To be or not to be a doctor?

[MrsDThaskala]

DD said today that she’s been in thinking about becoming a doctor. Not sure what area, not sure what kind, just said it out of the blue today. I mean she’s doing well in her sciences. But quite honestly, the doctors I know, GP and hospital doctors, and a surgeon always say how stressed they are, how much pressure hospitals are under, how hard medical school is….etc. not necessarily for my DD but what do you think? With all that we know about the NHS right now, what’s your take on becoming a doctor?

I’m with @Bluechoc !

I’m guessing they’re in London or Scotland then?

I am glad my three didn’t choose Medicine. I did 56h shifts so the current hours are better. But everything else is worse. Esp the amount of time doing non-clinical work.

As my career comes to an end, I am glad my kids aren’t starting in Medicine. Hats off to those who still apply though.

Oh my bad mumsneedwine you were talking about your DD and her friend who had very, very obviously been given bad advice about mat leave.

London has more than one deanery.

London, overwhelmingly.

Bluechoc indeed.

I am coming into the latter stages of my career. I would be so sad and worried if my child followed in my shoes, because they would either have to enter the toxic workplace that is the NHS, or they would be living in a different country to me.

But it isn’t medicine, and it wasn’t always the NHS.

I was one of the last cohorts to work unbroken nights and weekends (so turn up to work Friday 8am and leave Monday evening once everything had been done). I then did the usual chopping and changing between weeks of nights and weeks of days.

It was physically and emotionally tough stuff ( including the whole finishing a day on take at 10, studying until 3 for postgraduate exams and getting up at 6 to go back to work), but I loved it. I felt camaraderie and kinship with my colleagues. I felt I made a difference in my own way. I saved a few lives and solved a few exciting puzzles. I even enjoyed being the med reg on call.

I also enjoyed the beginning of my consultant career. I was able to build services, through which I was able to serve my community more than one patient at a time. I took on a training role, and felt I was able to help those that follow me by really standing up and demanding decent quality training for them.

Incrementally, I found I was fighting the system more and more to make what I felt was right happen. This has hugely accelerated over the last 15 years. I find myself battling more and more and giving of myself more and more, not to make sure my patients have the standard of care that I aspire to give, but to try to stop things falling to a standard of care that I will not accept.

Nowadays, it often feels like I am the only one who gives a damn, but I know that’s not true. Everybody else is fighting and fighting, and holding on by their fingernails.

It is scary.

In my first few years as a doctor, we had to Tetris patients in and out of cubicles in A&E - so they were in a cubicle to be assessed, and then moved into the corridor once this was done. Money was invested, and this disappeared. Yes we had the 4hr target to deal with, but we could give people their dignity. The bad old days haven’t just come back, but they look like the rosy days of Arcadia now! Every space that could have been converted into a room or a bay has been converted. There are trusts that have advertised for consultants to be responsible for the care of corridor patients. Patients receiving their care in corridors is a real thing.

I was always tough, calm, adaptable and optimistic. I just don’t know where the hope comes from anymore. The whole thing makes me want to weep.

I wouldn’t want my child or anybody I cared about to work in this environment.

Maybe things will be better in the future, but the intervening period is going to be horrible.

Redundancy?!

Why the detailed autobiography?!

I have been a FT NHS hospital consultant for nearly 30 years. I have never called in sick and have done a pretty good job to date. I still enjoy my job. And, perhaps controversially, I am fine with my pay. Well I enjoy the clinical bits at least when I’m allowed to.

One of my main issues is that our HR, IT and estates are not fit for purpose. It is astonishing how poor the support services are in the trust where I work. And these lead to inefficiency. For example, on some days of the week we have lots of staff in the building, but not enough rooms to conduct clinics in. Ridiculous.

But at least I have had many years of being allowed to see patients. Without needing to do endless non-clinical tasks which seem to be designed to tick various boxes so that doctors can move onto the next stage of training.

From my experience, the best resident doctors are not the ones who score most highly on the various parameters. They are the ones with excellent communication skills, empathy, ability to multitask and be calm, clear-thinking and organised. I am not sure that all these arbitrary learning objectives and audits and leadership courses are what counts in the end.

Working in the NHS is not what it was. For any staff. And the new residents won’t be getting the same pension that I will. So the ‘perks’ are perhaps no longer as appealing as they once were.

I have some phenomenal residents. But I do worry about how their future will look.

Yes, I agree with all of this. My training was intense and exhausting. But there was camaraderie and it felt like we were making a difference.

Obviously, I do work hard and try to make a difference still. But it does feel like we are fighting the system. When I look back at the service we offered patients in the 90s, it is shockingly different to how we can support patients now.

Totally agree with you both @FallingIsLearning and @GrowAway
I retired a couple of years ago so am also of the age to have done 80+ hour weekends and 1:3s with prospective cover. Whilst obviously I wouldn't advocate for a return to those hours the baby has well and truly been thrown out with the bath water and there were a lot of positives about being a doctor in those days. I'd say the last decade of my career was the worst by a long way. Up until then I was very happy most of the time. But I felt less valued and less able to have a positive impact on my last day as a Consultant than I did on my first day as a House Officer. When I said that to a table full of my friends from medical school at a recent get together, every single one of them agreed with me. And it wasn't really anything to do with pay that made us all so unhappy either.

There are many jobs where you are not fully qualified until 25 plus - eg Chartered Engineer. I’m sure no one wants high rise buildings to fail. Also the whole of the self employed economy is way more dicey than being a doctor. Often long hours and no pension unless you pay in. No employer. Some jobs such as self employed architects have the long training and stress of getting work and running a business.

It seems lots of people have made a mistake being a doctor. There are other jobs but a consultant on a minimum of £105,000 is pretty good when compared to many consultant engineers whose training is just as long.

My neighbour’s daughter is a doctor. She is currently training to be an eye doctor and she is loving every minute of it.

She wanted to be a doctor and nothing else. She worked extremely hard at school and got four A levels at grade A. She’s extremely charismatic as well as clever. She told me that the most useful attribute she has is resilience.

The money is not an issue.

It isn’t the long hours. Or seeing the occasional traumatising thing. Or even the regular verbal and sometimes physical abuse from the public. As the poster below you says, that’s what resilience is for.

I don’t think most people who go into medicine (or nursing or physio or any AHP role have gone into it with a mistaken purpose). Most prospective medics could have their choice of a lot of different careers. But we choose medicine because we want to help and we want to make a difference. We want to solve people’s problems.

The issue is that it is so very difficult nowadays to do this in the system that we have to work in. I realise that we tend to be driven perfectionists, but it isn’t a problem that you cannot deliver perfection nowadays. It is that you have to fight so hard to look after people in a fashion that you would not be ashamed of.

I have always told my juniors and then my team that if you are guided by “what would I want for my child/my spouse/my parent/my grandmother” in this situation, and then adjust to make sure the patient’s wishes are preserved, then you won’t go too far wrong.

I would not want my Grandmother to be cared for in a corridor. It is mortifying and distressing to have to go and try to examine somebody properly in a corridor, in full view of any bystander.

This isn’t the case of rose-tinted glasses. We have had transformative advances through my career - stroke medicine, biologic therapies, immunotherapy for cancer, gene editing - to name a few in Medicine alone. But the basic care that we can deliver on the NHS is worse.

There is still joy that keeps me going into work - the occasional life saving decision, that rare diagnosis made on clinical grounds, seeing someone whose quality of life has been transformed by your action, seeing something unlock and understanding dawn when you are training someone, standing up for a colleague, introducing a simple change that decimates a waiting list in a safe and clinically appropriate fashion. None of these things have anything to do with money. They are all about feeling you have made a positive difference.

The stress and unhappiness comes from the tension between what you know is right and what the system is pushing through, and you feeling that you have to push against it. This happens multiple times a day. Not quite with every patient, but sometimes it feels like it!

Maybe we all need to let go of that last shred of idealism, and we’d be a lot happier going with the flow. But where is the satisfaction in delivering sub-standard care?

@FallingIsLearning I found your comment about ‘feeling part of a team’ v sad for current young doctors. Because they never do. Constantly rotating so are often made to feel like they are new. Dealing with an alphabet soup of other jobs and if lose training opportunities because they take them (being permanent) they are just told to ‘be kind’. Being part of a team would be so welcome I think. And make things feel nicer.

Thank you for trying. DD has had some amazingly supportive consultants. She says the coffees are always v welcome 😊

If posters don’t want to listen to us ‘mummies’ maybe listen to the wise experienced doctors who are telling you how much of a mess things are.

And no idea why people who know nothing about being a young doctor seem to keep popping up on these threads. I always think they probably applied for medicine and didn’t get in, and that chip is still v firmly stuck on that shoulder 😂. I don’t bother even reading threads about lawyers.

Visited DDs new hospital yesterday. It looks like Seattle Grace !!! V strange for an NHS hospital.

I think jobs where your actions and decisions can directly lead to life or death, have a unique nature of stress and responsibility that perhaps only people in the industries can understand. Like being a pilot. I think that needs to be factored in when comparing being a doctor to roles like lawyers. My lawyer friends and family agree.

@Auchencar I’m never sure if you mean to be rude or it’s just you. London deaneries can be huge, and long commutes or moving are required. I’ve met many senior staff dealing with training in each Deanery and they pretty much all feel
its a stupid system currently. As some
one said earlier, it’s like they look at your home address and then find the hospital furthest away. But you obviously know better, being so involved in doctor education.

Outside London, many deaneries are massive, as you must know being an expert. KSS is Margate to Southampton. Moving is necessary, unless you own a helicopter. It’s a fact that most doctors have to move v often when they rotate, unless they are v lucky and never work at a DGH (not sure which specialty allows that).

Doctors are treated badly. It might be a vocation, but that doesn’t pay the rent. A 22% pay cut is obscene. Pensions are expensive and student loans too. Exam fees, GMC, liability etc mean take home can be £1,600 for an F1. But hey, one day, they might get to be a consultant, so that will pay the rent. Or be unemployed like lots will be in 2 months time. How v v sad that people won’t fight for these young people who want to give to the NHS.

Im off to work now. To run an A level revision clinic. Several of my students are prospective medics, and even knowing all the bad stuff, still want to try. Admittedly they are looking at it as an international career these days.

@GrowAway thank you for trying to explain why being a doctor is not a usual job. Strangely it always seems to be lawyers who come one these threads and claim a bit of ‘whataboutary’. Or people who saw a doctor once so know all about the job (as a teacher this happens a lot 😂).

Thank you for being a great senior to your residents. I know from my own DD how much it’s always appreciated.

mumsneedwine I pointed out that London deaneries were not small only because you said that my DCs and their friends must be at ‘vv small London deaneries’.

Doctors in London choose their homes strategically in order not to have to move each time they rotate, if possible. I can say with confidence that none seem to have moved house purely because of their rotation. Of course I don’t track each friend but my kids are quite chatty. I don’t hear anything like the amount of moaning from them/ their friends as I do on these threads on MN. Certainly a number of concerns about the state of the NHS, almost exactly as described by the consultant above, but none of the endless griping about rotations, pay or training positions. They all seem to have a vastly more positive attitude than the young people that you know.

We have an even number of medics and lawyers in our family and I have to say that the medics don’t try to make out that their profession is inherently superior. Which is good because they’d be squished by the lawyers (who do work which is of great consequence socially).

I’m truly saddened with what has happened/is happening to the medical profession. It’s a sad world when healthcare isn’t valued.
The nhs is all about being free to all at point of need. I’m beginning to wonder if patients had to pay, and truly saw the costs of treatment and the emotional effects on the medics( I include all hcp in this term) of some of the things we deal with, whether things would improve. It isn’t about earnings, it’s about not being seen as humans doing a vocation.
Last week I was dealing with a really nasty motorcycle accident, young woman not with a helmet. She’s so lucky to have survived, she will recover. We spent over 10hrs in surgery mending her face, eye socket, teeth.
Her mother said she’d sue if she’s left with scarring.
That’s why I don’t want to do this job any more

For the hard of understanding

And this