Junior Doctors Striking Against an NHS ‘On Fire’‘Signing Up to a Life of Pain and Misery’
Effie Webb talks to past and prospective junior doctors who describe a crumbling healthcare system and the demise of what was once a prestigious career
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This week’s 96-hour junior doctor walk-out signals both a crumbling NHS and a workforce at the end of its tether.
Forty per cent of junior doctors feel burnt out ‘always’ or ‘often’, while the Health Secretary has dismissed their call for pay restoration as “unreasonable”. Poor conditions and pay have given rise to a retention crisis, with the number of doctors quitting the NHS to practice abroad or leaving the profession altogether at an all-time high. Almost 13,000 left last year, up 9% from the year before. Those who remain must pick up the pieces, overstretched, short-staffed and subject to increasing public resentment.
But what about medical students about to embark on their careers in the NHS? Are over five years of hard work, and student debts up to three times higher than the national average really worth it? Or has a once prestigious profession lost its appeal?
Fifth-year Oxford medic Vith Ketheeswaranathan points to a ‘sunk-cost’ logic among medics, who feel they’ve invested too much money, time and graft to consider quitting, no matter the circumstances: “We’ve come so far, we’ve just got to deal with it, no matter how bad it is”. He says it’s common to “push through” the two years of junior doctor training, after which you are qualified as a doctor and can apply to work elsewhere.
Graduate medic Damian Lewens, 23, who will have amassed over £150,000 in student debt once he qualifies, shares this sentiment. Whilst doctors currently earn only £14.09 an hour, he says that paying doctors more “solves only part of the problem” which largely originates from a chronic lack of government investment at each stage of medical training.
First, there is a cap on how many medical students the government funds. A new medical school set up specifically to increase UK doctor numbers was recently refused the funding to recruit a single domestic student. Last year nearly 800 medics were told there weren’t enough foundation training places to take them on, despite shortages. Further down the line, there are caps on consultant and special pathway roles, making progression difficult. Some specialisms average 200 applicants for one place. To reverse this bottleneck, more jobs for consultants need to be generated and more people accommodated in special pathways.
‘Recovering ex-doctor’, James Davidson, 30, watched the state of the NHS go from bad to worse during his five years as a junior doctor. With NHS public satisfaction at its lowest level ever, he said the thankless nature of the job was soul-destroying.
“I just felt like a warm body with a GMC registration,” Davidson told Byline Times. However, like many doctors, COVID was the breaking point: “The intensity got to the point where it was killing me… I was really mentally unwell”. Understaffing, underfunding, and inefficiencies meant he couldn’t provide patients with the right care to the point where work felt “unsafe”.
For a long time, Damian Lewens says, the Government has “preyed on the fact that there will always be people to do the job”, but the latest figures suggest otherwise. The UK has 2.8 doctors per 1000 people, significantly below the 3.5 OECD average. To reach this, the NHS would need to recruit an additional 45,000 doctors. Earlier this year, 10,000 doctor vacancies were recorded, and there was a 9.7% drop in UK applications to medical school. And it’s perhaps unsurprising that 40% of junior doctors consider leaving the NHS during their foundation training. Many seek better pay and conditions practising abroad, whilst an increasing number are switching to more lucrative industries.
Major consulting firms like McKinsey and BCG have medical elective programs that target final-year medics, and most have checkboxes on their applications to fast-track ex-doctors. There are head-hunters and recruitment companies that entice doctors with generous remuneration, company perks, and better opportunities for career progression. And who would blame them for making the switch?
Ex-doctor turned private equity consultant, Mani Rahi, has had a 60% salary increase in just over a year since leaving the NHS. Burnout and working conditions drove his decision to quit halfway through his second year of junior doctor training. He recalls working on a ward with “A3 print-out photos of windows” stuck onto the walls in an attempt to emulate natural sunlight, and being accused of ‘stealing food from patients’ after eating a yogurt from the communal fridge during a 12-hour night shift. Now, he’s allowed to claim £30 to buy dinner when he works past 8 pm.
These strikes are about more than just pay restoration, but about working within a collapsing health service. The NHS is being propped up by ‘quick fixes’ like agency staff, while government efforts to tackle workforce erosion like the GP retention scheme have no obvious junior doctor equivalent.
Following last month’s failed negotiations, the frostiness between the BMA and Health Secretary isn’t showing any signs of thawing. Last week, Steve Barclay agreed to restart negotiations with the precondition of media silence, after which he immediately briefed the Telegraph, much to the frustration of his counterparts.
On Monday, NHS leader Matthew Taylor urged the government and unions to call on the conciliation service Acas “to provide some basis for negotiations”. At present, neither camp is closer to moving from its original position.