Like everyone, at any moment I may find my life in the hands of a junior doctor. But I am not just a patient, I am also a medical student, who, if all goes to plan, may be the doctor who greets you at a hospital in 18 months’ time. And I’m terrified. Why? Because, while the new contract proposed by Jeremy Hunt is set to wreak havoc on the lives of today’s junior doctors, it also sets tomorrow’s generation up to fail. What’s worse, as university students rather than NHS employees, we cannot officially join the strike, despite the fact that it is being undertaken to protect our future, as well as our future patients.
The plans will hit us hard in a number of ways. The pay cut, though galling for students who were also the first cohort to pay £9,000 tuition fees, is only the start of it. Hunt has promised that no current junior doctor’s pay will go down – of course, it will in real terms, as progressional pay rises are reduced and doctors are penalised for frivolous activities such as starting families and scientific research – but pay protection is little comfort to the student with no pay to protect. What really scares me is my growing belief that, when I inherit it, the job of a junior doctor will be harder than ever before.
The government has made it clear that the purpose of this contract is to achieve a seven-day service without hiring more doctors or paying them any more. This inevitably means one of two things: fewer junior doctors during the week as others are “redeployed” to the weekend; and a greater workload for those working weekends, with no increased support from consultants or ancillary services such as imaging and laboratory testing. It is the typical approach of doing more with less. This is unimaginably scary for me, because I’ve seen that junior doctors do not have more to give. The new contract’s stipulation that NHS trusts will police themselves, and only intervene if doctors work more than 72 hours in one week, gives me little reassurance.
My qualified friends tell me how they practically fall asleep at the wheel driving home, how they stay for hours (unpaid) after most shifts, how they are forced to make decisions they are neither trained nor experienced to make. No divine knowledge is conferred at the transition between final-year student and first-day doctor, yet a huge level of responsibility suddenly is. The learning curve is steep, and errors are inevitably made. My biggest fear is that, with fewer colleagues to share an increased workload, patients with complex problems, and no concrete safeguards to prevent a trust overworking me, the chance of making a mistake which harms or kills a patient is simply too high.
I’m not sure I can take that risk, either medico-legally, or morally. Nor if I have the confidence or willpower to knowingly enter an unsafe system. And I am not alone – while a typical medical student coffee-break chat used to be about specialities and training programmes, my friends now discuss accelerated graduate schemes in the city, legal firms that offer to fund medics’ conversion courses, and routes into private sector medicine. This year, the medical school careers workshop added a talk on “opportunities outside medicine” for the first time. A recent poll found that even medical students are rapidly losing interest in becoming doctors.
While this has dire implications – the scaremongering over the strikes shows just how a junior doctor shortage would bring the system to its knees – I will not be among the exodus. I’m fortunate enough to have a sideline as a crime writer, but whenever I’m asked if I would leave medicine to pursue it full-time, I answer “never”. Nothing else combines cutting-edge science with the reward of genuinely making a difference in other people’s lives. This new contract won’t change that. It will put me and my generation of junior doctors at a greater risk – of missing family, of mental health problems, of suicide, of relationship breakdowns, of lawsuits. But those risks pale in comparison to the harm patients could come to, and the prospect of being a participant in that harm is deeply troubling.
I cannot strike on Tuesday. Though this fight will define our future working lives, the UK’s thousands of medical students are relying on our forerunners to succeed – that’s one thing we now have in common with every person who may come to need the NHS in the future.