Medical students’ views on the new junior doctor contract
BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i282 (Published 20 January 2016) Cite this as: BMJ 2016;352:i282All rapid responses
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It is difficult to know what to think as a medical student at this time of uncertainty. On the one hand we still have our unmarked desire and motivation to study medicine and become the doctors of the future. Our sense of vocation is still strong; one of the main reasons the vast majority of medical students choose to study medicine is the aspiration to help people and care for them. Yet we have recently been introduced to a potential new contract that if imposed will make the care delivered to patients from August of this year unsafe.
Nobody wants to care for patients in an unsafe system, both from a personal perspective and from a medico-legal perspective. I am not sure how strongly 'I had been working long shifts and was tired' would hold up in front of the GMC. Therefore it is no surprise the application rate for UK doctors to work overseas has increased substantially in recent times. A BMA survey in July 2015 showed 46% of doctors reported morale as being low or very low [1], this statistic is if anything undervalued now as recent suggestion of imposition had thrashed junior doctor morale. I for the first time ever am considering leaving the UK to train elsewhere once I have graduated, this cannot be something the government is aiming for after investing so much in training me for the last 4 years.
The JDC of the BMA recognise the significant impact the new contract will have on medical students. Having listened to the BMA JDC chair Johann Malawana speak publicly on a number of occasions (most recently at the Association of Surgeons in Training conference less than two weeks ago at the time of writing) it is clear we are #oneprofession and that when he is talking about the consequences of imposing a new contract, that he clearly is not just referring to current junior doctors. To me and so many of my colleagues the case is simple. The government want to create a 7 day NHS. Emergency services in the UK are 24 hours a day, 7 days a week, 365 days a year. If the government want to spread non-urgent care over 7 days, then they have to be prepared to pay for more doctors and NHS staff in order to provide this. The system as we know is currently is stretched to its limits and will not be able to sustain 7 day non urgent care without significant financial assistance.
I am frequently told by my senior colleagues 'not to worry' and that 'it will all be sorted by the time you get there'. However I fear this is by no means a short term dispute and will continue for years to come.
References: [1] BMA. BMA quarterly tracker survey. 2015. Available at: http://www.bma.org.uk/working-for-change/policy-and-lobbying/training-an....
Competing interests: No competing interests
The junior doctor contract debate rages on, with no apparent end in sight. Several years of negotiation between the BMA and the Department of health (DoH) came to an abrupt halt at the end of 2015 when the two parties were unable to agree on the terms of the new contract. The Department of health has threatened to impose its plans for the new contract without the agreement of junior doctors, but this plan has been widely criticised as both unfair for doctors and unsafe for patients. The threat of imposition culminated in the first junior doctors strike since 1975 but this and months of subsequent intermediation by Advisory, Conciliation and Arbitration Service (ACAS) has failed to advance the negotiations further. [1,2]
The strength of feeling of junior doctors has been made clear and needs little elaboration; the recent BMA ballot of its members resulted in 98% of respondents voting in favour of industrial action including strike action [3], and other surveys have found that up to 71% of Junior doctors are prepared to leave the NHS if the DoH imposes its contract [4].
Most of the national discussion has focused on current junior doctors. More recently however, concerns have been raised over the effect of the contract issues on the future recruitment of doctors to the NHS. Siddiqui et al highlighted the fact that medical students are the sole group that will undertake the entirety of their training under the proposed contracts, and that recent weeks have seen a surge in the number of seminars explaining alternative careers that medical students may want to pursue [5]. Similarly The Student Room, a website that houses the largest online community of students in the UK, recently surveyed almost 1,550 students and reported that 37% of individuals who had once hoped to study medicine have now said they no longer wish to as a result of the health secretary’s proposed contract changes [6].
Medical students are the junior doctors of tomorrow and stand to work for more years under the proposed contract than current junior doctors. Many have attempted to show their discontent and solidarity with their junior doctor colleagues over recent months; they have marched in protest, have reinforced picket lines and over 7000 have signed a BMA pledge in support of their junior doctor colleagues (7). Expression of these views has remained principally anecdotal; in order to quantify the strength of some of these views we surveyed 130 clinical medical students (those within three years of qualification) in one London medical school after the recent breakdown of ACAS mediated negotiations.
The results of our survey confirm the overwhelming support of medical students for their junior doctor colleagues. 94% do not support the health secretary’s contract proposals, 95% have little or no faith in his ability to lead the NHS, and an overwhelming 92% support junior doctor strike action. Whilst these results confirm positions that might be expected, little has previously been said about the effect of these issues on medical student career intentions. Of the students we surveyed, 89% said that they felt demoralized about their future careers in the NHS because of the contract issues and 91% felt that the NHS will struggle to retain staff if the proposed contract is imposed.
We also asked students what they intended to do if the health secretary’s contract proposals are imposed. Whilst 29% said that their career intentions wouldn’t change, 35% reported that they would not work in the NHS at all, either moving to work abroad or leaving the medical profession altogether, while a further 14% said they would leave the NHS after foundation training (the first two years after qualification). 1% said that they planned to leave medical school before qualification. These are worrying statistics as they suggest that up to half of UK medical students would leave the NHS within two years of graduation, representing a catastrophic threat to the long term viability of the junior doctor workforce. The remaining 21% of respondents stated that whilst they would still intend to work in the NHS, imposition of the proposed contract would affect their choice of specialty. This suggests that in addition to a dramatic loss of UK trained medical students, imposition of the contract would push future junior doctors away from the specialties most affected such as accident and emergency medicine; those which are already experiencing severe shortages of applicants.
The junior doctor contract dispute has caused discouragement and anxiety amongst medical students and is a deeply worrying time for all. The strength of opinion amongst medical students is clear and our results support the notion that the imposition of an unfair and unsafe Junior Doctor contract will force a significant proportion of medical students to work outside the NHS after graduation. This carries real weight when discussing the contract proposals as it provides a crucial insight into the future trajectory and viability of the NHS if the proposed changes are to be enforced. We hope by being the first to quantify the opinion of medical students, our results can be used to make a more informed decision in this critical debate.
References:
1. Bagenal J, Moberly T, Godlee F. Problems with the new junior doctor contract. BMJ. 2015;351:h5077.
2. Farne H. More problems with the new junior doctor contract. Bmj. 2015;351:h5409.
3. BMA. Industrial action: juniors vote in favour: BMA; 2015[cited 2016 31/01/2016]. Available from: http://www.bma.org.uk/news-views-analysis/news/2015/novembwer/juniors-vo....
4. Campbell D. Junior doctors: 7 in 10 to leave NHS if Hunt pushes through new contract | Society | The Guardian [Internet]. Guardian News Paper. [cited 2016 Jan 31]. Available from: http://www.theguardian.com/society/2015/oct/20/junior-doctors-thousands-...
5. Medical students' views on the new junior doctor contract. Siddiqui et al BMJ. 2016 Jan 20;532:i282. doi: 10.1136/bmj.i282.
6. Aftab A. Over a third of students “no longer wish to study medicine” amid the junior doctors’ contract row, says poll | News | Student | The Independent [Internet]. The Independent Newspaper. [cited 2016 Jan 31]. Available from: http://www.independent.co.uk/student/news/over-a-third-of-students-no-lo...
7. BMA. Medical students stand firm with juniors 2016 [cited 2016 31/01/2016]. Available from: http://www.bma.org.uk/news-views-analysis/news/2016/january/medical-stud....
Competing interests: No competing interests
I was interested to read the points made about the effect of the junior contract proposed changes on medical students. While I agree that these changes will have a profound impact on doctors-to-be, I do believe that much of the ill-effect of the changes will be compounded by an exodus of talented young graduating doctors.
Medicine is a fantastic career, and it is vitally important to remember this. Even as a busy medical registrar, my on-calls are stimulating and rewarding. My day job, cardiology, has more effective treatments than ever and my rota includes roughly half protected training time in the cath or echo lab.
Yes - the new contract is unsafe. It's also unfair. But despite these threats, we need to remember what is still fulfilling and challenging about the job. More "senior" juniors also need to remember to keep shouting about this.
Competing interests: No competing interests
Re: Medical students’ views on the new junior doctor contract
Undertaking a medical degree has traditionally been a vocational choice for students who embark on the 6 year journey to become a doctor. However more recently it feels like this custom has been challenged. Not long ago I received an email from the head of the Medical School titled “Thoughts on the new Junior Doctors Contract” – the second of such correspondence we have had in the past month.
Reading the letter, it becomes clear there is a heartfelt concern regarding the proposed contract imposition, and the effect this will have (if not already) on student moral at the medical school. Indeed his concern is not ill-founded. The question of “where would you like to work” is as times less frequently greeted with a list of deaneries than it is countries. Arguably more worrying is the growing movement to leave the healthcare profession altogether. Medically educated graduates are highly sought after from other industry sectors – many of whom are offering significantly higher salary packages and an improved lifestyle balance. Having spent seven years at University in two different fields, I have never witnessed such disenchantment about future career prospects. The presumption that going to medical school is a vocational choice is being challenged now more than ever.
Nevertheless, recent months have paradoxically made me more proud than ever to join the healthcare profession. The country has witnessed an unparalleled unanimity between thousands of doctors. Seeing patients in wards and on A&E, I am constantly reminded of the resolute support and gratitude from members of the public for what doctors do. I encourage other students and trainees to keep their heads held high, and regain confidence in that they are joining one of most dedicated and motivated workforce.
I believe the past couple of months have demonstrated the true strength of the NHS, and the unwavering determination to improve the lives of patients. That fundamentally, is why I joined medical school.
Competing interests: No competing interests