A recent GMC surgery show that burnout amongst trainees is at an all-time high. NHS backlogs are threatening the wellbeing and health of doctors. A recent junior doctor by the name of Emily has poster on twitter @emilycpb that she is leaving the UK foundation programme and has given several reasons for this on her twitter feed. At the time of writing the NHS also has 60,000 job vacancies so you would think as an organisation it would be making working for it more attractive.

We have a look at some of the reasons that have been given and offer our views, having been through medical junior doctor training, albeit over 15 years ago.

The pay of a trained professional doctor should not be less than 29k. The comment that an FY1 doctor is experienced is not valid as 5 years of medical training has already been completed.

• We agree with this. The pay of all doctors has not varied much over several years. Starting salaries of graduates in law firms can be £42250 with financial services around £32850.

• In addition, the medical graduate will also have to pay tax, national insurance, student loan repayments as well as contributions to the NHS pension. The current starting salary of £25494 on the BMA scale for a FY1 is outdated.

There is a lack of medical training, compare to service provision. Emily mentions the lack of time to watch an endoscopy due to the number of tasks on the ward.

• Every FY1 has ‘protected’ learning time in which they will be provided training in which they cannot be disturbed. In effect, the ‘bleep’ and any ability to contact them will not be present.

• If this compulsory training is not being provided, then this is a cause for concern.

• However, learning how to undertake an endoscopy is not a core foundation year competency and the trainee should not expect this time to be protected. As part of your role as a doctor, you are expected to see and look after patients, and this is going hand in hand with your training.

Other ward staff speaking to the foundation doctor in an unprofessional and rude manner.

• This is not acceptable. The foundation doctor is an employee and is expected to be able to work without any abuse. We encourage the doctor to report any such events to their employer.

• However, we understand that trainees may not be willing to do this worrying about the effect on their future career and the backlash from staff with which they will likely have to continue working with.

The wards in the NHS are not staffed appropriately to provide safe levels of care

• This is a chronic problem in the NHS. Although the General Medical Council encourages doctors to report any risks to patients, which clearly understaffing is, there is often no solution to the problem due to chronic underfunding of the NHS and lack of candidates to fill vacancies.

Lack of supervision for junior doctors, especially during outside of core NHS hours, meaning a risk to patients.

• Again, a problem of chronic underfunding of the NHS and a shortage of doctors. It also puts the clinician at risk of making mistakes, for example in the case of Dr. Bawa Garba where she was asked to cover several clinicians work with very little senior cover.

• If these is an error, the blame will rest with the junior doctor, even though the consultant is supposed to hold ultimate responsibility for patients under his care. The managers of the hospital, including the chief executive, are not affected.

Infantilisation of the medical profession and a lack of respect of the medical profession in the NHS

• Unfortunately, constant attacks from the media on the medical profession will only exacerbate the situation. This continues through a doctor’s career, for example a locum GP even though being fully qualified is considered inferior to a GP partner.

• The value of doctors has been eroded in the public and other professions over time.

• I have also come across cases where in clinical meetings, senior doctors had food provided and seats reserved at the front, with other doctors and staff forced to watch them eat from the back, sometimes standing up.

Lack of control and effect on work life balance with a career as a doctor in the NHS

• Hospital rotas are extremely rigid and often run with minimal staff and at minimal cost. In the past, hospitals have been known to pay for locum doctors to cover leave of employed doctors. This is now less likely to be the case.

• I have been informed of cases where doctors have been told in the past to ‘swap’ annual leave with another doctor and not to take leave when they were working nights. In addition, for some posts, the annual is pre-determined and set in stone with no alterations possible, even if notice was given months in advance. Subsequent investigation by a fellow doctor indicated that the rota and leave policy was illegal, but it took intervention from the British Medical Association for the trust to act.

• It is understandable why a doctor would leave (or not even apply) to such a post. Junior doctors are now more resilient in the fact they now care more about work life balance and the effect on their family, and rightly so.

• The NHS needs to adapt. Refusing a colleague to attend a wedding with several months notice is not acceptable. However, this has to be balanced with the needs of a hospital to provide 24 hour care of patients.

• I can see in some of the follow up post it mentions a veiled threat that the doctor may not be ‘signed off’ at the end of the year, coercing the doctor.

Dysfunctional multidisciplinary teams in the NHS that put their own concerns before the patient and other clinicians

• I do partially agree with this. As the foundation year doctor (previously known as the house officer) you are the lowest rung on the ladder. By default, all day-to-day ward tasks will fall to you.

• In principle, I do not have any problems with this, but the foundation doctor need to be allocated time to undertake these tasks.

• If the hospital decides not to employ a phlebotomist to take the bloods and this task falls to the foundation doctor, the hospital needs to find someone else to cover the foundation doctors work whilst they do the phlebotomist’s work. No doctor should be expected to work past their allocated shift time.

• Why can a phlebotomist say she has no time as she has ‘enough’ work, and the doctor cannot? Altruism can only be pushed so far.

The Blame Culture in the NHS

• I agree with this. Several cases have shown the hospital trusts tend to protect their own reputation rather than make a genuine attempt to improve services for their patients or adhere to the duty of candour.

• Non-disclosure agreements are forced upon doctors, who can be forced to resign. Whistle-blowers are threatened with referral to the GMC and made scapegoats. This happens in all parts of the NHS, both in secondary and primary care.

Not being able to share staff rest facilities whilst working as a doctor in the NHS

• To be honest, I have never come across this, so I cannot comment.

• It is true that doctors tend to sit with other doctors during rest breaks and lunch but have never come across a ‘protected’ space only for certain staff.

Comparing taking notes as a foundation doctor during the NHS ward round to being a glorified secretary

• Do not agree with this one. Someone has to make records of consultations during a ward round. In my experience it was often the consultant – with me making my own notes with a list of jobs I needed to do.

• However, would not complain if this task was given to me. In fact, I was also the one who did the initial presentation of every patient during ward rounds – so if I wrote them, it was easier for me.

No time to take breaks and when they are undertaken whilst working as a NHS doctor, they are often disturbed by bleeps.

• You can politely tell the ward staff not to contact you during a break unless it was an emergency. Make it clear what time you will be back.

• This does not always resolve the problem, and I don’t advise escalating it, as this only results in more bleeps as retaliation.

In conclusion Emily raises valid points. However, it is ultimately the response of the government to fund the NHS and make it an attractive place to attract talent. Medicine is now much more an international career. In our experience, doctors do not often chase the highest paying posts, but those that provide a more suitable work life balance.

Blue Peanut Medical is run by a group of doctors who help students get into medical school. We help with training for the UCAT examination and Medical School Interviews, as well as provide Clinical Work Experience Placements. Please get in touch if you need any further information at support@bluepeanut.co.uk