Back of an envelope

13 reasons why junior doctor’s morale is at rock bottom

The government has commissioned an “independent” review of Junior Doctors Morale and Wellbeing to be chaired by Dame Sue Bailey. However, junior doctors have rejected this as inappropriately timed, questioned its independence and object to the terms of reference excluding pay and terms and conditions of service.

However, it doesn’t take an expensive review to identify the issues draining morale. I listed them on the back of an envelope in a couple of minutes.

  1. Service vs training
    The constant increasing pressure on the NHS demands that junior doctors spend more time delivering service rather than accessing further training. For example, doctors are taking annual leave to have the time to access ultrasound training, a core component of the curriculum in Obstetrics and Gynaecology. Junior doctors are employed as specialty trainees, but it seems that the training just isn’t a priority.
  2. Rota Gaps
    The NHS is currently does not have enough doctors. In most specialties there are unfilled slots on rotas. A recent survey showed that gaps existed in 20–25% of rotas. These gaps can only be filled by the remaining junior doctors or locums. Covering gaps results in more time delivering service and fewer training opportunities.
  3. Menial tasks and paperwork
    We are constantly reminded how much the NHS has invested in training us as junior doctors. So why are highly skilled juniors spending their time overloaded with menial tasks rather than being further trained to provide patient care? Foundation doctors spend the majority of their time filling forms, using slow clunky IT systems and taking bloods. This is not a right of passage, but a complete waste of valuable resources.
  4. Infantilism
    Junior doctors are professionals in their twenties and thirties. Many, like myself are responsible enough to have our own children. However in the NHS we are treated like children. Whether it be the hospital hierarchy, mandatory induction, e-portfolios, e-learning, compulsory sign off for things you have seen or just the fact that we are still called “junior” doctors.
  5. Loss of the firm structure
    Medicine is an apprenticeship, but this has been eroded over recent years by removing doctors from close knit teams and constantly switching who they work with. This makes it hard to form a professional educational relationship between trainer and trainee.
  6. Consultants not interested in training
    Only recently has the GMC formally recognised medical educators. However, trainees are placed with a variety of senior doctors, some of who have little teaching skills or desire to train junior doctors. Why can’t trainees be placed in hospitals and teams that excel in medical education?
  7. Continuity
    Doctors in training frequently rotate jobs, sometimes as often as every four months. This doesn’t allow time for continuity of training. Juniors don’t become embedded in the culture of the organisation and have few opportunities to genuinely improve the department in which they work.
  8. Long commutes
    Frequently changing departments and hospitals is disruptive to both training and life. Often doctors are sent to hospitals that are long commutes from where they live with as little as six weeks notice. Driving long distances after a thirteen hour night shift isn’t safe. Sadly some doctors have died in road traffic accidents after working long shifts.
  9. Having a personal life
    What kind of organisation despite advance warning rosters you on your wedding day? The standard computer says no response, is that you have to swap out of it. This understandably causes unnecessary stress and shows the contempt rota planners have for junior doctors lives.
  10. Bullying and undermining
    The GMC survey each year identifies bullying and undermining, but little has changed. The socratic method of teaching by humiliation unfortunately still exists, often going unchallenged. However, we are told we aren’t resilient and need further resilience training to cope with it, rather than tackling the root cause, the bullies.
  11. Rotas don’t reflect hours worked.
    Clinics regularly overrun, patients need to be seen before and after theatre and doctors are professionals who won’t leave until the job is done or properly handed over to the next shift. But on paper doctors shouldn’t work over 48 hours a week, and that is what they’re paid for. Doctors don’t object to working long hours, but they should get recognition that they do so.
  12. No Breaks
    When you become a doctor, you quickly learn not to expect time for lunch. You’re lucky if you get chance to down a sandwich during a teaching session. Every doctor will remember being called ten hours into their shift to see the patient with low urine output and realising the patient has actually passed more then themselves.
  13. Fees
    To progress in medicine it is essential to sit postgraduate exams. However, unlike medical school the pass rates for these exams very low. The cynic would think that this is to generate more income for medical royal colleges from both exam and course fees. Then once you finally pass, the bills come rolling in for membership fees. In some Colleges there are compulsory fees to access advanced training. Accompanied with medical indemnity, GMC and mandatory courses the totality of these fees can be in the excess of £1000 per year!

This list isn’t exhaustive, the solutions aren’t all easy. But ultimately, doctors in training need to be valued. Either we tackle these challenges or become another lost generation. We are the future of the NHS, we owe it to our patients, the NHS and ourselves to stand up for junior doctors.

Please share this post and comment below. What are the other reasons for low morale and perhaps more importantly what potential solutions are available to solve this.