In our first article about the junior doctors’ pay and hours dispute, we queried whether the negotiators for the doctors will avoid the mistakes of previous years. Those agreements left some junior doctors in specialities, such as general medicine, feeling the deal was unfair as colleagues, in other specialities, were not liable to be called in after hours as often but earned more. You can read that article on our Facebook business page and also on this blog by clicking on this link.
This article looks at the dispute from a different but important angle.
Shorter Working Hours – Adverse Effect on Experience?
It is right that excessive working hours are not a routine requirement but the hours worked also have a bearing on the exposure that doctors gain to the diagnosis and treatment of less common illnesses/conditions. When discussions took place in previous years, one concern was how a junior doctor would gain appropriate experience especially as patients with interesting or less common conditions may be admitted outside of ‘normal’ working hours.
When medical Consultants voiced this issue in the past, that was perceived as an attempt by consultants to avoid them providing longer periods of cover for junior doctors. Many consultants worked long hours before previous disputes occurred as well as during such disputes.
Many junior doctors seek to qualify via the appropriate medical body such as the Royal College of Physicians or Surgeons. Long working hours and on call duties make studying more difficult. Doctors value the opportunity to take one or two weeks of study leave to revise and cram for their examinations. Studying to rigorous standards helps with knowledge but it is not a substitute for dealing with actual cases.
Balancing Appropriate Working Hours with Developing Experience/Skills
Attaining this balance needs more thought. There are significant problems to overcome such as the provision of appropriate levels of cover. That includes the need for experienced locum cover for study leave/professional development absences. The seeds of potential solutions are outlined below.
Learning technology – it should be possible to create inter-active learning opportunities via videos etc. that give doctors the chance to see less common conditions and diagnosis in action. Developing observations skills and ‘what if’ type approaches need to be covered to ensure that doctors weigh up their observations, available test results and question and examine further, if appropriate. Time to participate in such training will need to be made.
Personal development time and accountability – doctors should be entrusted with planning their development with practical support from consultants who are gifted at mentoring. Study leave should be incorporated into an annual development time allowance which should become a flexible part of the contract (flexible because operational cover is still a priority). Gaps in experience/exposure should be reviewed to see whether an individual should be encouraged or required to take time off to participate in specific observations/training. At the same time, doctors should be made aware that their development is not optional in the sense that if they do not take up such learning opportunities, including on wards and in education centres, they may be curtailing their career path.
Career routes – at one stage, junior hospital doctors started to leave hospitals in greater numbers to join general practices. There tends to be more opportunities for flexible and/or part time work in GP practices. Another reason was the long period of time it takes to attain consultant status in a hospital compared to the shorter time to achieve a partnership in a GP practice. Changes in recent years to the management of general practice life may make such roles less attractive but that remains to be seen.
The exit data indicates that 48% of junior doctors left the NHS after their two year foundation training [see note 1].
A further review of the career structure of ‘junior’ doctors.may be appropriate to see whether there are blockages especially at grades just below consultant level and also whether flexible working across the grades is a practical option for wider application.
Recruiting more career doctors – training a doctor is costly so the scale of loss is of concern and inefficient. If working hours are shortened, it may make more financial sense to:
- Introduce a culture of flexible working and increase the number of ‘junior’ doctor roles that are subject to flexible working;
- Recognise that not every doctor will be able to take up a consultant role but equally individuals do not wish to be treated as juniors on a treadmill forever. The term junior doctor should be phase out and they should be encouraged to see and experience the value of spending longer in the rapid learning grades of Foundation Years and early Specialist Training;
- Reward individuals for broadening and deepening their skills in those grades;
- Review the actual working hours of doctors in different specialties and hospitals as the staffing pattern varies and with that the actual v theoretical working hours; examine actual working v on call/stand by periods and the frequency of call ins;
Reward levels are important but so is the perception of a doctor who makes a career choice to stay on the early Specialist Training ‘grades’. Attitudes need revising to purge the view that such individuals have failed in their career. The rewards, recognition and status of such career minded doctors need to be revisited along with flexible working opportunities as they could well be the backbone of the medical workforce.
Such an approach would be more more cost effective in the longer term as more doctors are developed to lessen the need for routine prolonged hours of duty and thus reduce the numbers leaving the NHS.
 The Guardian, 5th December 2015.
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