AIBU - Junior Doctor Rotas

[Allofme1]

Just wondering about how a Doctor's rota works in the NHS ?

I've heard of people asking for annual leave 9 weeks in advance and been given on-calls. How does that work?

Anybody work in the HR department care to shed some light on why rotas are late(supposed to be 6 weeks in advance)?
Why they don't give time for teaching in training posts ?
Does the person doing the rota acknowledge and understand the job descriptions of those he or she is putting on the rota?

I did the rota as a registrar - a thankless task. If you had an on call/night etc in your leave you needed to swap it if not you can’t have the leave. Service delivery was a nightmare without facilitating training etc. Unfortunately having children and being a junior doctor is hard and you need solid childcare - you can’t just not turn up.

As a consultant we organise the rota between us and it’s a lot easier

It's highly variable. PLENTY of people lie to get time off (often out of choice), that's all I'm gonna say.
Be selfish, be organised, and be nice to the secretaries.

I have been made to find a swap for my graduation many years ago and put on nights for my wedding (8 months notice and an acknowledgement email from rota coordinator at the time did not equate to any leave). Having said that, the profession does overall try to help, and doctors will swap whenever they can to cover colleagues they barely know - its what keeps the place afloat. I find now taking leave is a case of looking at the rota and picking the path of least resistance i.e. best staffed week as trying to get specific dates for friends' weddings etc is always a nightmare!

Yes it was a silly thing to do to swap into 28 days straight of 15hr 13 hr shifts. I didn't actually realise I'd done it until about 8 days into my swaps when I looked ahead in my diary and realised I didn't have a day off for aggggeeees. My boyfriend at the time was v nice and looked after me. I knew the patients inside out backwards by the end! (it was a nicu) and actually that made the shifts much easier.

How did it happen? It was in 2011, and doing swaps means you opt out of EWTD (this is still true nowadays I believe), and a junior doctor colleague was in charge of the rota and of swaps, so it wasn't policed. I think it's against the gold guide for training /bma advice too but once I realised it was too late to change it. The consultants must have realised but they didn't question it. Think they enjoyed the continuity!

My colleague had taken the busiest month of the rota off to go to Australia on parental leave for 4 weeks, plus we were short staffed plus I'd swapped so many other shifts for another holiday, it somehow ended up like this. Mind you my dad was unsympathetic as he used to work a 1 in 1 (every day and night) as a junior doctor in the 70s....!

I had to literally book 6 months in advance when I took my first house officer job for my wedding. That was 2003. The hours were horrible. A&are destroyed me and infact both me and my ex-h divorced because for 12 years we were passing ships at night as both of us were junior docs. It was tough. I have no savings as all my money went into a nanny to ensure we had robust , tight childcare:
Good luck. It’s tough but love being a GP

Sorry meant * A&E

But worse in the 70s when my dad did oncalls every weekend and literally ran a cottage hospital by himself just fresh out of med school

Sadly there are many inadequacies of the rota system eg inexperienced F1s being on consecutive long nights covering wards they have no experience of over weekends, difficulty of booking leave in next rotation as rota not known so important family events have to be missed. The result of this is that many young doctors are not even bothering to seek training posts after F2 and are instead going off travelling and finding out if other countries such as Australia are a better option than the NHS. The crisis can only get worse.

Without derailing the thread or getting into a who had it worse type conversation...I’m not sure doctors in the past had it worse despite hundred hour weeks and running large numbers of wards alone or doing 24 hour on calls. Take medicine-in 1980 a patient has a stroke, you see them, prescribe some aspirin and tuck them up in bed telling them in a few weeks we’ll see what recovery happens. Nowadays you need to get them urgently scanned and make a decision whether to give clot busting drugs-which can only be given under your direct supervision whilst also trying to manage the rest of your acute admissions all of which are far more complex to manage in this day and age due to the availability of treatment that wouldn’t have existed even 10 years ago. All the while with the lowest number of hospital beds for decades and a total lack of other resources. Yes you aren’t working for 24 hours but the acuity of the work in 12 is far far greater.

@veganmedic - that is a really good point. In general patients are living longer too, with multiple co-morbidities making very complex cases. I'm also acutely aware of potential lawsuits hanging over our heads and the GMC ofc ! So the job has really changed - you can't really compare fairly.

Your thread has me nostalgically remembering medical staffing suggesting DH 'fly back' to do a weekend oncall in the middle of our planned honeymoon

I’m sure there is software out there for this. It’s basically a bunch of rules and will tell you if your proposed swap is disallowed (eg you would be working a night and the next day without a sleep or over the EWTD). It seems a lot of manpower is spent on rota-ing and people are pretty dissatisfied.

rotamap.net/clwrota#
I used the above and it worked ok. Easier for people to look for others to swap with. Can’t remember if it implemented the rule about not having day after a night shift though.

I'll be starting F1 in August and i'm on some forums where junior doctors discuss issues about work/life.

Sending thoughts and prayers

You should have done dentistry.

IME anything involving rotas in the hospital was a shit show. You were very fortunate if you had a good and understanding team who would do swaps or cover.

Good luck OP!

I'm in Paediatrics it's normally a doctor doing the rota. I was that person in my first year in paeds training.
Reasons why the rota was late and had mistakes when I was doing it:

1. I wasn't trained in rotas and didn't really know what I was doing
2. I was doing the equivalent of 3 full time jobs. Paediatrics, the rota and I had specialty exams at the same time. My priorities in order were the job I was paid for (looking after sick children), then exams (my future job needs). The rota was last on my list and I was rubbish at it.

The good thing about doctor led rotas is that swaps are often more flexible and add long as they aren't scary unsafe you can usually break rules when you swap.

Yes some rotas are awful but some are fine and people pull together.
Join the F1 buddy group on Facebook and then when you start you'll get a buddy who will support you with the job and when people are being unreasonable to you.

OP, please concentrate on your finals. If you have concerns about how, or if, working as a doctor is for you (which is what is coming across), then speak to one of your consultants. If you’re a woman, then find a woman with children to talk to. No one will think you silly for doing so. I feel really sad when juniors grumble amongst themselves and never go up the medical chain - use the experience of those who have been through it. There are plenty of women who have fought hard to get where they are, and still have a partner and balanced children to show for it. You might be lucky and find they’re the ones who do the rota!

Jobs and rotas vary widely in satisfaction, but one thing is constant: you need cast iron childcare planning, and that falls to you. If you’re aiming to be a career grade doctor (ie not locum) then you will need to have a certain attitude of sorting out problems and not blaming others for your misfortune. It’s up to you to make the best of a bad situation. If you don’t like hearing this here, then you’ll like it even less when facing the Deanery and hearing it from them. Use the GMC satisfaction survey as a guide.

But, it’s a great job. Tiring, funny, soul-searching, and great camaraderie.

I actually feel a bit panicky reading this thread! So many awful memories of nightmare rotas. I didn't have children as a house officer but I did have them quite early in my career (career suicide apparently 🤔), others did understand that I couldn't stay late and couldn't cover absences as easily as others who didn't have kids.

Would you consider less than full time? Usually you're supernumerary so less rota/holiday considerations to work around. It does take longer to compete your training. Good luck anyway. Have you got a career plan? I tried to be a hospital doc but I couldn't make it work with family life and retrained part time as a GP, which I would definitely recommend.

Software costs a lot of money for the licence
Even then you end up doing it manually half the time.
I’ve only used one type software in my time that was worth the hassle (E roster/employee online)
An excel spreadsheet and a solid key system is usually what people go back to

I find this thread very depressing. Medicine is a great job with loads of good points. Yes rotas can be rubbish but if you work hard and get on well with your colleagues there is always a way round them. The people who have difficulty swapping are usually those who never help anyone else out.
Lots of jobs are difficult and with the EWTD medicine is no worse than a lot of them in terms of hours. Anything well paid such as finance and corporate law is actually much less regulated.
Focus on the plus points and enjoy the job ( there is lots to enjoy) and if you want to have children early in your career get on and do it. It's not career suicide but you do need good childcare. Over the years I've worked all sorts of nightmare rotas - the 1in 2 ( already illegal ) which became a 1 in 1 when someone was sick. Yes the acuity may have been different but lots of jobs that are now done by nurse practitioners/ward nurses like cannulas and iv antibiotics were done by house officers so it was never quiet and just 'tucking people in''
I agree with LadySpratt - take her advice but don't be one of the people prepared to moan before the job has even started.
There is plenty to like and the other options are not all perfect. Yes you can make more money in the city but the hours will be terrible and I for one don't want to manage other peoples money all day
Good Luck

@policeandthieves sorry have to disagree about swaps-they are a nightmare on the new contract and it’s nothing to do with how likely you are to have done swaps for other people. I’ve done some truly awful swaps to allow colleagues to get to exams or holidays or weddings but it’s been incredibly difficult to actually make them compliant within the rota. We are now monitored very closely so that we don’t break compliance rules making swaps extremely difficult regardless of how much people try and help each other out.

How about Scotland - they don't have the new contract. Are the Rotas better?

@Veganmedic I think it depends a bit where you work as well. I think my trust don't worry about a few swaps under the wire. Quick straw poll today of 5 juniors and no one had found difficulty with covering any major events. That said there was a situation a few years ago with a complete standoff between 2 FY2s with one almost deliberately taking days the other needed. So personality does come into it but I take your point if the management is very rigid its difficult.
All of which is crazy as when you get to be a consultant no one cares how many days or nights you work on the trot.

My observations as a nurse are that the junior doctor rota is done with no consideration whatsoever of the staff doing the rota, either whether they are on holiday or whether there are adequate rest breaks between shifts. Staff have to find a swap or cancel their plans.

There is also a huge amount of pressure to take extra on call shifts at short notice.

Life is shit for junior doctors.

Junior doctor rotas are shit. I had to swap into 14 night shifts in a row once to go on a holiday that was booked a year in advance. Sadly they have you over a barrel because refusing to work is putting patient safety at risk and therefore a GMC reportable offence.

You can locum after FY1 but you should consider the downsides of locuming as well and how it will affect sick pay/pension/appraisal/revalidation etc.

@Dm5678 I have worked in Scotland and England but before the contract in England changed. I find Scotland a little bit less pressured but that may be because of my speciality (anaesthetics) where consultants more often than not will be considerate doing the rota.

Currently not working in anaesthetics where 7+ days on the trot still happens though. But at least my current rota was out well in advance (they did forget to send it out to me though).

I think just knowing what weekends you have off well in advance is a massive +++ for wellbeing.