The NHS Junior Doctor Experience

By Dr Kuvira Manamperi

Navigating Stormy Seas

In the heart of the UK’s healthcare system, a crisis is unfolding. A cost-of-living crisis, combined with burnout and well-below-inflation pay rises, is prompting dedicated junior doctors to question our commitment to a profession we hold dear. In 2022, junior doctors were dealt a pay rise of just 2%—far below the rate of inflation. A recent survey by the British Medical Association highlights the harsh realities faced by junior doctors nationwide. Shockingly, over the past year, more than 50% have grappled with utility bill payments, nearly 50% have resorted to borrowing from family, and around 80% have had to make painful sacrifices by cutting food and heating expenses¹. It’s a disheartening scenario, where junior doctors find themselves in a relentless battle to balance their basic needs with the demands of their profession. These are individuals who have worked tirelessly, whether it was during the darkest hours of the pandemic or in the ongoing battle against immense backlogs and pressures within the healthcare system.

The Junior Doctor’s Odyssey

As a Foundation Year 2 doctor in the NHS, my journey has been a tapestry of dreams, challenges, and resilience. I was born and raised in Colombo, Sri Lanka, and like many aspiring medical professionals, I had my sights set on working in the United Kingdom. The allure of practicing medicine in a country known for its diverse patient population and excellent training in the NHS was too compelling to resist. Although my initial plan to study medicine in the UK didn’t materialize, my determination led me to Dublin, where I embarked on a path to make my parents proud and to make a real impact in the world of healthcare.

My path so far as a junior doctor was not without its share of hardships. The idealistic image of working in the NHS collided with the harsh reality of being “overworked and underpaid”. The financial burden of starting a new life in the UK and being away from my family, took its toll. It led me to question whether I had made the right decision in pursuing a medical career.

Facing Tempests: Overworked and Underpaid Experiences

My transition to life as an FY1 brought to light the stark disparities between my dream and the challenging reality of my profession. As a junior doctor who had just started, I felt like I had already walked a path fraught with the challenges of being overworked and underpaid.

It’s a journey that starts with the weight of an expensive five-year medical school education, leaving us with considerable student loans that demand repayment. For many of us, this responsibility extends to paying back parents who have selflessly supported our dreams. The burden of educational debt is a constant companion as we navigate our demanding careers.

To advance professionally and pursue specialization, we must invest significant sums to sit for crucial exams. These examinations are not just tests; they are gateways to opportunities for growth, specialization, and personal fulfillment. Yet, they come at a considerable financial cost, adding to the financial hurdles we face in our quest to better our careers.

The core of our dedication and commitment lies in our on-call duties. It’s an arduous task that often expects us to juggle responsibilities across multiple wards simultaneously. The relentless ringing of our bleeps during grueling 12-hour shifts becomes the backdrop of our lives. It’s disheartening that, in addition to the countless challenges we face, there’s the matter of a salary deduction equivalent to 20 minutes, all under the guise of ‘break time’ that we often struggle to find amidst our demanding schedules.

The pressure is unrelenting. Bed managers often urge us to prioritize discharges, even when more clinically urgent and priority tasks require our immediate attention. The persistent prioritization of administrative duties over patient care can be demoralizing, challenging the very essence of our profession.

Beyond the confines of the hospital walls, the challenges persist. When we finally return home, the work doesn’t stop; it lingers like a persistent shadow. I often find myself questioning the decisions I made – did I make the right call, could I have done more? The relentless anxiety becomes an uninvited companion, fueling my doubts and anxieties. The high-pressure environment of tough on-call shifts, once contained outside, now transcends the physical boundaries and sits in my head. It replays, haunting me with the ever-present question of whether I did enough. The struggle to find respite, both physically and mentally, is an enduring battle that underscores the profound toll our profession can take on our well-being.
Our workdays are further complicated by the lack of control over our rotas and having to beg for annual leave. Some of us find ourselves working more on-calls than others, yet we all receive the same pay. This sense of inequity creates frustration, as our dedication and effort often go unrecognized and unrewarded.

It’s a paradoxical situation. We, the individuals directly responsible for saving lives, find ourselves financially undervalued. Our work unfolds in high-pressure, often toxic environments, and yet, we grapple with the disheartening reality of being underpaid for our life-saving efforts. Our commitment remains unwavering, but it’s crucial that these challenges are acknowledged and addressed to ensure the sustainability and well-being of junior doctors, who play a pivotal role in the healthcare system.

Patient Voyages: Conversations Amidst Strong Tides

During FY1, I recall a particularly poignant encounter with a patient on a strike day that left a lasting impression. I had been following my regular rota’d shift on a day when many of my colleagues were striking. The patient, understandably curious, asked me why I wasn’t participating in the strike, and my response was a candid reflection of the financial pressures I
faced at that point in my career.

I explained, “There’s a pay cut for days we strike, and right now, I can’t afford to do it.” I remember at the time it was also quite challenging to find locum shifts that didn’t clash with my rota for the month to mitigate the effects of the pay cut. It was a moment of vulnerability, laying bare the very real financial struggles that I, like many junior doctors, grappled with during my early years as a doctor.

Navigating the High Seas of NHS Strikes

My perspective of the strikes is one deeply rooted in my personal experiences and the broader challenges I face. Many of us find ourselves in resolute agreement and unwavering support of the movement, a sentiment stemming from the hardships we’ve encountered. It’s not just about fair compensation; it’s about the recognition of our dedication, the commitment we bring to our profession and better working conditions.

In this context, the quote, “Joining the picket line is a last stand²,” resonates deeply with many of
us. It reflects the profound sense of urgency we feel as we witness a system that seems to “exploit our goodwill”. We often question why we should continue to give our all, including our health, for a profession that sometimes offers so little appreciation in return³.

At the same time, there is a pervasive concern for patient safety during strikes. We understand the critical role we play in healthcare, and this responsibility weighs heavily on our shoulders. However, it’s important to consider that this concern is not one-sided. A systematic review, “The impact of strike action on patient morbidity: A systematic literature review,” reveals some intriguing findings. While strike actions in healthcare have been relatively common over the years, the study’s results suggest that strike action has, in fact, had little impact on patient morbidity. The majority of studies report that strike action had either a neutral or mixed impact on patient outcomes⁴. It’s clear that the consequences of strikes on patient well-being, while a valid concern, might be less severe than initially feared.

In the end, my perspective on NHS strikes is one that’s complex and multifaceted. It reflects a genuine commitment to the profession, concerns for patient safety, and the need for fair treatment, all set against the backdrop of personal experiences and the broader challenges of an overworked and underpaid healthcare system.

Resilience on the Open Ocean: The Journey Within

As an F1 junior doctor, I frequently found myself grappling with a fundamental question: was the overworked and underpaid situation I was experiencing something I wanted to endure throughout my entire career? To be honest, my initial response was a resounding “no.” In my moments of doubt, I began searching for alternative career paths, even exploring medical and healthcare-related roles. However, as I embarked on this soul-searching journey, I had a critical
realization – I genuinely enjoyed medicine. I had to reconnect with my initial motivation, my “why” behind choosing this path.

For me, medicine just felt right. I discovered a profound enjoyment in making medical decisions, a fascination with the intricate workings of the human body, and a strong desire to specialize in cardiology. It was as though I was telling myself, “Yes, I’m working in what feels like a burning building. But deep down, I have an unquenchable urge to keep going.”

Armed with this renewed determination, I began crafting tactics to help me cope with the challenges. I adopted a more positive mindset, and I started looking forward to the possibility of specializing in the field that truly inspired me.
Now, as an F2 junior doctor, I can confidently say that I feel much more at ease working in these dire conditions. My perspective has evolved, and I now see the burning building not as an obstacle, but as an environment that has sharpened my skills and determination. While the challenges persist, my resilience has grown, and my commitment to medicine remains unwavering. I look ahead with hope and a sense of purpose, knowing that the journey is tough, but the destination is worth the struggle.

Charting Courses: Uniting for Change

The plight of junior doctors in the NHS is a testament to unwavering dedication, resilience, and an unrelenting commitment to the well-being of patients. Our experiences, though marked by hardships and financial struggles, serve as a clarion call for change. As we reflect on the challenges we face and the urgent need for full pay restoration, let us remember that it is our voices and shared stories that have the power to bring about transformation. Our journey is far from over, together, we can make a difference for junior doctors and the patients who depend on us.

References

1. Gardner-Newell, H. (2023) Why junior doctors are striking – a guide for patients, The British Medical Association is the trade union and professional body for doctors in the UK. Available at:https://www.bma.org.uk/our-campaigns/junior-doctor-campaigns/pay/why-junior-doctors-are-striking-a-guide-for-patients (Accessed: 24 October 2023).
2. Otte, J. (2023) ‘joining the picket line is a last stand’: Junior doctors on the four-day strike, The Guardian Jedidajah Otte. Available at: https://www.theguardian.com/society/2023/apr/12/junior-doctors-views-four-day-strike-england (Accessed: 24 October 2023).
3. Patterson, C. (2023) Enough is enough: Government ‘exploiting junior doctors’ goodwill’, The British Medical Association is the trade union and professional body for doctors in the UK. Available at:
   https://www.bma.org.uk/news-and-opinion/enough-is-enough-government-exploiting-junior-doctors-goodwill (Accessed: 24 October 2023).
4. Essex, R. et al. (2022) The impact of strike action on patient morbidity: A systematic literature
   review, Wiley Online Library. Available https://onlinelibrary.wiley.com/doi/10.1002/hpm.3418 (Accessed: 24 October 2023).
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