Hospital Life One Year On: To Stay or To Leave?

[Arsenal123]

Hi all

I recently qualified in the medical field and work within the largest and busiest hospital in my vicinity. I trained here so I know many clinicians who I get on well with. However, recently due to low staff levels, increased demand, and inadequate funding, the job has really been grinding me down. My preceptorship was cut short and I was thrown in at the deep end. In order to work safely I had to work unpaid (find a second opinion after my shifts ended etc). I have had to train registrars before I have felt confident myself and I see them treated in the same poor way that I was.

To cut a long story short, the months post-qualification were a tough period and I am much more confident and experienced now.

A hospital where I previously did placement has offered me a job. It's a much smaller hospital and there are fewer chances of progression. It's also 4 days a week instead of 5 which suits me and my current position and intention to get back to physical health and start a family within the next 4 years (I've been burning the candle at both ends due to workload, study and commuting). I do have an enormous amount of debt from SLC and a career development loan but with careful budgeting I can clear this with 4 days a week work.

My conundrum is this: Do I go for the manageable workload, less responsibility, and ultimately perhaps make less of an impact? Or do I stay loyal to the hospital I trained at, where the current turnover of staff is plunging them into a crisis?

In my heart I know I can't work like I have been forever, but perhaps I am being rash and as more experience comes I will find it less draining and demanding?

I'd go for the quieter job, if You want to start a family so you need to look after yourself and you never know where it could lead, who you might meet along the way, you might find it more satisfying even if it's not so exciting. You will make an impact wherever you work, your work is important and you might find you have more time to spend with patients doing the job you obviously love doing. I was loyal to my teaching hospital but moved on, you can always keep in touch and join the social club, you could do locum if you miss it.

Do I go for the manageable workload, less responsibility, and ultimately perhaps make less of an impact?

If this will allow you to work in this career for longer then you will end up making more of an impact in your own way

Or do I stay loyal to the hospital I trained at, where the current turnover of staff is plunging them into a crisis?

Why do you feel you owe them any loyalty, they have already torn up the terms of your preceptorship, something that was only set up and formalised a few years ago to ensure patient safety and to stop the ever increasing number of junior staff leaving before they even had a chance to find their feet. The NHS in its current form will not support you, you owe them nothing, do what makes YOU happy, you will be a better health professional for it, and you will serve your patients better as a result...this is presumably why you choose the career in the first place.

But perhaps I am being rash and as more experience comes I will find it less draining and demanding?

Yes and No, the stress of just doing your basic job will become less as your confidence increases, but the destruction of your moral will only get worse as time goes by, when shift work or extra hours impact on your health more and more over time, or you are unfortunate and experience the bully culture that is NHS complaints handling, or there total disregard for your career development despite all their empty promises.

I think that they key think sticks out to me is your intention 'to get back to health' - if it is that bad without a shadow of a doubt move. If you lose your health you will not be making any kind of impact anywhere.

I work with doctors (but I am not one myself) - they are studying for a PhD and openly state that they are using this time to recover their work life balance whilst still doing part time (1 day a week) clinical shifts. Maybe that is an option? They get to keep the same salary as a full time medic so money wouldn't necessarily be an issue? Some even use the extra free time to study to get fellowship of their appropriate Royal College. From what I can tell it seems to be a good stop on a path to consultant.

As someone who nearly burnt out in a completely different field I can tell you - your best will never quite be enough I am afraid. It is like a treadmill - as soon as you get something under control, you will be given even more work. Sometimes you need to step back and take note of what everyone else is doing to get ahead. Ultimately what I have learnt is that the more I respect myself and my time, the more other people respect me. The nicer hospital sounds like a good start.

Thank you for the advice.

In terms of my health: the procedures I do take their toll on my wrist, shoulder, neck and back. It's not heavy work but requires fixed positions or awkward manoeuvres. I always help my assistants with manual handling too which doesn't help as many of our patients have a high BMI or reduced mobility.

I have little time to attend the gym or eat right as I am studying as soon as I get home to try to fill any gaps or learnt the latest best practice advice. I don't eat well, and stress tempts me to overeat junk. I snack while reading and have put on weight.

My partner is actually the year below me in the same specialty and will qualify just as I leave. I feel bad as they haven't been able to cover as much training as me due to changes within department meaning junior staff are required to cover more actual lists and have fewer training sessions.

I hate to say it but I am so focused on (or consumed by) my role that had my partner not been in a similar roll I doubt I could have held down a relationship. I feel very lucky as loneliness would have killed my passion for my work completely as I know I would not be happy living like this if I didn't have someone to come home to.

Many juniors have previously left as soon as they have qualified. Other staff members have been somewhat vocal in their opinions of them being deceitful or damaging to the department. These staff can cover twice the amount of work as I can. They have 20 + years experience but I feel they probably get annoyed at my productivity compared to theirs.

While some juniors have openly said they have left to pursue more money privately, many have been fed up with conditions and moved to smaller hospitals. I have provided a year's service and will be taking a paycut in the new role. Once I find my feet I could potentially go back to full time if conditions are good.

I just feel guilty somehow still.

You really have to stop feeling guilty and start looking after number one!

I was funded through training (AHP) by my trust, but treated diabolically along the way.

I have now gone part time (on the bank) as shift work was taking a huge toll on my health.

I feel vindicated every time one of my colleagues drops dead (another one this week, still working age, not booked off sick afaik), that really is the bottom line, you will work yourself into an early grave unless you take back control of your work life balance. You need to start thinking about the here and know, not how it is always somehow going to be better in the future.

The health service will continue treating it's staff as it currently is, as long as we all let them!

Be careful of building up a martyr complex. "I love the job but it's killing me, I feel so guilty I couldn't possibly take another route where I would be of more use because I would be able to devote my full attention to it rather than constantly fighting fires and working beyond my physical and mental capacity because I feel I am doing more here"

You aren't. That's just the adrenaline talking from successfully getting through the day without making a serious error. Look at the high turnover of staff. It's like that for a reason, because the conditions aren't conducive for anyone staying there long term. You do work you don't get paid for because you and your patients to be safe. If you took a slower pace you would have the time to ensure patient safety within your working hours and actually learn more because you have the time to address more.
It's already impacting your health and with little time to do any remedial physiotherapy and exercise to help stop permanent damage, you risk ending your career in a few short years, or months if you are really unlucky because you can no longer physically do it.

*Because you want

They won’t look after YOU though, that much is clear, you need to exercise some self care here. If anyone asks hold your head up high and say that you are dissatisfied with staffing safety.

Thank you for your advice, opinions and experiences. It's becoming clearer what I must do.