Mary Dejevsky in The Independent
You know things have reached a pretty pass in any dispute when the combatants start to invoke the spirit of deceased politicians. But when two men who have reached the top of their political trees also start invoking their own mothers – as Jeremy Corbyn and David Cameron did at Prime Minister’s Questions – well, the possibility of any agreement looks remote indeed.
Yes, after a merciful, but all too brief, period of remission, we are back in the heat of the junior doctors’ dispute. The Labour leader accused the Government of showing bad faith and “misrepresenting” statistics (about hospital deaths at weekends); the Prime Minister returned to his mantra about people not getting sick only on weekdays. Whatever else the Government may be ready to compromise on, it appears not to be a “seven-day NHS”.
And quite right, too.
“Our” NHS is not run for the benefit of the staff, however long they have spent in training, however mountainous their student loans, however arduous and responsible their work. A great many people would probably like to work only Monday to Friday, 9 to 5, especially if highly-paid overtime for additional hours comes virtually guaranteed. But this is not the reality for most people, and there is no reason, when so much in this country now functions 24/7 – with the staff on rotas and little, if any, overtime paid – why it should still be such a struggle to get the emergency services to do the same. Yet it is here the overtime culture has proved most resilient.
There will be those – and I admit to being among them – who saw the final offer to the junior doctors as too generous. By preserving a system of overtime, for Saturdays after 5pm and all Sundays, it leaves in place the idea that doctors can expect to work something like traditional office or factory hours with additional rewards for anything else. Those expectations need to be scotched.
Junior doctors, and their many vocal supporters, have tried to turn the contested statistics about weekend fatalities to their advantage, suggesting that a “cut-price” seven-day NHS would simply raise death rates around the week. Anyone who visits hospitals on weekdays and at weekends, however, will be familiar with the glaring disparity in staffing – at every level, and what sometimes appears to be a surfeit of employees, especially in the least skilled jobs, during standard working hours. There is surely money to be saved here, that could offset the cost of more staff at weekends.
Nor can the junior doctors’ dispute be seen in isolation. Their new contract is just one part – if a large part – of reform of the NHS that is yet to come. If next in line are to be the consultants, for whom the junior doctors are often deputising at nights and weekends, you can understand why the Government might be keen to hold the line.
What occasioned the latest sword-crossing in the Commons was the announcement by the British Medical Association earlier this week that the junior doctors would hold three more days of strikes, and would fight the Health Secretary’s imposition of the new contract through the courts. In the first instance, this means seeking a judicial review.
On precisely what legal grounds the BMA intends to fight is not yet clear. For all the perception that the English judiciary has become more politically engaged in recent years, it is hard to see a judge ruling that an elected government is not within its rights to set the terms of a contract for public sector employees, particular when in line with a manifesto commitment. Going to court is only going to inject more poison into this already toxic dispute.
It is beyond time that the BMA called it a day and recognised that the junior doctors have won as much as they are going to – more than they could have expected at the outset and more, indeed, than may be wise for the future health of the NHS. The BMA’s continued insistence a “safe” seven-day NHS is somehow beyond the country’s means is defeatism of the first order, and really not junior doctors’ call to make. It is the stated policy of an elected government.
That said, the extent to which this dispute has become politicised has made it infinitely harder to resolve. Jeremy Hunt has not just been defending his government’s policy of a seven-day NHS, he has been engaged directly in negotiating the small print of a new contract. This has enabled junior doctors, and the BMA on their behalf, to cast the project as a heartless Tory plot.
The most senior non-politicians – the chief executive of NHS England, Simon Stevens, and the medical director, Sir Bruce Keogh – have both been conspicuously absent from the fray. This may be because, if heads had to roll, the Health Secretary is deemed more dispensable than either of them. But here, perhaps, also lies the key to change. For 10 years or more – most recently in the Conservatives’ 2010 election manifesto – proposals have been mooted to separate the NHS from politics by placing it under an independent board. Policy, such as the creation of seven-day service, and the overall NHS budget would be set by central government, leaving the rest to professionals. Each time, however, a consensus evolved to the effect that the NHS was so integral a part of national life and the sums of money allocated so vast, that there had to be direct political accountability. The scandal at Mid-Staffs augmented that view.
But the downside of the argument is again before us. Junior doctors and a Conservative government at loggerheads; there is talk of relations blighted for a generation. One solution might be for the Government to return to its election manifesto of 2010 and divest itself of managerial responsibility for the NHS. If junior doctors can cast that as a victory, so be it. But there is no reason why the sort of hands-off arrangement that is considered good for the BBC and – increasingly – for schools should not be good for the NHS, too.
Showing posts with label junior. Show all posts
Showing posts with label junior. Show all posts
Thursday 25 February 2016
Tuesday 5 January 2016
By the end of my first year as a doctor, I was ready to kill myself
An Anonymous junior doctor in The Guardian
On my morning drives to the hospital, the tears fell like rain. The prospect of the next 14 hours – 8am to 10pm with not a second’s respite from the nurses’ bleeps, or the overwhelming needs of too many sick patients – was almost too much to bear. But on the late-night trips back home, I’d feel nothing at all. Deadbeat, punch-drunk, it was utter indifference that nearly killed me. Every night, on an empty dual carriageway, I had to fight with myself to keep my hands on the steering wheel. The temptation to let go – of the wheel, the patients, my miserable life – was almost irresistible. Then I’d never have to haul myself through another unfeasible day at the hospital.
By the time I neared the end of my first year as a doctor, I’d chosen the spot where I intended to kill myself. I’d bought everything I needed to do it. All my youthful enthusiasm for healing, big dreams of saving lives and of making a difference, had soured and I felt an astronomic emptiness. Made monumentally selfish by depression, I’d ceased even to care what my husband would think of me, or that my little boy would grow up without his mother.
Doctor suicide is the medical profession’s grubby little secret. Female doctors aretwice as likely as the general population to take our own lives. A US study shows our suicide rate appears higher than that of other professional groups, with young doctors at the beginning of their training being particularly vulnerable. As I wrestled silently with the urge to kill myself, another house officer in my trust went right on and did it. To me, that monstrous waste of young life seemed entirely logical. The constant, haunting fear of hurting my patients, coupled with relentless rotas at work, had rendered me incapable of reason.
Though we know large numbers of doctors kill themselves, what is less clear are the reasons why, when dedicated to preserving human life, some doctors silently plot their own deaths. A 2006 study at the University of Pennsylvania identified that during their first year as doctors, young physicians experienced skyrocketing rates of burnout, with symptoms of emotional exhaustion, depersonalisation, and reduced sense of personal accomplishment soaring from 4% to 55%.
For me, the explanation ran deeper. I was entrenched in a hospital system that brutalised young doctors. Working on my hospital’s surgical emergency unit, there were simply too few of us to cope with the daily onslaught of patients. Officially eight or 10-hour days ran routinely into 13, 14 or 15 hours as we house officers worked at fever pitch to provide what was, at best, a mediocre service for our patients. Run ragged, we fought to keep our patients safe, but their numbers outstripped ours 20 or 30 to one, and the efforts this took were superhuman. The nurses knew, the consultants knew, even the hospital management knew, yet no one seemed to give a damn.
It wasn’t just exhaustion that drove me into depression. Plenty of jobs are busy. But there is something uniquely traumatic about being responsible for patients’ lives, while being crushed under a workload so punitive it gives neither the time nor space for safe assessment of those patients. Days were bad enough, but nights on call were terrifying. I remember running from the bed of one patient, still haemorrhaging blood from her surgical wound, to another whose heart rate had plummeted to 20, perilously close to a cardiac arrest. Two stricken patients, but only one doctor, wracked with the knowledge that if something went wrong, the guilt would be hers alone.
I was lucky. I was pushed by the colleague in whom I finally confided into seeking professional help. It took anti-depressants, therapy and a narrowly-avoided psychiatric inpatient admission to bring me back to the land of the living.
Now, on the cusp of junior doctors’ first national strike in 40 years, I’m astounded the health secretary persists in ignoring unanimous condemnation of his new contract from juniors and medical leaders alike. If he gets his way, Jeremy Hunt will make it easier for hospitals to abuse their juniors, by stripping away the safeguards that stop hospitals overworking us, fining those that do. Under his new contract, our hours will become even longer, even more antisocial – at a time when we simply have nothing more to give. And as we are pushed to treat more and more patients, faster and faster, fatigue and psychological distress will dull our competence: your lives will be less safe in our hands. And our own? Take it from someone who’s been there. Watch the suicide rate climb.
On my morning drives to the hospital, the tears fell like rain. The prospect of the next 14 hours – 8am to 10pm with not a second’s respite from the nurses’ bleeps, or the overwhelming needs of too many sick patients – was almost too much to bear. But on the late-night trips back home, I’d feel nothing at all. Deadbeat, punch-drunk, it was utter indifference that nearly killed me. Every night, on an empty dual carriageway, I had to fight with myself to keep my hands on the steering wheel. The temptation to let go – of the wheel, the patients, my miserable life – was almost irresistible. Then I’d never have to haul myself through another unfeasible day at the hospital.
By the time I neared the end of my first year as a doctor, I’d chosen the spot where I intended to kill myself. I’d bought everything I needed to do it. All my youthful enthusiasm for healing, big dreams of saving lives and of making a difference, had soured and I felt an astronomic emptiness. Made monumentally selfish by depression, I’d ceased even to care what my husband would think of me, or that my little boy would grow up without his mother.
Doctor suicide is the medical profession’s grubby little secret. Female doctors aretwice as likely as the general population to take our own lives. A US study shows our suicide rate appears higher than that of other professional groups, with young doctors at the beginning of their training being particularly vulnerable. As I wrestled silently with the urge to kill myself, another house officer in my trust went right on and did it. To me, that monstrous waste of young life seemed entirely logical. The constant, haunting fear of hurting my patients, coupled with relentless rotas at work, had rendered me incapable of reason.
Though we know large numbers of doctors kill themselves, what is less clear are the reasons why, when dedicated to preserving human life, some doctors silently plot their own deaths. A 2006 study at the University of Pennsylvania identified that during their first year as doctors, young physicians experienced skyrocketing rates of burnout, with symptoms of emotional exhaustion, depersonalisation, and reduced sense of personal accomplishment soaring from 4% to 55%.
For me, the explanation ran deeper. I was entrenched in a hospital system that brutalised young doctors. Working on my hospital’s surgical emergency unit, there were simply too few of us to cope with the daily onslaught of patients. Officially eight or 10-hour days ran routinely into 13, 14 or 15 hours as we house officers worked at fever pitch to provide what was, at best, a mediocre service for our patients. Run ragged, we fought to keep our patients safe, but their numbers outstripped ours 20 or 30 to one, and the efforts this took were superhuman. The nurses knew, the consultants knew, even the hospital management knew, yet no one seemed to give a damn.
It wasn’t just exhaustion that drove me into depression. Plenty of jobs are busy. But there is something uniquely traumatic about being responsible for patients’ lives, while being crushed under a workload so punitive it gives neither the time nor space for safe assessment of those patients. Days were bad enough, but nights on call were terrifying. I remember running from the bed of one patient, still haemorrhaging blood from her surgical wound, to another whose heart rate had plummeted to 20, perilously close to a cardiac arrest. Two stricken patients, but only one doctor, wracked with the knowledge that if something went wrong, the guilt would be hers alone.
I was lucky. I was pushed by the colleague in whom I finally confided into seeking professional help. It took anti-depressants, therapy and a narrowly-avoided psychiatric inpatient admission to bring me back to the land of the living.
Now, on the cusp of junior doctors’ first national strike in 40 years, I’m astounded the health secretary persists in ignoring unanimous condemnation of his new contract from juniors and medical leaders alike. If he gets his way, Jeremy Hunt will make it easier for hospitals to abuse their juniors, by stripping away the safeguards that stop hospitals overworking us, fining those that do. Under his new contract, our hours will become even longer, even more antisocial – at a time when we simply have nothing more to give. And as we are pushed to treat more and more patients, faster and faster, fatigue and psychological distress will dull our competence: your lives will be less safe in our hands. And our own? Take it from someone who’s been there. Watch the suicide rate climb.
Tuesday 29 September 2015
‘I can’t sacrifice my family for the NHS’: the junior doctors forced out of jobs they love
Amelia Gentleman in The Guardian
At what point does a dedicated doctor, with a lifelong commitment to the NHS, decide it is time to quit? For Dr Singh, 34, a junior doctor in general medicine, the moment will come when he is no longer able to pay his mortgage and childcare bills, a situation he expects to find himself facing sometime next year.
Dr Singh has worked in hospitals, with regular A&E shifts, for 10 years since qualifying, loves his job and describes himself as “the kind of doctor you’d want to see to your gran”. But, having done an online calculation assessing how the Department of Health’s new junior doctor contract will affect his household income, he believes he and his paediatrician wife face a 25% cut to their joint take-home pay, making life in London unaffordable. He plans to move into the pharmaceutical industry.
New junior doctors' contract changes everything I signed up for
Several of Dr Singh’s friends have already left the medical profession to work as bankers and consultants in the City; others are considering emigrating to work as doctors in Australia or New Zealand. Most of them are dispirited by the proposed contract, but are more fed up with the daily stress of their work, annoyed that the long hours and considerable financial and personal sacrifices they make during their training are not appreciated, and they worry about the impact that dwindling morale could have on the NHS and its patients.
“I am not looking for parity of pay with my friends in the City. But if you can’t afford to pay your mortgage or your child’s nursery bills and you can’t look after your child yourself in the evening or [at] the weekend because the government is proposing you should work those hours on a normal basis, you can’t continue with that kind of life,” he says, asking for his full name not to be published to avoid annoying his employers. “I am a very valuable resource to the NHS. I do work incredibly hard, I really enjoy looking after my patients and I get immense satisfaction from it. I have an absolute commitment to the NHS but I can’t sacrifice my entire family for that. I have to put a roof over my son’s head.”
Junior doctors will be balloted to decide whether to strike over a radical new contract imposed on them by the Department of Health, which redefines their normal working week to include Saturday and removes overtime rates for work between 7pm and 10pm every day except Sunday. The government says the changes will come with a rise in basic salary, higher hourly rates for antisocial hours and will be “cost neutral” – but doctors believe this change could reduce salaries in some areas of medicine by up to 30%. The British Medical Association (BMA) argues that it is “unacceptable that working 9pm on a Saturday is viewed the same as working 9am on a Tuesday”.
It is unusual to hear doctors getting angry and this swell of rage is disconcerting. A social media campaign means their voices have begun to be widely heard over the past week. If the effects of the government’s austerity drive on care workers, for example, have gone largely unnoticed, the seething protest from this powerful group looks set to be harder to ignore.
Most junior doctors are smart enough to know that they will have to work hard to persuade the public that they are a genuinely needy section of society. A perception of doctors as well-paid professionals has stuck and even a semi-attentive observer knows that the harsh 100-hour-week working pattern that used to characterise medical training has been abolished.
What most people outside the medical profession are probably unaware of is that you aren’t just a junior doctor for a fleeting period after qualifying; this makes up a substantial chunk of your career – sometimes a decade, and often stretching late into your 30s. Basic salaries start at around £23,000 and are enhanced by various complicated supplements, including the antisocial hours pay that is set to be cut. Because medical training takes longer than other degrees, most junior doctors have large amounts of student debt and are expected to continue paying for the exams as part of their ongoing training, in addition to putting in large amounts of unpaid study time and paying out monthly professional payments to the General Medical Council (GMC) and the BMA.
Few people chose to go into medicine for the money, but this contract has triggered a surge of resentment about how much harder doctors work for less money than their equally ambitious and well-educated peers in other fields.
Radiologist Anushka Patchava says she will have to quit the profession if the proposals are implemented. Photograph: Teri Pengilley for the Guardian
Anushka Patchava, 29, a radiologist who qualified in 2011 and has at least two more years as a junior doctor before she graduates to being a consultant, plans to switch careers and is midway through a rigorous interviewing process with two management consultancy firms. She is fed up with the hours and the current pay and is despondent at the prospect of getting a substantial cut to her salary. She earns £31,000, which includes a 40% supplement to her basic salary, to compensate for the antisocial hours she works. Once the new contract is imposed, she thinks she will see this reduced to £27,000 or £28,000 and she expects the hours she works will become even more antisocial. She campaigned for David Cameron in May’s general election, but has subsequently rescinded her membership of the Conservative party in protest at the contract.
If she gets the management consultancy job, Patchava will quadruple her salary on day one. “It’s horrific, isn’t it?” she says. She doesn’t consider herself to be materialistic and, in normal circumstances, would not want to leave a job she loves, but the level of needless daily stress has become wearisome and she is constantly aware of lack of morale among her colleagues.
“Going into work is a struggle – you have to psych yourself up. You’re so short staffed that you can’t offer patients everything you want to offer them. There aren’t enough doctors to fill the posts that there are available now, even before the contract is brought in,” she says. “We are not supported and morale is low. You work really long hours, taking decisions that impact on people’s lives and, at the same time, you’re worrying whether your pay check is going to be enough to cover your bills.”
The daughter of two NHS surgeons, Patchava has an deep-rooted sense of loyalty to the NHS, but her parents understand the pressure she is under and why she wants to leave. There are no perks; she has to buy expensive food and coffee from the hospital cafe and pays £12 every night shift to park in the hospital car park. She calculates that, once the long hours are factored in, she earns about £10 an hour, so these costs are not negligible. As junior doctors, her parents used to get free food and free accommodation. Four of her closest friends from Cambridge, where she studied medicine, have already left to work in the City. “One of them got a gold medal in medicine, for being top of the year, but they dropped out for exactly these reasons.”
These are not alarmist stories being spread by campaigners. Even the Conservative MP and doctor Sarah Wollaston, who chairs the Health Select Committee, knows about the brain drain – her daughter has left the NHS for Australia. Now she, her husband and eight of their friends work in a hospital where they have yet to meet an Australian junior doctor in the casualty department. “It is staffed almost entirely by British-trained junior doctors,”Wollaston wrote this week.
Patchava worries about what will happen when she wants to have children and has to organise childcare for the irregular hours. Another aspect of the new contract is that parents who take time off to look after their children will no longer see their pay rise automatically while they are on leave. People who take time out of the medical training system to do research will be similarly penalised. Other changes include the removal of a supplement paid to those going into general practice, to match those working in hospitals, which doctors believe could see trainee GPs losing a third of their pay.
“I don’t have a luxury lifestyle, but I don’t think I could support children with that money and those hours,” Patchava says. “The NHS runs on the philosophy of altruism. Everyone comes in an hour early and stays late to make sure the work is done. We love the NHS, but this has been such a kick in the teeth. I’ll have no hesitation about taking a job elsewhere.”
This sense of mismatch between the commitment put in and reward taken out is widespread. “I’m 30 years old, live in a friend’s flat with three other people, don’t own a car and have still got thousands of pounds of debt,” writes one junior doctor in an angry email. “My friends outside of medicine have bought houses, have children and the majority have their weekends and evenings for themselves. On top of my ‘48 hours a week’, I teach and lecture in my free time, attend courses (which we have to fund), study and do everything I can to be a better doctor. I love my job – I couldn’t imagine living with myself if I left. However, the prevalence of locums and holes in the rota, overstretched stressed GPs and A&E staff make the atmosphere toxic. We miss weddings, funerals, birthdays. Relationships are lost, friends estranged, all because we love our job.”
Foiz Ahmed, a junior doctor in emergency plastic surgery (who is grappling with £30,000 debt) argues that the new contracts will strike a pernicious blow to the NHS and patient safety. “This isn’t just about salaries, although of course a 10-30% pay cut is unmanageable for most of us. Let’s ignore the fact that I used to earn more an hour while working for a mobile-phone company as a student ... With the continued denigration of public perception of doctors, there is a sustained attempt to make the NHS fail. A demoralised workforce performs less efficiently, and a less-efficient system can be broken up and sold to private firms.”
The Department of Heath insists these fears are misplaced. “We are not cutting the pay bill for junior doctors and want to see their basic pay go up just as average earnings are maintained. We really value the work and commitment of junior doctors, but their current contract is outdated and unfair.”
Junior doctors are not convinced. The GMC had 3,468 requests for a certificate of current professional status, the paperwork needed to register to work as a doctor outside the UK, in the 10 days since the new contract was announced; usually it processes 20 to 25 requests a day. Partly this was the result of a concerted online campaign to get junior doctors to apply as a way of showing their anger. But some doctors, such as David Watkin, 30, a paediatrician based in Birmingham, truly intend to leave if the contract is imposed. Watkin recently returned from a year working in New Zealand, has stayed in touch with his employers out there and is confident that there will be a job for him.
The day-to-day stress Watkin experiences in Birmingham, which is mainly the result of standing in for unfilled doctors’ shifts, was absent in New Zealand. “But stress is not really the issue,” he says. In New Zealand, he says he felt more looked after, with meals paid for and professional fees covered by the hospital.
Would I be a fool to return to the NHS on the new junior doctor contract?
“Here we feel very under-appreciated by the government and the Department of Health. We have sacrificed a lot – years of training and extra hours studying outside of our work. We have moved around the country every six months to go where our training jobs send us, with no say in where we go, so it’s difficult to settle anywhere and hard to buy a house. We, as a body, are feeling under attack; it feels like any concerns we raise are being misrepresented with hospitals portraying us as just wanting more money.”
At 30, he still has about £9,000 in debt (down from about £30,000). He has done seven years as a junior doctor already and has another four to go before he becomes a consultant. “I worry that this is going to lead to an exodus of doctors, and I worry about the pressure that this will put on those who stay – and on patients. I had a work-experience student with me this week; it feels harder to come out with a positive line about why they should do it.”
Holly Ni Raghallaigh: ‘I worked very hard and put myself in a lot of debt to get here.’ Photograph: Teri Pengilley for the Guardian
Holly Ni Raghallaigh, 29, a trainee urologist, is planning to go to Scotland (which, like Wales, will not impose the new contract). She has been pushed to the brink of bankruptcy by the cost of her training, and doesn’t feel able to take a pay cut. With five more years as a junior doctor, she doesn’t think she could afford to continue if her pay is reduced.
“I worked very hard and put myself in a lot of debt to get here,” she says. At one point she had to pay for a urology course ahead of an exam and was so overdrawn that she missed two consecutive monthly payments to the GMC, was temporarily removed from the medical register and subjected to a large fine. She estimates she has spent £5,000 on mandatory surgery courses and exams during surgical training; she is paying back her remaining £10,000 of student loan at a rate of £450 a month. Once her rent in London and her monthly subscriptions to the Royal College of Surgeons (£50), GMC (£40) and BMA (£18) are paid, she has nothing left. It isn’t possible to save towards a deposit on a flat.
“Every single time I found myself in my overdraft or having to borrow petrol money or forego a flight home to Ireland to book a course, or every weekend I spent working as a locum to fund my education – I would do it all over again,” she says. “I adore my job and, honestly, working in the NHS is all I have ever wanted to do. And, for the record, I am grateful to the taxpayer who has put me here.” She says she hopes the tales of difficulties she found “embarrassing and demoralising” make people understand the financial pressures junior doctors face. “I don’t want it to sound like a sob story. I could have managed my finances better, but I had no money.”
At what point does a dedicated doctor, with a lifelong commitment to the NHS, decide it is time to quit? For Dr Singh, 34, a junior doctor in general medicine, the moment will come when he is no longer able to pay his mortgage and childcare bills, a situation he expects to find himself facing sometime next year.
Dr Singh has worked in hospitals, with regular A&E shifts, for 10 years since qualifying, loves his job and describes himself as “the kind of doctor you’d want to see to your gran”. But, having done an online calculation assessing how the Department of Health’s new junior doctor contract will affect his household income, he believes he and his paediatrician wife face a 25% cut to their joint take-home pay, making life in London unaffordable. He plans to move into the pharmaceutical industry.
New junior doctors' contract changes everything I signed up for
Several of Dr Singh’s friends have already left the medical profession to work as bankers and consultants in the City; others are considering emigrating to work as doctors in Australia or New Zealand. Most of them are dispirited by the proposed contract, but are more fed up with the daily stress of their work, annoyed that the long hours and considerable financial and personal sacrifices they make during their training are not appreciated, and they worry about the impact that dwindling morale could have on the NHS and its patients.
“I am not looking for parity of pay with my friends in the City. But if you can’t afford to pay your mortgage or your child’s nursery bills and you can’t look after your child yourself in the evening or [at] the weekend because the government is proposing you should work those hours on a normal basis, you can’t continue with that kind of life,” he says, asking for his full name not to be published to avoid annoying his employers. “I am a very valuable resource to the NHS. I do work incredibly hard, I really enjoy looking after my patients and I get immense satisfaction from it. I have an absolute commitment to the NHS but I can’t sacrifice my entire family for that. I have to put a roof over my son’s head.”
Junior doctors will be balloted to decide whether to strike over a radical new contract imposed on them by the Department of Health, which redefines their normal working week to include Saturday and removes overtime rates for work between 7pm and 10pm every day except Sunday. The government says the changes will come with a rise in basic salary, higher hourly rates for antisocial hours and will be “cost neutral” – but doctors believe this change could reduce salaries in some areas of medicine by up to 30%. The British Medical Association (BMA) argues that it is “unacceptable that working 9pm on a Saturday is viewed the same as working 9am on a Tuesday”.
It is unusual to hear doctors getting angry and this swell of rage is disconcerting. A social media campaign means their voices have begun to be widely heard over the past week. If the effects of the government’s austerity drive on care workers, for example, have gone largely unnoticed, the seething protest from this powerful group looks set to be harder to ignore.
Most junior doctors are smart enough to know that they will have to work hard to persuade the public that they are a genuinely needy section of society. A perception of doctors as well-paid professionals has stuck and even a semi-attentive observer knows that the harsh 100-hour-week working pattern that used to characterise medical training has been abolished.
What most people outside the medical profession are probably unaware of is that you aren’t just a junior doctor for a fleeting period after qualifying; this makes up a substantial chunk of your career – sometimes a decade, and often stretching late into your 30s. Basic salaries start at around £23,000 and are enhanced by various complicated supplements, including the antisocial hours pay that is set to be cut. Because medical training takes longer than other degrees, most junior doctors have large amounts of student debt and are expected to continue paying for the exams as part of their ongoing training, in addition to putting in large amounts of unpaid study time and paying out monthly professional payments to the General Medical Council (GMC) and the BMA.
Few people chose to go into medicine for the money, but this contract has triggered a surge of resentment about how much harder doctors work for less money than their equally ambitious and well-educated peers in other fields.
Radiologist Anushka Patchava says she will have to quit the profession if the proposals are implemented. Photograph: Teri Pengilley for the Guardian
Anushka Patchava, 29, a radiologist who qualified in 2011 and has at least two more years as a junior doctor before she graduates to being a consultant, plans to switch careers and is midway through a rigorous interviewing process with two management consultancy firms. She is fed up with the hours and the current pay and is despondent at the prospect of getting a substantial cut to her salary. She earns £31,000, which includes a 40% supplement to her basic salary, to compensate for the antisocial hours she works. Once the new contract is imposed, she thinks she will see this reduced to £27,000 or £28,000 and she expects the hours she works will become even more antisocial. She campaigned for David Cameron in May’s general election, but has subsequently rescinded her membership of the Conservative party in protest at the contract.
If she gets the management consultancy job, Patchava will quadruple her salary on day one. “It’s horrific, isn’t it?” she says. She doesn’t consider herself to be materialistic and, in normal circumstances, would not want to leave a job she loves, but the level of needless daily stress has become wearisome and she is constantly aware of lack of morale among her colleagues.
“Going into work is a struggle – you have to psych yourself up. You’re so short staffed that you can’t offer patients everything you want to offer them. There aren’t enough doctors to fill the posts that there are available now, even before the contract is brought in,” she says. “We are not supported and morale is low. You work really long hours, taking decisions that impact on people’s lives and, at the same time, you’re worrying whether your pay check is going to be enough to cover your bills.”
The daughter of two NHS surgeons, Patchava has an deep-rooted sense of loyalty to the NHS, but her parents understand the pressure she is under and why she wants to leave. There are no perks; she has to buy expensive food and coffee from the hospital cafe and pays £12 every night shift to park in the hospital car park. She calculates that, once the long hours are factored in, she earns about £10 an hour, so these costs are not negligible. As junior doctors, her parents used to get free food and free accommodation. Four of her closest friends from Cambridge, where she studied medicine, have already left to work in the City. “One of them got a gold medal in medicine, for being top of the year, but they dropped out for exactly these reasons.”
These are not alarmist stories being spread by campaigners. Even the Conservative MP and doctor Sarah Wollaston, who chairs the Health Select Committee, knows about the brain drain – her daughter has left the NHS for Australia. Now she, her husband and eight of their friends work in a hospital where they have yet to meet an Australian junior doctor in the casualty department. “It is staffed almost entirely by British-trained junior doctors,”Wollaston wrote this week.
Patchava worries about what will happen when she wants to have children and has to organise childcare for the irregular hours. Another aspect of the new contract is that parents who take time off to look after their children will no longer see their pay rise automatically while they are on leave. People who take time out of the medical training system to do research will be similarly penalised. Other changes include the removal of a supplement paid to those going into general practice, to match those working in hospitals, which doctors believe could see trainee GPs losing a third of their pay.
“I don’t have a luxury lifestyle, but I don’t think I could support children with that money and those hours,” Patchava says. “The NHS runs on the philosophy of altruism. Everyone comes in an hour early and stays late to make sure the work is done. We love the NHS, but this has been such a kick in the teeth. I’ll have no hesitation about taking a job elsewhere.”
This sense of mismatch between the commitment put in and reward taken out is widespread. “I’m 30 years old, live in a friend’s flat with three other people, don’t own a car and have still got thousands of pounds of debt,” writes one junior doctor in an angry email. “My friends outside of medicine have bought houses, have children and the majority have their weekends and evenings for themselves. On top of my ‘48 hours a week’, I teach and lecture in my free time, attend courses (which we have to fund), study and do everything I can to be a better doctor. I love my job – I couldn’t imagine living with myself if I left. However, the prevalence of locums and holes in the rota, overstretched stressed GPs and A&E staff make the atmosphere toxic. We miss weddings, funerals, birthdays. Relationships are lost, friends estranged, all because we love our job.”
Foiz Ahmed, a junior doctor in emergency plastic surgery (who is grappling with £30,000 debt) argues that the new contracts will strike a pernicious blow to the NHS and patient safety. “This isn’t just about salaries, although of course a 10-30% pay cut is unmanageable for most of us. Let’s ignore the fact that I used to earn more an hour while working for a mobile-phone company as a student ... With the continued denigration of public perception of doctors, there is a sustained attempt to make the NHS fail. A demoralised workforce performs less efficiently, and a less-efficient system can be broken up and sold to private firms.”
The Department of Heath insists these fears are misplaced. “We are not cutting the pay bill for junior doctors and want to see their basic pay go up just as average earnings are maintained. We really value the work and commitment of junior doctors, but their current contract is outdated and unfair.”
Junior doctors are not convinced. The GMC had 3,468 requests for a certificate of current professional status, the paperwork needed to register to work as a doctor outside the UK, in the 10 days since the new contract was announced; usually it processes 20 to 25 requests a day. Partly this was the result of a concerted online campaign to get junior doctors to apply as a way of showing their anger. But some doctors, such as David Watkin, 30, a paediatrician based in Birmingham, truly intend to leave if the contract is imposed. Watkin recently returned from a year working in New Zealand, has stayed in touch with his employers out there and is confident that there will be a job for him.
The day-to-day stress Watkin experiences in Birmingham, which is mainly the result of standing in for unfilled doctors’ shifts, was absent in New Zealand. “But stress is not really the issue,” he says. In New Zealand, he says he felt more looked after, with meals paid for and professional fees covered by the hospital.
Would I be a fool to return to the NHS on the new junior doctor contract?
“Here we feel very under-appreciated by the government and the Department of Health. We have sacrificed a lot – years of training and extra hours studying outside of our work. We have moved around the country every six months to go where our training jobs send us, with no say in where we go, so it’s difficult to settle anywhere and hard to buy a house. We, as a body, are feeling under attack; it feels like any concerns we raise are being misrepresented with hospitals portraying us as just wanting more money.”
At 30, he still has about £9,000 in debt (down from about £30,000). He has done seven years as a junior doctor already and has another four to go before he becomes a consultant. “I worry that this is going to lead to an exodus of doctors, and I worry about the pressure that this will put on those who stay – and on patients. I had a work-experience student with me this week; it feels harder to come out with a positive line about why they should do it.”
Holly Ni Raghallaigh: ‘I worked very hard and put myself in a lot of debt to get here.’ Photograph: Teri Pengilley for the Guardian
Holly Ni Raghallaigh, 29, a trainee urologist, is planning to go to Scotland (which, like Wales, will not impose the new contract). She has been pushed to the brink of bankruptcy by the cost of her training, and doesn’t feel able to take a pay cut. With five more years as a junior doctor, she doesn’t think she could afford to continue if her pay is reduced.
“I worked very hard and put myself in a lot of debt to get here,” she says. At one point she had to pay for a urology course ahead of an exam and was so overdrawn that she missed two consecutive monthly payments to the GMC, was temporarily removed from the medical register and subjected to a large fine. She estimates she has spent £5,000 on mandatory surgery courses and exams during surgical training; she is paying back her remaining £10,000 of student loan at a rate of £450 a month. Once her rent in London and her monthly subscriptions to the Royal College of Surgeons (£50), GMC (£40) and BMA (£18) are paid, she has nothing left. It isn’t possible to save towards a deposit on a flat.
“Every single time I found myself in my overdraft or having to borrow petrol money or forego a flight home to Ireland to book a course, or every weekend I spent working as a locum to fund my education – I would do it all over again,” she says. “I adore my job and, honestly, working in the NHS is all I have ever wanted to do. And, for the record, I am grateful to the taxpayer who has put me here.” She says she hopes the tales of difficulties she found “embarrassing and demoralising” make people understand the financial pressures junior doctors face. “I don’t want it to sound like a sob story. I could have managed my finances better, but I had no money.”
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