To Carry on Regardless?

I don’t love my job as a “Junior Doctor”; indeed there are ever diminishing moments I love but there are parts of it I would be so bold as to say I absolutely hate! Surprising? Most likely, especially for those of you following the statements of how Junior Doctors “love their job” in the many recently published articles, blogs and open letters to do with this Junior Doctor “Cluster Bomb”. I use the “war” language theme initiated by Jeremy Hunt, the Secretary of State for Health when he referred to us as “militants” and threatened to use his “nuclear option” of imposing a new contract rather than continuing negotiations with the British Medical Association (BMA), the doctors Trade Union. If imposition does go ahead then I am left with a choice: do I carry on regardless and sign the contract, which I am not alone in believing to be unfair and unsafe for both patients and doctors; or do I apply my “nuclear option” of not accepting the contract and walking away to find work elsewhere?

I chose to work Less Than Full Time (LTFT) in 2010 when it became clear there was no way I could continue to do competitive sport on the ACCS rotations – the initial training for Emergency Medicine. It’s a “Category 2” reason – that includes pursuit of sport at a National and International Level. I had to fight to be allowed to apply for working LTFT, met with resistance as I was the first person in my specialty at that stage of training so there seemed to be a fear of the unknown about how it would work. An injury has sadly brought my competitive sport to an end earlier than desired, but due to rehabbing the injury and an attempt at a “come back” I am yet to return full time.

I’ve been living in London for the past 7 years, only with the help of inheritance from my late mother have I been able to buy and renovate a small flat. I have a family living nearby including a new baby cousin, some great friends. I work in an excellent Emergency Department, which until recently would have been keen for applying as a consultant in the future. I don’t want to leave London really, but I feel like I can’t afford to stay currently both financially and because of the way the professional has been treated leave me not wanting to work under the current “leadership”.

I have considered going to Australia to work, but for current family reasons I don’t want to be so far away for the immediate future. So instead I have applied for a non-training job with 20 per cent Pre-Hospital Emergency Medicine (PHEM) included in North Wales, aiming to start in February 2017 if I am successful at interview. Indeed I write this as I finish a week of locum shifts in Northern Ireland, my first time working outside of England in my eight years as a Junior Doctor. I’ve used my Annual Leave to do this work, quite simply because I need the money to both pay off debts. However I’m also keen to see what other hospitals are like to work in, ultimately to see if they may be other places I’d want to work as a Consultant in the future.

So what are the main reasons I looking for work outside of NHS England both in the short term and potentially long term? Doctors tend to like to categorise their answers, so here goes:

1. Positive Reasons: Job experience and life outside medicine

The Clinical Fellow job in North Wales would allow me to experience working in a rural district general hospital whilst also have allocated time to do some PHEM to help me decide whether I am more suited to a subspecialty training in either PHEM or Paediatric Emergency Medicine (PEM). A day a week outside of the “hot zone” of the Emergency Department shop floor I hope will give me a chance to “come up for air”. The relentlessness and intensity of the work in the Emergency Department is the highest I have ever experienced – it is simply not sustainable at this pace. There used to be peaks and troughs throughout the day and week, currently it’s rare to be working at anything but full speed. That’s not ideal for staff health, and thus retention, nor patient care and safety.

Living in North Wales for a year would give me a chance to live close to both the Snowdonia Mountains and the sandy beaches of Angelsey, which I will cherish walking and running with my Border Collie, Bella. Hopefully I might even be able to develop from “paddling really fast, standing up on and board and then rapidly falling off” to actually doing something resembling “surfing”! Yes – I won’t deny it – I would like a life outside of medicine! You cannot expect to insist that medical school candidates not only excel academically but also achieve in sport, music, arts and show leadership skills and then expect them to give everything up as adults!

2. Practical reasons: Finances.

It is not “all about the money” but I do have to pay my bills, just like everyone else!

Simply put I cannot afford to keep living in London, run a car, look after a dog and pay for medical courses, conferences and exams without accruing more debt. Yes I could increase my hours, but I hesitate due to the risk of becoming exhausted, drained and unwell. Additionally the crazy but simple economic situation means that it makes more sense financially to do occasional Locum shifts than increase hours in a training job: a ridiculous situation for the NHS to be in.

Hopefully a year in Wales, with the combination of a significantly lower cost of living, renting my flat out and going full time will help me to pay off debts, and maybe even allow me to save some money! If I’m really lucky I may even be able to afford some Moët and a lavish holiday “The Sun” Newspaper believes Junior Doctors are accustomed to!?!

3. Negative Reasons: Lack of adequate and appropriate leadership.

During my time doing high level competitive sport, a Gap Year Commission with the British Army and time at medical school in a University Officers Training Corps I realised I need to be working for leaders who understand the job I do, have integrity and honesty so I can trust and respect that they are making the right decisions. I need my leaders to be willing to listen to me, to explain their rationale for improvements and inspire me to facilitate change – not dictate and create a “them and us” culture. This is key for me – both on a local level in the department and hospital I work, but the “bigger picture” leaders of NHS England Medical Director, the Department of Health and the Secretary of State for Health.

I believe trust and respect have to be both earned and maintained. Sadly the last 9 months in particular for me have shown that not to be the case in the “bigger picture” leaders – sadly there is a massive disconnect between what I see daily on the shop floor and their ambitions for the future of the NHS. There is a lack of adequate planning for both material resources and staffing levels to achieve this sound bite “truly seven day NHS“. Of course I would love a seven day NHS that provides a standard level of care at any day of the week; however we need to consolidate our current level of service before attempting to expand.

The future?

The reality in my mind is that even with adequate funds, it would likely take 15-20 years to train enough healthcare staff (not only doctors) to roll out a “truly seven day NHS“. Now no government, only focused on power for a 5 year cycle will ever want to hear this, but they absolutely need to understand it.

I hope that a year away from this toxic and demoralising situation will allow enough time for us to climb out of this mess and move forward as a collaborative team to see the improvements wanted, and needed, in the NHS.

I hope I will want to return to finish my training in London and be keen to stay as a Consultant in Emergency Medicine. However I fail to see how this is achievable with Jeremy Hunt so adamant that he won’t even talk to the very people he needs on board for positive change to happen. Simply put I would be reluctant to return if continues his current behaviour – the opportunities outside NHS England, in a #huntfreezone, whether in the UK or further away, will hold even more of a draw if he fails to change, or is not replaced with one of the many Members of Parliament that have worked as a doctor. Ultimately I need confidence in my “bigger picture” leaders and key decision makers; currently I sadly feel failed and betray by them.

It’s time to show some real courage Jeremy Hunt and admit you need a different approach – it’s #timetotalkjeremy. If you fail to accept the offer to talk from the Junior Doctors protesting outside the Department of Health before the historic first withdrawal of emergency care Junior Doctors’ Strike, I will be waiting for you (with Bella) on Tuesday 26th April – ready and willing to talk.

Carrie and Bella

Carrie and Bella

Dr Carrie Thomas

Dr Carrie Thomas, LTFT Specialist Trainee in Emergency Medicine

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