Intended for healthcare professionals

Views And Reviews Acute Perspective

David Oliver: Vocation takes doctors only so far

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5610 (Published 25 September 2019) Cite this as: BMJ 2019;366:l5610
  1. David Oliver, consultant in geriatrics and acute general medicine
  1. Berkshire
  1. Davidoliver372{at}googlemail.com
    Follow David on Twitter: @mancunianmedic

The word “vocation” is often raised in letters or online comments responding to stories about doctors and our training, terms, and conditions. But is it a useful concept or a justification for treating us poorly?

Remarks such as “It’s supposed to be a vocation” are used to criticise doctors who want decent pay settlements, more flexible or family friendly hours, or reduced clinical sessions to avoid punitive pension liabilities. It’s never long before someone says, “But they took the Hippocratic oath!” This is no longer the norm in every medical school (despite the myth), although its principles are still relevant to the ethics of modern practice.1 The subtext is that selfless dedication to patients and our profession should come before any self interest.

The origins of the word “vocation” date back to at least the 15th century. For instance, Old French vocacion or Latin vocationem meant a personal calling to an occupation or profession that a person was particularly suited to. Although its origins were in religious ministry or orders, by the early 20th century we started to see more secular references to a person developing their skills in pursuit of a career.2 Even in that earlier religious sense we must remember that being a monk, nun, or priest offered relative stability, status, and education alongside the charitable works and ministry—so having a “vocation” was never purely altruistic.

Not everyone who picks medicine does so for purely vocational reasons.34 Academically capable young people, and their parents and teachers, know that a medical degree is a better guarantee of a secure, well paid, high status career than most. Entrants may be fascinated by the science and the research possibilities. And the realities of the job may not live up to expectations: some find themselves looking enviously at friends from school or university who seem to be enjoying better paid, better supported, or more stimulating work.

Not just healthcare

A sense of vocation doesn’t apply merely to healthcare or other key public service roles such as teaching, emergency services, or the military. Nor is it the preserve of charity and campaigning work. Precarious, highly competitive, and often poorly paid jobs—in academia, scientific research, journalism, the arts, or professional sports—rely on people being prepared to take big risks to pursue their dreams. I wouldn’t argue that a calling to any of those roles justifies accepting an impossible workload, bullying from management, or poor terms and conditions. It’s why we have trade unions, a national living wage, and employment law.

In the UK most doctors, nurses, and other health practitioners are state employees. We’re working for and effectively paid for by the public, and we accept that. The nature of our work is often critical to people’s lives, work, wellbeing, and even life and death. Yes, the public will read stories of practitioners retiring early, reducing their hours, leaving the system, or speaking out against worsening terms and conditions or punitive pension changes.56 They’ll hear of us trying to manage our workload to avoid burnout, mental or physical illness, or compromised safety from fatigue or short staffing.78 They may even see us protesting in the streets, organising on social media, or threatening industrial action.9

None of this lessens our sense of vocation or commitment to our professions, the NHS, or patient care. So, vocation shouldn’t be used as an excuse to treat people badly when they sometimes put themselves or their families first. With no clinicians, there will be no NHS.

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