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‘Honestly, it’s no life…’
‘But, it’s all I ever wanted to do.’
Sitting in the coffee shop, by the window, with the sunlight streaming through her hair Dr Smith (I’ll call her that to protect her identity), could be a Botticelli angel.
A closer look at the dark rings under her eyes, sunk deep into her drawn features, the huge sweater drowning her skinny body…
… honestly, she looked more like an Alberto Giacometti woman.
We were talking about the moral and ethical dilemma of strikes and the daily grunt of being a resident doctor.
There’s a quiet truth rumbling underneath all the noise about junior doctor pay, strikes and morale…
... the way the NHS trains its residents has created its own storm clouds…
… a system that shuffles young doctors around the country like loose luggage. Pack up, move house, new flat with old mould behind the fridge.
It’s disruption dressed up as ‘broad experience’. In reality… industrial-scale dislocation…
… that costs a fortune. For young doctors earning, truthfully, modest salaries; exams, relocation, travel, accommodation… the bills are mountainous… nudging £100,000...
… in a system that creates its own workforce shortages.
As they say; ‘in my day’ doctors had a career for life. Today, they want a career and a life.
Is that such a bad thing?
The BMA are handling this all wrong. If the strike is about wages, public support is on the slide, but...
... as far as I can see, it’s less about wages and more about terms, conditions, debt, opportunity, hot food and a home life.
Is that such a bad thing?
Training can never be a duvet day but neither does it have to be a bed of nails.
Learning should be about buddying, not bullying.
Is it really necessary for highly skilled professionals to have been previously trained in resilience and the techniques of urban survival.
Are we surprised when hard edges turn into bullying and careless, casual, prejudice, misogyny and racism?
My Giacometti woman’s dad was an old-school consultant who spoke lovingly about the firm. A team. Continuity. Apprenticeship…
… my registrar… my house officer… my consultant… a sense of belonging.
Someone who knew your name and watched you grow.
We threw that away for a carousel of placements. A box-ticking tour of Britain.
No wonder they feel rootless. No wonder morale is brittle and they can be treated like squatters in a Trust rather than a valuable member of the team and an investment in the future.
If you were designing a system to exhaust bright young people and push them abroad, this would be it.
What to do?
Start by pointing anyone who tells of ‘what it was like in my day’, to the knacker’s yard. To mock ‘their day’ doesn’t make you a daydreamer. It makes it time to call it a day and make way for a new day.
Bring back the idea of the firm? Longer placements with stable teams. Stop the endless merry-go-round.
Continuity is the cheapest investment in training we’ll ever make.
Ring-fence proper training time. Guaranteed, protected, honoured. You can’t train future consultants on the embers of time left over from firefighting the day.
Expand specialty training places where shortages are chronic. We graduate plenty of smart young doctors, then block their path with bottlenecks.
A proper workforce plan, designed by people who know what they’re doing, with a route to success... is that so difficult?
Sort out the finances. Relocation support, sensible exam-fee reimbursement, consistent study-leave rules. Staged student debt loyalty-forgiveness after 5, 7 and 10 years?
Culture; mandatory supervisor training, zero tolerance for bullying, real support when things go wrong. Treat them like the professionals they are… not expendable cogs in a machine that won’t work without them.
We train expensively, chaotically, without enough care for wellbeing, wallets or where.
We can fix this.
If we want doctors to stay, thrive and become the consultants of tomorrow, we must start by changing the way we treat them today.
My Giacometti woman thinks of marriage and children and then thinks of placements and rotas.
There is a story about a (then) junior doctor who was forced into cancelling her wedding because her leave was cancelled.
Apocryphal? Fictitious? A downright lie?
Dunno… but something needs fixing with rotas, because...
... the fact the tale has any currency at all, the fact it could be true, the fact it sounds about right and can still be rumbling around today...
... tells you something is very wrong about the way we're preparing for tomorrow.
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