Most people are aware of the ongoing dispute over junior doctors contracts. As a medic myself with a partner who is a practicing junior doctor, I identify very strongly with the issue. In short, I along with many of my peers am steadily heading for the door, I'm even learning a third language in order to expand my options further.
Throughout all this, Jeremy Hunt, secretary of state is nowhere to be seen. Despite telling doctors that his door is always open, he has not been seen or heard from for some days. Currently junior doctors are using their spare time to protest outside the Department of Health 24 hours a day until Hunt is willing to reenter talks with doctors and our union the British Medical Association.
Union Council has voted to support the junior doctors and we have vowed to stand in solidarity with the BMA and junior doctors. Not only does this affect our 2000+ medical students, but it also affects every single one of us as potential patients of a system which is currently being dismantled before our eyes.
Stephen Naulls, one of my fellow medical students has written an open letter which is gaining signatures from medical students. I have added my personal support, as has Martin Lupton, Head of Undergraduate Medicine. If you wish to add your support, click here.
The letter reads as follows:
As medical students, our experience of the NHS is a unique one. We interact with all staff in all departments at all times of day and night, and this provides us with a particularly unique insight ‘behind the scenes’ into clinical medicine. Of course, this unique position comes with responsibility; namely, that we are obliged to reflect on what we observe. We are also obliged to share things that might harm future patients. Because of this duty, we feel we must tell the public about a problem, little discussed, that may damage the future of the NHS.
For many students there has been an insidious decline in the quality of our experience of medicine both on the wards and in general practice, predating any recent controversy. This has had a profound effect on morale and left some of us wondering if a career in medicine is really worth it.
Time after time, we are told by senior doctors to ‘get out while you can’, and that ‘it isn’t too late to do banking.’ Some final year students are doing exactly that, or moving abroad to practice. On GP placements, students are told, simply and unequivocally, ‘don’t do this’ - it is not surprising to us that one in five GP trainee posts remained unfilled after two rounds of applications in 2015, and that additional benefits need to be offered to attract graduates to some of the countries most undersubscribed regions(1). Nor is it surprising that in 2014/15, 21% of respondents to a census of consultant physicians reported significant rota gaps in hospitals, with worries that ‘they cause significant problems for patient safety’(2). The demoralisation present in the doctors responsible for our teaching is deeply disheartening.
Coupled with the concerns surrounding patient safety, rota gaps seriously threaten the level of education medical students receive. ‘No medical students tonight, we already have 13 patients that have been here past the 4 hour waiting time’ one student was told at the start of a mandatory A&E night shift. ‘Everyone was rushed off their feet and didn’t have 10 minutes for a break, never mind to teach us’, he reflected. Consequently, medical students are being placed in increasingly awkward positions if they want to seize on the dwindling opportunities to learn. One student told us that: ‘when we did get a patient to clerk, there were not enough staff members to chaperone, but we felt like we couldn’t refuse given they had already told us how busy it was.’ A junior doctor in North West Thames told us the other side of the story: ‘we are regularly emailed and called to fill in on-call shifts. I feel knackered most of the time and although I love teaching, find that I use that time to catch up with my own workload rather than share my knowledge and skill with students. It is a real pity that the next generation of doctors are not nurtured the way I was as a medical student.’
Experiences on the wards aren’t the only cause of demoralisation for future doctors. The financial cost of doing a medical degree is becoming prohibitive. On average, we leave medical school with at least £80,000 worth of debt (3). Research has highlighted that ‘doctors from underprivileged backgrounds are poorly represented in medicine’ (4) – a feature of the profession likely to become more obvious if a lack of financial support dissuades poorer students from applying. With medical school applications already falling by 13.5% in the past two years, this is a growing concern (5).
Further research at our medical school highlights that ‘87% of students in their fifth and sixth year of medicine said they had financial concerns, and 50% of the respondents also said that the pressure affected their physical or mental health’(6). Furthermore, in 2015 30% of polled students ‘had experienced or received treatment for a mental health condition while at medical school’(7). We think that the changes to the NHS Bursary scheme threaten to make things worse, for people already studying in an intensely stressful environment for a prolonged period of time.
We want to care for patients and make the world a better place – many of us have dreamed of being a doctor for years. However, our experience of perpetual staffing shortages, a deteriorating learning environment and a dejected, demoralised, and depressed body of doctors, is gradually sapping our enthusiasm and subverting our dreams.
It is difficult to care for others if you are in a bad place yourself. The morale of medical staff is important to all of us.
Imperial College Medical School
References
1 - GP National Recruitment Office. (2016). ST1 Recruitment. Available: https://gprecruitment.hee.nhs.uk/Recruitment#panelOne. Last accessed 8th March 2016.
2 - Joint Royal Colleges of Physicians Training Board. (2016). One fifth of consultants state that rota gaps are causing ‘significant problems for patient safety’. Available: http://www.jrcptb.org.uk/news/one-fifth-consultants-state-rota-gaps-are-causing-‘significant-problems-patient-safety’. Last accessed 8th March 2016.
3 - Ercolani MG, Vohra RS, Carmichael F, Mangat K, Alderson D. The lifetime cost to English students of borrowing to invest in a medical degree: a gender comparison using data from the Office for National Statistics. BMJ Open, 21 Apr 2015. Available: http://dx.doi.org/10.1136/bmjopen-2014-007335
4 - General Medical Council. National training survey 2013: socioeconomic status questions. Oct 2013. Available: http://www.gmc-uk.org/Report___NTS_Socioeconomic_Status_Questions.pdf_53743451.pdf
5 - UCAS Analysis and Research. Deadline Applications Statistics: October. Oct 2015. Available: https://www.ucas.com/sites/default/files/mr_october_151015_medicine.pdf
6 - Watson J, Wheeler T (2015). A report on clinical year student funding for MBBS Medicine.
7 - Billingsley, M. (2015). More than 80% of medical students with mental health issues feel under-supported, says Student BMJ survey. Available: http://student.bmj.com/student/view-article.html?id=sbmj.h4521. Last accessed 8th Match 2016.
