by Lynda Goetz
Photo: Cedric Fauntleroy from Pexels.
My daughter is British and a junior doctor. She is not on strike. She is working in New Zealand. She went for various reasons, intending to stay for a year or two. However, she may not return. She is not alone, although Australia rather than New Zealand tends to be the favoured destination for younger British National Health Service (NHS) doctors, as Harry de Quetteville explains in a Daily Telegraph article published last Saturday.
The current aggressive approach taken by the doctor’s union, the British Medical Association (BMA), may not be to everyone’s taste or meet with universal approval, but there is little doubt that the respect and working conditions which doctors used to enjoy no longer apply today. Today’s junior doctors (which means anyone who is not a consultant; so from those who are newly qualified to those who have done all the training and are looking for a consultancy post) may not in fact be working more hours than their seniors did years ago, but they feel less supported, more stressed, and not so much badly paid as badly treated.
Much discussion centres around the word ‘vocation’, with a criticism from senior members of the profession that when they joined, becoming a doctor was a vocation, not just a ‘job’. That may well still be the case for some, but others may have considered medicine as a respectable job, one which would always be in demand, would be useful to society and which would earn them a reasonable living. That, surely, is not an unreasonable approach to choosing a career when heading to university? Unfortunately, these days the pay and conditions are just not working for so many young doctors in the NHS.
There are a number of reasons for this. Firstly, there are simply not enough doctors. This means that those there are, are working in an environment which is short-staffed and extremely stressful. Successive governments have, for one reason or another, not set up the new medical schools which would be needed to train the numbers of extra doctors required, given the increase in the UK’s population and the increasing longevity (often not in good health) of that population. The training methods which used to apply no longer do so and some feel that this has not helped. The old ‘firms’ consisted of a consultant, who led the group and after whom it was named, some four of five trainees of varying seniority who weren’t permanent members, but belonged to it, and often a senior nurse. For many it was a consistent source of professional and emotional support. The quality of education and training, however, varied and depended very much on the particular consultant. In spite of this, many see the abolition of this system in 2005 as the beginning of the disenfranchisement and low morale amongst junior doctors. Nowadays, most consultants do not know the trainees personally and simply have to tick boxes to confirm that trainees have completed certain tasks or parts of their course. Whether or not the ‘firm’ system would help morale (and not everyone is in agreement over the point), there is no doubt that the current system is not working either for staff or ‘consumers’ i.e. patients. “Our NHS” is not the panacea and world-envied system many seem to believe it is, or was.
What is the attraction then for doctors of the Australian or the New Zealand systems? Well, for a start, pay is better, but so are conditions. My daughter points out that if she asks for leave at a certain time, the response is usually “certainly”, as opposed to the fairly standard response in the NHS, “we can’t let you have that time”, or, “you’ll have to arrange a swap with someone else”. This was even the response given to one of her colleagues asking for leave a year ahead for her wedding and honeymoon! That sort of treatment is unacceptable and would not occur in any other organisation. In Accident & Emergency, 13-hour shifts are the norm in the UK, with tired doctors sometimes left to face an hour’s drive home after such a shift. There is little or no on-site accommodation as there used to be in my sisters’ day (both are anaesthetists; one has now retired, early, from the NHS, and the other is in Australia). In New Zealand, A &E shifts are 10 hours maximum and only last for 4 days, followed by 4 days off.
The other thing which makes the Australian and New Zealand medical systems more appealing for doctors is that fees for the compulsory and ongoing exams are paid for by the health system on behalf of the trainees. In the UK, doctors may not be that badly remunerated, as Zoe Strimpel maintained in a recent article, but they have massive student debt and are obliged to pay exam fees (up to £800 a time) out of their current earnings. They are also required to pay non-optional membership of the General Medical Council (GMC), which seems to be there largely to penalise them for any complaints by the public. As Ms Strimpel rightly says, pension remuneration is generous, but if you are thirty years old and struggling with the ongoing cost of living, a punishing work schedule and a rubbish work/life balance, the promise of a financially comfortable retirement at seventy is hardly that alluring! A recent letter to a national newspaper from a consultant stated that ‘when I was appointed as a consultant surgeon in London in 1999, the senior consultant pointed out that when he was appointed in the 1970s, on an NHS salary, he could afford a house in London, a house in the country, send two children to private school and go on two foreign holidays a year’. The letter-writer goes on to say that for his generation to do the same they would have to work full-time in the NHS and the same again in private practice and adds that ‘today’s generation pay tuition fees, leave medical school with debts of £100,000 and have no hopes of ever earning enough money to buy a house in central London’.
Medicine may well be a challenging and rewarding profession, but no one is going to join if all the hard work and massive responsibility is inadequately remunerated, if experience gained abroad is ignored (as it is currently) and if there is no flexibility whatsoever in a system which appears to be entirely hierarchical. Already, the NHS is finding itself paying out very high fees for locums. The reason for this is that not only are junior doctors far better paid for locum work but they then remain in control of their holidays and free time. Surely those in charge of the NHS (where is Amanda Pritchard, NHS England’s chief executive, by the way?) and the government must see that the current trajectory is completely unsustainable and that without major reform we are not going to have a health service?
Quite what the Royal College of Nursing and the BMA are currently playing at is hard to know. Do they want the NHS to collapse? What do they intend to do when it does? There is no doubt that the takeover of the BMA by those of a Marxist mindset is unhelpful, and clearly a demand for a 35% pay rise in the current climate is unrealistic in the extreme. However, without doctors and without nurses (although the nurse’s story is a different one for another time) there will be no NHS. Surely it must be clear to those in authority that without drastic reform (probably a move away from the ‘free at the point of delivery’ system to the social security system favoured by almost every other developed country in the world, including Australia) there will be no public health system in this country at all very soon. That would be a serious setback.