way, I lost that desire and am currently on a leave of absence to work out what I want to do next. The thing is, it doesn’t surprise me to know that I am not the only medical student who feels this way.

We are incredibly lucky to have, in my opinion, the greatest healthcare system in the world. Sadly, the current government are hell bent on destroying it. The NHS probably won’t be sustainable forever, and it has its flaws, but there are so many more positives about it that we, as medical students, doctors, and members of the public, have to fight for. Medical trainees from all over the world aspire to work in the UK health system, but with the changes this contract will bring, all those highly sought after trainees will go elsewhere. And those that are in the UK already will leave. If practising doctors are considering their alternatives, and medical school graduates like myself are looking at other options, where does that leave the NHS?

It’s easy for the government to sit back and make whatever decisions they want to extend working times, reduce overtime pay, and remove safeguards for doctors. They are not the ones who will have to deal with the fall out. They won’t be the ones who will end up being treated by doctors who are tired, overworked, and damn right miserable about the conditions they work in. That will fall on the general public and all the people who rely on the NHS for their health care.

And it’s just not fair.

Read more from theconfusedmedic

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Striking Doctors and Healthcare Innovations

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I can hardly believe it’s happened. Yesterday, for the first time in 40 years, doctors went on strike. I went out to the picket line at Guy’s and St Thomas’ hospital today to speak to and support the doctors out there. It was incredible how dignified this whole campaign has been. They know they have the moral high ground, because ultimately what they’re fighting for is the future of the NHS.

I have to say, it’s really weird not being one of them anymore. Weakening my bond to Medicine under normal circumstances would be difficult, but with all this unprecedented action going on, I feel like I’ve abandoned my colleagues and my profession when they most need support.

However, it is liberating not to be threatened with legal action and GMC hearings, as unfortunately some doctors have been lately. I feel I can truly speak my mind without having to worry about my career.

With this in mind, I said yes when my friend and mentor Gyles Morrison asked me if I’d spend the strike day with a small private healthcare company that provides advice and treatment over the phone or email. I know there’s a lot of controversy, even within the medical profession, as to how much private and public healthcare should be mixed, and with certain branches of the media so desperately keen for sensations at the moment, a training doctor couldn’t really be seen as being connected with a private company. Even though I’ve left, I have to confess feeling some trepidation as I made my way over to their office in Waterloo today. I could almost see the papers now… ‘Doctor spends strike day at private healthcare company.’ Well, at least she writes her own derogatory headlines…

One of the things this company were doing today was taking calls for free in support of the strike. I spoke with the CEO of the company. He told me that, while working in the city, he found it difficult to get GP appointments without taking time off work.

While I agree with reducing time-wasters for GPs, I know there are many who would say this kind of private initiative undermines the NHS. It’s a tricky one. When I met the founders of Doctify last year, Dr Stephanie Eltz explained how the idea for the online specialist database came from her own personal struggle to find someone who could treat her. She explained:

If you try to innovate within the NHS, you’ll be waiting forever. There simply aren’t enough resources. If you want to develop something new for the NHS, you have to do it outside of the system, and then take it back to the NHS once it becomes successful.

It’s difficult as a doctor to think commercially sometimes. We automatically reject any talk of monetary value, because our priority is our patients of course, and the thought of having to decide how money is spent on them is honestly a bit repulsive. When you choose to be a doctor, the financial side of things just doesn’t come into it.

Instead we let non-medics dominate the world of clinical commissioning and health policy. I met Dr Harpreet Sood, a Senior Fellow for NHS England, and he completely shocked me when he told me that when he arrived, there wasn’t a single clinician at the top level of NHS England. Until it became desperate, everyone accepted this situation. Now, however, we’re left wondering where the hell the £130 million NHS budget goes, and why NHS services are being out-sourced to private companies. The few medics that do exist in that ‘world’ have often turned out to be the rotten eggs – money-grabbing sell-outs who crossed over to the ‘dark side.’

Could the solution be these innovative start-ups, hatched and grown in the private sector until they’re ready to tackle the NHS? I really don’t know. This is a world I am new too and O just don’t understand it yet.

The New Junior Doctor Contract

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A great deal has already been said about the junior doctor contracts row, so I will keep this short.

As the years have passed, working as a doctor in the NHS has become more and more about service provision and meeting targets than about good patient care. As training overhauls like MTAS, eportfolios and the degradation of the firm structure have come to pass, training itself has become more of a tick box exercise. You are no longer rewarded for actually being a great doctor, and can easily work your way up the system by simply looking good on paper. For doctors who care, and who chose the profession as a vocation, this is incredibly demoralising.

The current political storm has revealed the extent of this disillusionment: many doctors are already at the end of their tether. Little things like having night-time resting facilities, access to a locker, or being allowed to park on hospital grounds for late shifts, magnify the more fundamental issues of adequate break times, poor management and punishing rotas. Meanwhile, external opportunities for doctors are increasing, whether it be working abroad, in locum agencies or changing career altogether, the pull to leave the NHS is getting ever stronger. 

In other words: if junior doctors had any doubts about staying in medicine, the imposition of the new contracts will be more than enough to erase them.