Intended for healthcare professionals


Starting a long journey

BMJ 2014; 349 doi: (Published 20 August 2014) Cite this as: BMJ 2014;349:g5200
  1. Tom Moberly, editor, BMJ Careers
  1. tmoberly{at}

Many doctors will vividly remember their first day working as a medical practitioner. These same doctors may now find themselves struggling to reconcile the optimism they felt on that day with their less benign feelings towards the current working environment in the health service. These contrasting perspectives are considered in two articles in this week’s BMJ Careers.

Will Sapwell shares his experiences from his first week working as a doctor ( “The biggest learning point is that there is still so much to learn,” he says. Sapwell discusses his fears (“Despite being surrounded by colleagues, I felt strangely alone”) and the gaps he has found between his expectations and the reality of life working as a doctor. He also reflects on the value of support from colleagues who “draw the knowledge and practical competence out of you by showing you that you’ve actually earned the right to be a doctor.”

We also report on a series of upcoming events aimed at tackling some of the difficult experiences among those who have spent years working in the NHS ( Clare Gerada, former chair of the Royal College of General Practitioners, writes of a “growing culture of fear and suspicion that pervades our NHS.” The NHS constitution makes clear pledges on staff wellbeing, but these are not being upheld, she says.

Abi Rimmer looks at what an independent Scotland might mean for doctors and examines the concerns being raised about the future of medical education, recruitment, and regulation (

Finally, Paula Chan may bring some reason for optimism as she explains the implications of a European Court ruling from earlier this year ( By recognising that workers should be entitled to their normal pay when on leave, the ruling opens the door to claims for back pay from those whose previous holiday pay ignored regular overtime payments.