1/3 life crises

It’s apparently quite common for people to have a few pangs of anxiety near the beginning of a career as life decisions and consequences suddenly become uncomfortably real. The catchy term “quarter life crisis” seems to be commonly used recently to describe people in their twenties and thirties who feel unsure of their direction.

I turned 26 this year, and it seems a little optimistic to mark this as “quarter-life” as the odds of me reaching 104 seem remote. But then again, I’ve been experiencing one sort of worry or another for as long as I remember so perhaps my quarter life crisis began some years ago, transitioning from the previous trivial anxieties without me noticing.

The most current worries are naturally career-related as at the end of the month is the deadline for applying for specialty training. I’m in the second of two compulsory foundation years post qualification and am expected to now declare my intended career, or accept unemployment.

Traditionally this would be a busy time of year for FY2 doctors, each scrambling to polish their CVs to compete for sought-after training positions in the various specialties. In recent years this has become less and less the case with the dwindling motivation of doctors to continue working in resource-stretched environment feeling undervalued. Such is the “state of unease” as understated by the annual GMC training report that the vast majority of FY2s I talk to have no intention of applying to speciality training this round.

A simplified flowchart of medical training (nicked from Google)

I think I am amongst a large number of FY2s who plan to take a gap year to take a break from the system. In my absence all the problems of the NHS and medical careers will be completely solved just in time for me to apply for further training in a year or two from now. I am warned by my wise parents that this plan of action sounds a lot like no plan of action, and I am merely prolonging the duration of my quarter-life crisis by postponing crunch time for a year or more. In addition there is some concern that a few specialties want to see evidence of "commitment to specialty" - and unfortunately taking time out of training to piss around is viewed as the opposite of "commitment".

Personally I don’t see the rush; if my lottery plan doesn’t turn out I as I expect it to then I will have to work until I’m 68, so I owe it to my next 40+ years to try and make a sensible decision. To that end I expect to spend my crisis rigorously researching my options and optimising my CV. Perhaps I'll try and save enough money to do a spot of travelling or, signing on, moving back with my parents and watching countdown in my underwear. At the moment, both seem preferable to the yoke of the unrelenting SHO rota.

http://careers.bmj.com/careers/advice/Fewer_foundation_doctors_are_going_straight_into_specialty_training,_says_GMC

http://www.gmc-uk.org/news/27482.asp

I vote for Jexit

Please see below extremely lazy buzzfeed-like sumamry post, a few choice images recycled from my facebook and twitter feeds.


 


Jeremy Hunt has to go.
The last two days have seen further junior doctor industrial action: full walkout of junior doctor support including emergency cover including A+E, the crash team, ITU, obstetrics and so on.

Contrary to the scaremongering from the hateful daily mail there have been absolutely no patient safety issues, obviously, as the care was expertly provided by experienced and dedicated consultants and allied healthcare professionals. And we are extremely grateful for their support.

And despite hostile sections of the media it is clear that patients and the public are largely supportive of the doctors. Whilst on-call last weekend an 85 year old gentleman I was seeing in resus with a fast irregular heart rate stopped my examination to ask whether I also supported the " young doctors sticking it to that nasty Mr Hunt".

On the picket line I attended this morning we received numerous heartening beeps from passing cars, buses and ambulances. Several of people came to talk to us and express their support, and it was also nice to see some very british members of the public awkwardly display nods and thumbs ups whilst walking past. An old man with a frame stopped across the road and applauded. Several consultants and members of the public also came by with donations of gratefully received food and hot drinks.

http://www.independent.co.uk/news/uk/politics/the-public-increasingly-blame-the-government-for-the-junior-doctors-strike-a7003056.html

The NHS is already straining under the current contract. There are not enough doctors to fill rotas, making each shift more stressful for the few doctors that work them. Having recently moved onto a medical job I can report that 0/4 of my 12 hour on call days had a full complement of medical staff; the remaining team were rushed off their feet to try and see all the ward medical problems and new admissions. 

This is a genuine junior doctor rota (names erased) from a different hospital. The boxes in yellow are represent shifts where there is currently no doctor allocated. These extra shifts are frequently advertised as locum jobs but without much success - it is unpleasant to work under such short staffed conditions and there is increased risks of making mistakes. Junior doctors are already tired from working 50+ hours a week and value their free time. New government policy to cap the hourly rate of such locum shifts removes any small remaining incentive to work further hours.

Jeremy Hunt frequently claims (lies) about increasing funding for the NHS, when actually it is facing real terms cuts. He expects to make doctors work harder and longer in the context of £20billion worth of "efficiency savings".  source

It is clear that a treacherous and callous government is taking a heavy heavy toll on junior doctor's morale.

GP satisfaction in the UK is plummeting. More and more (junior and senior) doctors are leaving - no sign of those 5000 promised new GPs.

The new contract is also explicit in its discrimination of women and those with disabilities

 - and may indeed be illegal according to Britain's equality watchdog.

The tactic seems to be to grossly underfund and destabilise the NHS to set the scene for private companies to rescue the profitable parts - this sneak privatisation is already happening and has been hastened by the conservative's 2012 health and social care act (then health secretary lansley responsible for this act now advises private companies how to profit from the NHS). 

Remember Jeremy Hunt himself co-wrote a book about how to privatise the health service. The NHS is paid for by generations of UK taxpayers and is valued most by the poorest and most vulnerable - the people who could not afford private health care (and the people who are unlikely to vote conservative.) It does not belong to the political elite and it is not theirs to sell.

Despite, and perhaps partly because of, the ongoing pressures facing the health service Junior doctors remain positive. Jeremy Hunt has inadvertently strengthened the profession as we unite against his government's abuses of the public sector. There is rekindled camaraderie amongst colleagues of different specialties, junior and senior, doctors and other healthcare workers standing together passionate in their defence of a world class free health service that is adequately funded, and fair for patients and staff. 

Picket line in Manchester April 26th 2016

Appendix

A good, simple explanation of the main concern:

I'minworkjeremy

I was at work last weekend. On Friday, Saturday and Sunday night I was the surgical FY1 on call, covering all the surgical patients in the hospital (with support from a team of dedicated more senior docs on call). Fortunately for me there were no real emergencies to deal with and the number of tasks was fairly manageable compared to other shifts I've done. Over the course of thirty six hours over three nights I prepared patients for surgery the following day, I assessed patients in pain or nausea and prescribed medications and fluids. I assessed unwell patients and alerted the seniors where appropriate. I sat and talked with anxious patients and I quietly examined and verified those few who had passed away. I prescribed anticoagulation for patients to prevent strokes and DVTs and started patients on treatment for infections. I organised blood transfusions, inserted intravenous cannulas and clerked and admitted emergency patients when the surgical admissions team were busy in theatre. This is all routine FY1 fare,  and this particular shift was far more tolerable than the average night; there wasn't all that much to do and I was never expected to do anything beyond my training or experience- I even managed to get through a decent chunk of a novel during the unprecedented bleep-free periods.

I was told that on this weekend over 20% of the hospital beds were occupied by patients who were "medically fit for discharge". These are patients who are awaiting social care input and so cannot be discharged until there is somewhere safe for them to go.  It makes the job of the ward cover on call doctor (moi) a bit easier when a large proportion of the patients are not officially unwell (though far too many of them will get a hospital-acquired infection whilst awaiting discharge and so become unwell again, further delaying discharge but also risking preventable death). If "spare" hospital beds are occupied with such patients then new patients can't be admitted. On Saturday night there were 87 "breaches" in A+E; on this single day 87 patients were are not admitted within the 4 hour target time, at considerable financial cost as each breach results in a hefty fine to the trust. Clearly the problem of insufficient beds is not solved by forcing more doctors to work at the weekend.

Although my latest weekend was relatively, and frankly astonishingly, quiet, it was still fairly unpleasant because of course it is unpleasant forcing yourself to be awake when you're too tired to think or speak, and of course it is unpleasant working straight through a weekend.  Believe it or not I'm not really complaining about this - it is important to have medical cover 24/7 and so some people will have to work evenings, nights or weekends. All sane people know this and all applicants to medical school knowingly sign up for this. It would be churlish to complain about my current rota in the current system as it really isn't bad as far as junior doctor rotas go; I probably work one weekend in three or four, and for every Saturday or Sunday I work I get a midweek day off -allocated at random. It's worse for FY1s at a lot of hospitals (a close friend has double the number of nights that I do), and almost certainly worse beyond FY1 as  in many specialties fewer and fewer doctors are available to fill on-call rotas. Under the current system anti-social hours are recognised and doctors receive a "banding" supplement to their basic salary to compensate.

One of the most infuriating things about the government's steamrollered "7-day" new doctor's contract is their refusal to acknowledge that a) the NHS already provides 24/7 emergency cover, obviously, and b) weekends are more valuable than weekdays, obviously. On Saturday I missed a gathering of close non-doctor friends I've not seen in months because I, and only I, was at work. Having Tuesday off, alone and fairly disoriented to time, was not much of a substitute. This year I also worked through the new year bank holiday weekend, as one of the lucky ones have escaped working Christmas. So, like almost all doctors in training, some weekends #iminworkjeremy, and happy to be. But to suggest/force/blackmail doctors into working more hours, more nights and more weekends for less pay is insulting, as is recognised by 98% of junior doctors who voted for, carried out, and will continue to take part in industrial action over this issue and others.