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The
Heckler speaks out
15/06/2007, 12:26
A few weeks ago I heckled Patricia Hewitt on BBC’s Question Time
over the junior doctor job application fiasco. This was not an
easy thing for me to do, as heckling is seen as such a
‘un-doctor-like’ thing to do, in fact I was publicly
criticised by a journalist in a national newspaper for being rude.
Someone who had absolutely no insight into me, firstly as a doctor
(‘Frankly doctor, your bedside manner stinks’) or the disaster
befalling the medical profession and the NHS as a whole. Doctors
are supposed to be apathetic and detached – ‘stiff upper
lip’, ‘shut up and put up’ – aren’t they? They can’t
care too much about their jobs, their patients, and their
livelihood? I am not a politician or a public speaker, just an
ordinary doctor. My passionate and emotional heckle that night,
was prompted by anger and despair – but also by fear – that
things would get worse. They have.
I am utterly heartbroken – and I got my first choice job. I do
not use these emotive words lightly, but I am distressed to the
point of distraction by the agony I have seen my loved ones,
friends and colleagues go through. The jobs for the first round
came out last week, and as I feared, thousands of junior doctors
were not allocated a job with just over 6 weeks until the new jobs
are supposed to start. In a nutshell, there are going to be
thousands of unemployed doctors, thousands unhappy with no
training posts, and thousands leaving the country. Very few
members of the public realise that this is even happening!
In the past, doctors left medical school, completed their first
year as a doctor and then could apply to whatever field of
medicine and surgery they wanted to, in whatever area of the
country, applying directly to advertised jobs in hospital trusts.
Doctors would then have to complete postgraduate exams through the
different Royal Colleges (e.g. Royal College of Surgeons) to
progress, to ultimately become a consultant. This process takes
many years in some specialities as experience counts, particularly
in the surgical specialities! This didn’t fit with the Labour
Government plan - more consultants are needed. Therefore,
Modernising Medical Careers (MMC) was born, training for doctors
would be streamlined so that the time to consultant would be
clearly defined with scheduled training all along. ‘Time to
consultant’ level would be less. The tool to implement this was
also conceived, Medical Training Application Service (MTAS), all
junior doctors would apply for jobs at the same time of the year
via this online computer system and would be matched to jobs using
it. Simple.
As with anything, behind the superficial façade lies the truth,
which I will explain. Training budgets were cut this year, so
millions of pounds dedicated to training junior of doctors, helped
amass a surplus in the overall NHS budget. The European Working
Time directive was being implemented – so the hours that doctors
can work legally (and be covered with medical protection
insurance) was slashed – so trainee junior doctors are getting
less training! The idea behind MMC was already being exposed as
being fundamentally flawed, less training funds, less training
time, less training years doesn’t produce the same quality
doctor – end of story. MMC is a tool for government to say ‘we
have more consultants.’ Actually they will have ‘more very
junior, inexperienced consultants,’ a very scary thought for
patients, and for doctors.
Then came the implementation of the ‘master plan,’ ignoring
the calls of the BMA and the newly formed junior doctor pressure
group Remedy UK. In February of this year, MTAS was launched,
despite never being tried or tested. This was the way junior
doctors had to reapply for jobs, all contracts and jobs were
cancelled from the 1st August 2007 as this system would allocate
doctors to the most appropriate jobs. As a result of the
implementation, junior doctors from the before mentioned ‘old
training system’ would be directly competing with even more
junior doctors who had already started on the MMC pathway. A
‘bottleneck’ situation was obvious. Doctors had to fill out
all their personal details on the internet website (including
sexual orientation), also completing multiple statements on the
online form which would be scored on a mark scheme. Questions
would include: ‘Tell me about a situation where your
communication skills fundamentally impacted on a patients care,’
the doctor would have to explain in 150 words or less, this
scenario. These answers were given more weighting in scoring than
the more traditional tests (on a CV) of how good a doctor was e.g.
such as previous research experience, prizes, degrees etc. They
were designed to identify the best doctors. Doctors could only
apply to four deaneries each within the UK. For example, to work
in London you would not apply to a particular hospital within
London, you would have to apply via the website to the deanery
called London/KSS, meaning you could be allocated to any job in
the whole of London, Kent, Surrey and Sussex. Large areas of the
country! The website kept crashing, the consultants marking the
forms were overwhelmed with work (on top of their duties to their
patients), then the fun really started. The job interviews came
out and it became apparent that thousands of doctors were not even
getting interviews – thousands not getting interviews for jobs
they were currently doing!
Very quickly, it was clear that MTAS had failed in many different
ways and doctors were angry, they had only one chance to apply for
a job per year, with only one monopoly employer for junior doctors
(the NHS!). No interview meant no chance of any job, unemployment
beckoned for thousands. Doctors marched thanks to the Remedy UK
organisation (a superb group of ordinary doctors, standing up to
the government), MPs up and down the country had despairing
letters from doctors and their relatives. The government panicked,
the goal posts changed, and changed again, the website crashed,
Patricia got heckled, morale fell, then fell further and further.
Patricia and Lord Hunt span facts about the NHS, ignored the anger
of junior doctors, then apologised for incompetence, and again,
and again, but things never really got better. Then everyone got
interviews, thousands of further interviews, thousands of doctors
hours lost. Consultants had to cancel lists, clinics, daily
duties. Then, nearly 4 months down the line, MTAS was axed and the
gallant Remedy UK were defeated in a court battle by the devious
government (who forced Remedy UK to pay thousands of court
expenses), and the first round of jobs were allocated.
This is where we are today. No happy ending though. No happy
doctors. Just lots of tears and lots of despair. Thousands of
doctors without job offers, with a second round that offers little
more promise. Those that have jobs are not even happy, they have
no idea what part of the region they will be in, what hospital,
what speciality, what consultant etc. – can you see the trend?
Furthermore, hospitals don’t know who they are getting or
whether they want to work in that hospital, a classic case of
‘bums on seats,’ except with people’s lives to add to the
mix. Many have been offered jobs with no training potential (no
chance of being a consultant if they stay in that post), but worse
still, many have been cruelly separated from loved ones in the
MTAS lottery. I have been separated from my long term girlfriend
because of this when even a spell on intensive care for me, has
never separated us. She didn’t get a London job and I did,
despite her being on a ‘gold circuit’ rotation already in
London. If she doesn’t accept a job offer elsewhere, she will be
unemployed and with our mortgage and £30000 each in tuition fees
to pay, we can’t afford to do that. We’ll have to live
separately for potentially many years, as the MMC master plan
doesn’t allow you to move regions! One of my closest friends, a
brilliant doctor, with all of the qualities you could ever want in
a physician has been shafted by this incredible system. Not one
job offer. I’m devastated for her and will never forget or
forgive the government for the suffering she has been through.
The shocking thing is, is that so many are in the same boat as
this, a situation that sickens me to the core. Anyone that is a
doctor, or knows a doctor will know the sacrifices a doctor makes
and continues to make to be one. Of course, sacrifice is not
exclusive to doctors, and no one would say that, but, the
incredible number of exams, stress, financial costs and years
studying to name a few things, not just at medical school, but
after qualification, is practically unmatched. You don’t become
a doctor to be rich, I get paid £7.50 per hour with all the extra
hours doctors do to care for their patients properly. You do it
because it’s a vocation, and you love your patients. You look
into their eyes and you know that you can help them; you want to
help them in their most vulnerable hours often, a thought that
inspires me even in my lowest moments. You are with patients at
happy times but also at times of great distress – you can make a
real difference. Competition is fierce even before entering
medical school, and is nothing new for doctors. We are certainly
not zealots adverse to change, it is part of every day practice.
Being a doctor is not just a job, it is your life, many of us live
and breathe it, worried about our patients when we go home at
night. There is nothing wrong in being passionate and fighting for
our jobs, I would want a passionate doctor fighting my corner if I
was a patient, rather than an apathetic one. This crisis has
devastated many junior doctors’ lives, devastated many of my
friend’s lives, which is unbearable to think about. People are
leaving the country, leaving the profession – good doctors -
because this crazy system has pushed them to the brink. I don’t
blame them, but it is a travesty of the highest degree and should
not be allowed to happen.
Now, Patricia will spin out facts about the NHS that will make you
think you’ve got vertigo. But let’s face facts, the reality if
far away from the verbal diarrhoea she oozes. The NHS is in
surplus financially – nonsense! The vast majority of trusts are
crippled by debts (from Private Finance interest payments which
they will pay off for many years) so that wards have closed,
thousands have lost jobs, all ‘non essential services’ cut,
wards understaffed because of locum cuts, the list goes on and on.
Waiting lists cut – nonsense - ‘cherry picked’ procedures
take priority over other patients – taking resources from one
patient group, to give to another. In no way am I demeaning the
patients awaiting these symptoms at all (they need their
procedures), but by taking it out of the control of the doctors
and nurses, reasonable decision making cannot be made on who needs
the treatment immediately in a fair manner. In my cardiac unit,
patients not on a government target list regularly have their
procedures cancelled multiple times while the ‘waiting list
patients’ skip past them. ‘The best year for the NHS’ –
give me a break! Speak to the doctors, nurses, physiotherapists
and other support staff whose morale has been destroyed.
So why should the general public be bothered? Apart from the
obvious vast amounts of taxpayer’s money to train unemployed
doctors being wasted (£250,000) and money wasted on the failed
computer system being a monetary incentive. You should be upset
that the government seeks to develop a generation of younger
consultants with much less experience and training to meet targets
(whose training budgets have been taken by government), think
about that if you’re needing an operation in the next few years.
You should be upset that YOUR doctors are being treated like this,
we are here for you if you are having a heart attack, here for you
if your baby needs delivering. The junior doctors are the
frontline with the nurses and support workers. From a human point
of view, you must see that this is wrong. There are no other
employers for junior doctors, the NHS is it. Granted, many will
say ‘no job is for life’, but if I was a journalist who did
not get a job at one newspaper, I would apply to another. There is
no such facility for junior doctors. Do you want doctors allocated
to specialist jobs on the back of an unfair system? Do you want to
be treated by a doctor so bemused and despairing, treated so
poorly, that he can’t bear to be in work? Hopefully even the
most cynical observer will see that all of these factors are
ultimately not good for patients.
The really ridiculous thing is that I voted Labour in power in
1997, my first ever vote. I’m from a working class background,
my parents never attended university, I went to a comprehensive
school, fought for my life in intensive care twice in the last ten
years because of my Crohn’s disease and even wrote a book
encouraging people like me to go the medical school. The Labour
government betrayed me and my generation of doctors over tuition
fees, now for many unemployment beckons. All I ever wanted to be
was a doctor. I’m sure there are thousands of doctors just like
me that feel the same but whose lives have been ruined by this
fiasco. This is a national disgrace and something that should not
be allowed to be hidden under other bad news. Shame on you
Patricia – ‘this is your legacy, this is Tony Blair’s legacy
– leave now!’
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 689 colleagues voted this a quality posting
when it was published on a medical forum, Doctors.net.uk |
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(18/6/07)
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