To think medicine isn't a great career choice

[Medicmog]

Growing up, I dreamed of being a doctor. I was bright and motivated, and worked hard at school, and did lots of volunteering, extra curricular activities, and work experience, to gain admission to medical school. It was encouraged by my school and parents, as something worthwhile to aspire to.

I worked hard to complete six years of medical school, while non-medical friends graduated after three or four years and walked into highly paid jobs (generally £40k+). Two or three extra years studying, and I started on little over half this (plus an antisocial hours allowance on some jobs). Fine, I never went into medicine for the money.

What I find difficult is that doctors (and moreover all public sector workers) are so vulnerable due to current politics, public confidence in the progression is at an all time low, bullying in the progression is rife, and it is such an absolutely thankless job, where your employer treats you appallingly.

I have been injured at work, due to my workplaces negligence, and they illegally docked my pay subsequently, despite my continued working. I have been sick, and had consultants say they don't care about occupational health recommendations.

I had a serious illness, and when I emailed work, together with a sick note, I was told that it would be a great inconvenience, and to get back as soon as possible.

I have felt unwell at work and told that I wasn't allowed to sit down.

I have been shouted at and bullied by colleagues.

I have been threatened by patients and relatives.

I have been pressured to do physical work while pregnant that endangered my health.

When I went on maternity leave I didn't get so much as an email wishing me well, let alone a card.

My children have suffered from the long antisocial hours, including the significant amount of unpaid overtime I have done.

I'm at breaking point, and genuinely dreading going back to work after maternity leave. Why would I want to leave my baby, in order to pay more for childcare than I earn, and be treated like shit?

I realise this is a self indulgent post, but in some ways it is cathartic to share. I wouldn't ever recommend someone to join this profession, and I think young people considering it should be given a balanced perspective.

Laurie that’s gross, for a standard 40hr job plan (which is not quite the same as working 40hrs - most work more. It’s the difference between billable hours and actual hours worked, if that makes sense). 8k London weighting for consultants, not sure what it is for GPs.

Some consultants in some specialties choose to do weekend Waiting List Initiative lists (basically private work for the NHS), or other extra sessions. But if you are just stuck late with a sick patient, or if clinic is overbooked (as it always is) and you end up staying late (as opposed to being specifically contracted to do extra hours by the trust), there's no extra pay.

Certainly in my specialty there are no WLI sessions and very little private work. Which is fine with me, I don’t actually want to do private work. But there’s a misconception that all consultants have a healthy private practice, while it’s actually only a minority IME who do any private work at all.

Nearly, my brother graduated with a 2:2 about 8 years ago. I graduated 15 years ago. It’s Advertising, they aren’t that bothered about academic grades if you can talk the talk. I don’t have DBro’s smart-arse personality (hence why DH suggested I look at PM or QA), but a lot of surgeons would do very well at it.

Teddy do you really think communication isn’t a key skill for all doctors?! It’s hardly going to be the thing holding them back from city jobs! It’s literally part of the admissions process.

I agree that talking about doctors being low paid alienates a large swathe of potential sympathisers. Frankly, it's the people who're not earning more than the national average who are your best allies - those earning the vast salaries are less likely to care about conditions in the NHS because they can always go private. Saying "I could have earned so much more than you plebs" does not win you friends.

That said, I completely agree with OP that it's not about the money. I think it's appalling that you're treated so poorly by your employer. Having to carry on with your shift while actively miscarrying is abysmal. I'm really shocked that NHS managers and HR are allowed to treat you all like this.

On googling, there is a supplement for on call from between 1%-8% of your salary

The way it’s managed in our trust is that one session (four hours) is annualised to take account of doing twelve hour days plus overnight on call from home when you are the consultant on the ward. Which is two weeks in 12, so doesn’t quite work out. But you get one half day off in lieu on the weeks when you are not on the ward.

Nephrology is pretty consultant-heavy though, with twice-daily consultant ward rounds. Gen med would have a much lighter on call commitment, ITU and EM much heavier.

Going back to an earlier point about resilience, and those recruited into medicine, I think it is really interesting.

I find talk about resilience difficult, as it tends to point blames onto individuals, for the failure of a system. Regardless, no amount of resilience of HCP will solve the problems within the NHS.

I do think there needs to be a shift in culture as to how medicine is sold as a career to school leavers. I knew from a young age I wanted to work in a caring job, and at the school career advise 1:1 session, I was told not to look at HCP career paths other than medicine as that was 'below me'. Medicine is sold as something good for bright school leavers to do, with no or little mention of the challenges faced. Schools push their bright young people into medicine as it looks good when they publish their leavers' destinations. Private schools especially. It's not helpful to anyone.

Medical schools are trying to diversify their intake currently, but there is a lot more to be done. Certainly, when I was at medical school, at least half were privately educated, and a significant number of those went to renowned public schools.

Personally, I did a lot of work experience, and spoke to a lot of doctors. I thought I was reasonably well informed, but the reality of the working environment has changed a lot from when I applied almost 15 years.

My dh is on an annualised contract and every year management up the targets so he has to work even harder. They have also introduced seven day ward rounds and seven day diagnostic testing - great for patients but they didn't get any extra consultants! Obviously he's on a rota for that so they share it out amongst the team, but no extra pay because it's supposedly factored into the contract. So he's lost a lot more weekends for no extra benefit. Because of his annualised targets he's always nervous of not hitting those so won't cancel stuff in the week when he has to work all weekend, so he works 12 days in a row. It's gone beyond ridiculous now and I really fear for his health.

bibliomania that's a fair point.

People who don't work for the NHS are always shocked when I share stories of how colleagues and I have been treated. Sadly it is commonplace. I know personally a colleague who continued to work a night shift while pregnant and bleeding heavily as well. From her description of the bleeding, she would have most likely had had surgical management, had she presented herself as a patient. Instead she 'just got on with it', as that is the expectation.

the reality of the working environment has changed a lot from when I applied almost 15 years

I graduated in 2004, and it has changed a lot in the time I’ve worked here! Much busier, much higher expectations/more interventions available - you didn’t used to be able to get CTs OOH, for example, so you parked strokes in a bed with a paracetamol and came back to them in the morning. No primary PCIs. Nobody really cared about AKI (not even nephrologists, it was beneath us ). Much more team working, much more downtime - patients used to hang around waiting for social services for months, so half our patients had nothing wrong with them, leading to very fast rounds. I used to do the killer sudoku in the mess after lunch as a PRHO, my current F1 eats her sandwich at the ward computer while she prints the phleb labels. Much more “fun stuff” at a junior stage - I was doing art lines and chest drains unsupervised as an F2 and did solo ward rounds most days, our current juniors mostly do admin interspersed with the occasional cannula. Obviously the current system is better for patients, but it looks relentlessly soul-destroying for the juniors.

ANd where have my paragraphs gone!

+I find talk about resilience difficult, as it tends to point blames onto individuals, for the failure of a system. Regardless, no amount of resilience of HCP will solve the problems within the NHS.*

In some ways the concept of resilience seems to have been used to justify the abuse of junior doctors and made their stress a personal failure.

But if you look at it objectively, the conditions that people are describing are untenable.

1. relentless hours with no protected breaks for bodily needs
2. understaffing and launching from crisis to crisis
3. fear of litigation if things go wrong, with what sounds like crap medicolegal support
4. high public expectation and a culture whereby death must be “fought”
5. social isolation from family and spouses and children due to working hours and additional stress with long commutes
6. the occasional but unforgettable clinical horrors that non medics won’t “get” (and shouldn’t be told).

It seems unfair to expose people to those stressors and then blame them for not coping.

I should add that I think I’m fairly resilient and there were no major issues with my time as a junior doctor (not in the U.K.) BUT, like everyone, there have been times over those years when I’ve been vulnerable. The difference is that I was supported. I’ve never had to work when sick and when I had a complicated first pregnancy I was able to finish work early. My then boss sent a card and present when the baby was born.

It seems unfair to expose people to those stressors and then blame them for not coping.

But that’s the reality so it’s a case of prospective candidates saying that’s the way it is, that’s the system/environment I will be working in. This will mean having a completely shit existence for a good 15 years. This will mean at least 15 years of complete sacrifice. Is this something I’m up for. Is this something I could realistically cope with. Yes/no. Like any other job that requires sacrifice to get ahead, it’s a choice, medicine does not have the monopoly.

My kids looked at these factors and would rather run a mile even though at least one would have ramped it in (and another who probably would have gained entrance has disabilities that would not be able to cope with the physical demands). Others are willing to suck it up and get on with it. Others do it then bitch at the injustice and lack of accomodation.

But that’s the reality so it’s a case of prospective candidates saying that’s the way it is, that’s the system/environment I will be working in. This will mean having a completely shit existence for a good 15 years. This will mean at least 15 years of complete sacrifice. Is this something I’m up for. Is this something I could realistically cope with. Yes/no. Like any other job that requires sacrifice to get ahead, it’s a choice, medicine does not have the monopoly.

I don’t think anyone, anywhere would say it isn’t hard and sometimes terribly hard. But the descriptions of people having to work through sickness, miscarriages and hours of unpaid work aren’t typical of where I trained. Saying that all medical training is shit so those in the NHS just need to push through is unfair to those trainees.

Thank you no longer surprised

Yes yes to this the occasional but unforgettable clinical horrors that non medics won’t “get” (and shouldn’t be told

I have seen genuine horrors at work, which I won't share here due to patient confidentiality. No debrief ever, nor any offer of psychological support.

There should be a system in place to manage this.

Sashkin that's interesting to hear. I knew it has changed a lot but don't have the same insight as you.

Hopping pavlova if you had read the thread, you will see that I had talked about this. Young people aren't going into medicine knowing about the reality of their career. The NHS has also changed rapidly in recent years, meaning that current medicine graduates signed up to something quite different to what they are entering now.

Nearlyalmost50

Absolutely. Everyone wants to compare themselves with Professors. Well, first, maybe 1 in 10 academics make Professor and another 1 in 10 make Principal Lecturer/Reader. The other 8 max out at Senior Lecturer, which depending on whether it's an old or new University pays something between about £55k or £49k at the top increment. Second, Professors are on individual salaries but these can start as low as £55k and only the super-superstars (think Nobel Prize winners) get much above £100k.

Like any other job that requires sacrifice to get ahead, it’s a choice, medicine does not have the monopoly. My kids looked at these factors and would rather run a mile even though at least one would have ramped it in

Hence the looming workforce crisis - not great for any of our futures.

Academia is very poorly paid with little stability and job security in this country. It's such a shame.

Thing about Academia nowadays is that you're lucky to even have a permanent job at 30-35. And if you get that it's off the back of UG, Masters, PhD and probably two crappily paid Post Docs, probably in another continent. Starting salaries are low - 30ish.

Lots of people I know got sick of bouncing from one shit contract to another and gave up.

I’ve had two good friends over the years who have broken down and said to me they can’t do it anymore and are going private. It wasn’t why they got into it, they felt ashamed and devastated to be turning their backs on their patients etc etc but why should our medical professionals get half the pay and do double the hours without so much as a bit of public appreciation. It breaks my heart to think of the relentless time and energy that our doctors and nurses and paramedics put into their jobs, and get less money than bloody train drivers! Don’t be a martyr OP.

Laurie god yes academia is definitely not a pay structure to aspire to! Nobody who’s worked in research would want to permanently jump ship that way. Medical academics have a different payscale though so not quite as bad. But I’ve seen the organisational demands and it looks very precarious even for established academics (successful courses shut down etc).

NC.

I’ve worked in the NHS for 20 years. 10 at consultant level (I went through the ranks very quickly).

So many valid points raised by pp and I could say so much.

Firstly I’m not convinced that on many levels a career choice of medicine isnt any worse than a long list of other ‘well paid’ careers. I know other people on 6 figures who aren’t medical; they travel, work evening and weekends, easily work 60-70+ /week. Most of them have an OH who ‘keeps the home fires burning’ either by having a more flexible/less well paid/part time job or by being a SAHP. Medicine is not family friendly, esp if you are female and the main breadwinner.

The pay is ok. The conditions are not. These are the things that push me over the edge, on a daily basis.

Never having a computer that works, but having to discover this by logging into 5 in a row to find one that does work.
Having to pay £600 for a car park permit with no guarantee of a space.
Having no staff toilet and having to wander around the hospital to find a toilet that isn’t blocked and doesn’t have a long queue.
Having to have a phone to work, but the hospital not paying for or contributing to my phone bill.
Having to beg colleagues to do tests that are urgent.
Having to explain to patients that the test they want isn’t urgent and they have to wait (cue lots of abuse)
Having patients that speak no english. It uses up SO MUCH time.
Having to use a keyboard that has keys missing.
Having to argue with HR and payroll to get paid correctly (at least a twice yearly affair).
Having to fight for cubicle space to see patients, because there simply isn’t enough space.
Having to clean cubicles before I use them.
Being spat at.
There are lots more, but it’s mostly simple stuff.

20 years ago I was invited to my bosses house. It would be worth over £2m now. His wife was a PT nurse and his kids at private school. 2 nice holidays a year. Few doctors live like that these days.

I hate my job. I’ve mitigated this by being a locum, working 2-3 days a week, no weekends, no oncalls and I take 10+ weeks/yr holiday. It’s still hideous. Patients suck the life out of you, which in itself is just about manageable. It’s all the other shit on top that just makes it impossible. Someday I just won’t go back. And no, I don’t feel guilty.

Absolutely. Everyone wants to compare themselves with Professors. Well, first, maybe 1 in 10 academics make Professor and another 1 in 10 make Principal Lecturer/Reader. The other 8 max out at Senior Lecturer

Those are the ones with permanent jobs- some god awful calculation was done to show that up to 95% of PhD in STEM subjects don't get permanent academic jobs- some is jumping ship but a lot are lack of opportunity.

I totally agree academic pay or organizational style is nothing to aspire to, it is also beset by the top down admin culture of utter time wasting and over management - however, I think there are pockets of better practice e.g. if you have a disability or family crisis, if you were in my dep't you would be well taken care of, and workload can be reduced a bit if you are prepared to accept you are not a superstar, once you are permanent anyway.

I just think the reward of so many professional jobs, perhaps described best as a vocation or just great job satisfaction, is gone- same in teaching, academia, social work, public health and so on. Everyone is overworked, overmonitored and the demands of the job are beyond what your average (if very clever) person can cope with. My parents were teachers and they came home at 3.30/4 every day, did possibly an hour in the evening, but had a lot of time for relaxing. Holidays also taken. There are some old guard professors and consultants working this model, but pretty much no-one in the lower paygrades (90%). It is a huge shame as these jobs were valuable as well-paid (at the time) but also highly satisfying in terms of personal and social value which many people do want in a job.

If you don't advise someone to do medicine, what do you advise them to do? IT? The City? HR? Sounds far duller than medicine to me which is why there is still an over-supply at the entrance level, with people leaving in droves or working p/t when the truth of their working conditions is realised.

I am a non medic but have worked in the NHS as a social worker. YANBU and it’s very upsetting to read about how skilled trainee doctors and indeed, consultants, are treated. The discussion about money has sidetracked things slightly. The money is one issue but the working conditions are shocking in some NHS trusts. Like some have said, I cannot see how the pay makes up for the poor working conditions, given the amount of time you spend training and working.

I have a doctor friend (orthopaedic consultant) who is exceptionally intelligent and compassionate. She has recently left one NHS trust and described a culture of bullying of women, especially ethnic minorities. Unfortunately, this is not the first time she has been pushed out by bullying senior management. She said she is re-thinking her entire career.

I’m a doctor (NHS, hospital based). I like my job, it’s secure and well paid and I feel like I’m doing something worthwhile with my life. It can be stressful and the hours are a bit shit but I don’t think I have it any worse than my friends who are on similar incomes in other professions (solicitors, finance/banking etc.).

YANBU to be unhappy but YABU to assume it’s the same for everyone.

When the poster above says;
"One of the reasons why medical school grads don’t, on average, go into the city (or don’t do as well when they go) is because they often try to make the move from a point of failure. Remember, no company wants a loser. And we would be asking a lot of questions as to why a supposedly talented medical school grad chose not to go into medicine."

She isn't being "unkind" - she is giving you an insight into a world that is very different from the NHS- it's just honestly, not unkindness. When you make your comparisons to this world I think there's a lot that you don't see. There are very few mothers in that world.