How to improve junior doctors’ morale and wellbeingBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1237 (Published 07 March 2016) Cite this as: BMJ 2016;352:i1237
Clare Gerada reflects on the difficulties and mental health issues facing junior doctors and offers some potential solutions for the health service to consider
Since health secretary Jeremy Hunt announced his intention to impose a new contract on junior doctors, we have seen a surge in calls and emails to the Practitioner Health Programme, a confidential service for doctors and dentists with mental health or addiction problems. This is against a background of a year on year increase in the number of referrals since the service opened in 2008.
Many of those coming to the service talk about feeling betrayed and bewildered by their loss of enthusiasm for a profession that they have worked so hard for so many years to enter (for most since their early teens). They say their desire to care for patients is being sapped by every working day.
This surge in young doctors coming to the service is part of a worrying change in the cohort of doctors we are seeing. The 2000th patient has just registered with the Practitioner Health Programme, and the average age of doctors presenting for treatment is getting younger and younger.
When the programme was launched in 2008, the average age of doctors coming to us was 44 years. It is now 37 years. At the start of the service the “typical” patient was an older man, often a general practitioner or psychiatrist with an alcohol problem.
Now over half of the doctors presenting are under 35 years old. Almost all of these younger doctors are in training, and they are presenting with depression, anxiety, and symptoms akin to post-traumatic stress disorder. The youngest patients have been qualified only a few months, and many are in the first few years of their career.
The language that these young doctors use would be better fitted to the battlefield than the hospital ward. They describe themselves as being “on the front line,” “surviving” another shift, and being “at war” with management.
They talk of feeling abandoned by the NHS, of working in an unforgiving environment where every error will lead to punishment and where every move is watched and recorded. They say that the fun has gone out of their profession and that they can no longer see a future for themselves in medicine.
Diagnosing the problem
The Academy of Medical Royal Colleges has been asked to undertake a review of why morale among junior doctors is so bad. It shouldn’t take long to determine what the problems are, and many of us have been articulating these problems for years.
For a start, young doctors (and those who are not so young) talk of the demoralising effects of:
A lack of team working and continuity of care
Terrible shifts designed by computers and not fit for humans to work
Rotations that take no account of a doctor’s personal circumstances
The inflexibility of run-through training
A fear of litigation and a blame culture that is endemic in the NHS.
Over the past decade, reviews undertaken by the government and arm’s length bodies have provided many possible ways of improving the wellbeing of the health service’s workforce. I have counted over 100 recommendations tackling the health of staff in various documents from 2009 to 2013. Something needs to be done. We need to turn the clock back, a little. For a start, I think we need to:
Restore the places where doctors can meet and learn and reflect together in groups
Establish a national leadership and support programme, so that at pinch points in a doctor’s career they can come together and reflect in a safe, residential space
Provide lifelong access to careers counselling and rotations that acknowledge that people can change their mind along the way or even just want to take time out and do something differently
Provide confidential support and counselling services for all doctors
Provide rotas that acknowledge that doctors are human and have personal relationships with others.
It is also important to recognise that the whole NHS workforce is demoralised and it would be a mistake to focus solely on the problems facing junior doctors.
The only way to deal with these serious issues is to create an independent body whose role is to act for the NHS staff. The role of such an organisation would be to counter the assumption that those working with the most vulnerable people in society can just get on with it and have no needs themselves.
Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare: I am a partner of the Hurley Group, an organisation that runs a number of practices and general practitioner walk-in centres across London, and medical director of the Practitioner Health Programme.