Does it get better?


Recently @parthaskar and I asked senior doctors on Twitter if they would choose medicine if they had their time again. I realise Twitter may not be a representative sample, but the overwhelming response was yes, they would.

It would be a rare doctor who never questioned their career choice – usually at 4am when doing something entirely unglamorous with a negative team and ungrateful patient. During our discussion yesterday I was reminded of the #itgetsbetter campaign aimed to reduce suicide in gay teenagers who can see no way out of their misery growing up to homophobic parents and friends.

Should we set up a similar reminder for junior doctors that for most of their working lives they’ll be in positions with better hours and more recognition than the jobs they’re in right now? Also, should we remind senior doctors of how big an impact negative criticism and lack of recognition has on their junior colleagues?

I realise that my junior doctor years are a couple of years (!) behind me but they’re still very fresh in my mind. I was lucky to have missed the truly terrible 1:2 and 1:3 rotas. Most of mine were 1:4 and as I started anaesthetic training 1:6 where your shift started at 5pm and you went through to the morning. This is still my preferred shift pattern, and I think the full shift systems that our current juniors have to deal with are worse, and much more disruptive to their circadian rhythm. The long days are also more socially disruptive.

I realise the above is UK specific, and if you’re reading this as an Irish junior doc you’re still working the sort of hours that leave you no time to maintain a decent family life, and give very little psychological headspace for you to treat your patients with the care and empathy they deserve.

What are the factors that make junior doctors question their career choice?

Let’s start with being new all the time. The average British employee finds it stressful changing jobs – new teams, new practices, having to prove you’re not rubbish, establishing rapport with a load of new people. Many of our trainees rotate jobs every three months, and so just as they’re beginning to get the hang of the place they’re in they move on. They are new all the time.

Learning is exhausting. If you’re working within your experience most of the time the tiredness you feel at the end of the day is usually much less than if you’re learning something new. The vigilance you need is much higher and it takes more concentration to perform the same tasks that an expert could achieve with only a fraction of the brainpower.

Being continually jet lagged from turning your day around every couple of weeks takes its toll. I know everyone is different, but I found the second night to be the most difficult. I was never able to sleep terribly well in the daytime and so much preferred doing one solitary night, then just staying awake and collapsing in bed about 9pm the following evening, circadian rhythm intact.

For these reasons I don’t think the seniors of my generation have a particularly valid point when they say the juniors of today have an easier job than 20 years ago. In addition the training is more bureaucratic and prescriptive, and the pressures of having to prove yourself while learning just as high as previously.

Becoming a “senior” doctor generally leads to less night work, a stable job, better salary and more recognition. It saddens me how much more polite people were to me after my ID badge changed to having consultant written on it.

Yes senior docs have more responsibility, more dealings with management, and it’s not necessarily always brilliant, but in general it’s a lot better. If you’re a senior doctor reading this please remember that the things that come easily to you now were a struggle at the start. Just because you were treated badly when you were a junior doc doesn’t mean you should treat your juniors the same.

As a junior please remember the trainee years are only a fraction of your career, and if you never doubted yourself you wouldn’t be a good doctor. Medicine does get better.

#medicinegetsbetter

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5 Comments

  1. Pingback: Reflection on Topic 3 | Everything. Ever.

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