A practice that changed my patienceBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7273.1406 (Published 02 December 2000) Cite this as: BMJ 2000;321:1406
EDITOR—As a busy consultant paediatrician at a district general hospital on call for a bank holiday weekend I had cause to reflect on enjoyable times past and an uncertain future. The medical world is under permanent criticism by the media, much change has occurred in the structure of junior staffing, and my job is becoming much more just a job (as viewed by my employers) than the vocation I joined.
Despite their current media image and the open ended nature of their contracts, most NHS consultants provide a good service above their employment contracts. Current negotiation of a new contract means that a resident consultant on call is inevitable to provide senior care and maintain a safety net in the absence of sufficient middle grade staff.
On that weekend I started my on call duty at 9 am on Saturday and finished at 9 am on Tuesday, immediately followed by a normal busy Tuesday and home at 7 pm—a total continuous period of duty of 82 hours, to be followed by the remaining three days of a normal working week (106 hours in seven days). This work pattern is clearly illegal by junior doctor and European definitions. Although I am on call from home, even with a junior registrar (who can only do 24 hours at a stretch) I spent 23 of the 72 hours in the hospital (10 hours between 9 am and 5 pm, and 13 hours between 5 pm and 9 am) and took numerous phone calls for advice.
The following is a conservative estimate based on an average 10 hour working day and an on call frequency appropriate to each post. It does not take account of increased rates of on call to cover colleagues leave but does allow for my annual leave, not all of which has ever been taken.
I worked as a junior doctor for 13 years before applying to be appointed as a consultant in the NHS, clocking up a total of 57 552 hours, equivalent to an average working week of 92 hours. My 13 years of training were equivalent to 21.5 years on the basis of the current 56 hour maximum for juniors.
I have worked as a consultant for 12 years, a total of 42 228 hours. My total time after 25 years of service is 99 780 hours, equivalent to 38.7 years on the basis of a 56 hour working week and a 46 week working year (53 years on the basis of a 40 hour week).
I believe that I and most of my colleagues have done our bit for the NHS. I am willing to continue, but not if our professionalism continues to be ignored and certainly not if our lot is to be more back at the coal face than we are already. I wonder if many of my colleagues will be willing to work the above hours resident on call—I think not—and if we work a new contract of 40-48 hours we will be able to complete less than half of our current 9 am to 5 pm commitment (ratio of 9 am to 5 pm : 5 pm to 9 am=1:2).
The goodwill of consultants is being rapidly lost; most of us are looking to early retirement (and would be gone now if we had our entitlement on the basis of hours rather than years worked). This sea change in morale has occurred over the past five years, occasioned by government policies, managerial attitudes, and college rearrangements of junior training.