Cloud cuckoo land : part time doctors
Dr Sarah BlayneyIt is customary for old farts to decry youth from a perceived moral high ground which can best be defined as “you young people do not know how lucky you are.”
Dr Crippen spent five precious years of his life working 100 to 120 hours a week with overtime pay rates that were derisory. It was ridiculous. Absurd. No one should have to work in that fashion. But there was an upside. Experience. Experience that benefited both doctors and patients.
Common sense, legislation, and the European Working Time Directive have put an end to that. Junior doctors hours are to be reduced yet further. Some junior doctors, like Dr Andrew O'Brien, know there is a real problem with lack of experience.
Ten to fifteen years ago, the average orthopaedic surgeon would have had approximately 36,000 hours hands-on experience before he was appointed to a consultancy. Dr Andrew O’Brien, a specialist registrar in orthopaedics will have had approximately 8000 hours experience when he becomes a consultant. (UK surgical training crisis)The recent BMA survey, as reported by the BBC, says:
Newly-qualified women doctors outnumber their male counterparts by almost three to two, a survey suggests.It is right and proper that women can pursue a career in medicine. But at what stage do we decide that the needs of medical training can no longer be subsumed by the needs of working mothers? It may not be politically correct, and there will be a torrent of angry comments, but Dr Crippen thinks the pendulum has swung too far.
The British Medical (BMA) found that 58% of doctors who graduated in 2006 were female compared with 51% in 1995.
Dr Sarah Blayney does not share Dr Andrew O'Brien's insight. Sarah is 24 and in her first year of work after graduating. She works at Arrowe Park Hospital, in the Wirral. She feels that the current system left doctors with very little choice or flexibility:
"The training jobs as they stand are all or nothing. You either do all the hours or don't get the post. I want to pursue a career in hospital medicine, which will mean me committing to a minimum of five years of fairly hefty on-calls. "Sarah lives in cloud-cuckoo land. She wants the job but she is not prepared to do the hours. If you want to be a hospital consultant you have to train for many years during which you will work long hours. But Sarah does not see it like that:
At the moment I am 24, single and am enjoying life. But in four or five years time my situation may have changed and I may not want to work those hours."
She said flexible working would be particularly relevant to female colleagues wanting to start a family, but said male colleagues were also interested in changing their hours. For example, some wanted to take time out to travel, she added.
"It should not need to compromise training. Doctors appreciate that they need to put the time in. It's about having more flexibility."
"I want to pursue a career in hospital medicine, which will mean me committing to a minimum of five years of fairly hefty on-calls. At the moment I am 24, single and am enjoying life. But in four or five years time my situation may have changed and I may not want to work those hours."Well, bully for you Sarah.
You need to grow up a little. You can’t expect to pop into the hospital to do occasional clinics at a time of your own choosing in between school runs, parent-teachers association meetings and back packing holidays. Life is not like that. Being a hospital consultant requires commitment, dedication and long hours. There is generous provision for paid maternity leave. What more do you want? Get a child minder like everyone else does. If you won’t do the hours, you can’t have job. Get a part time appointment in the Family Planning Clinic. Just because you are a girlie, you can’t expect medical training to be turned on its head.
But just a minute. Sarah Blayney works at Arrowe Park Hospital, in the Wirral. That sounds familiar. Is that not where Sue and Dave, two of NHS BLOG DOCTOR’s oldest friends, work?
It is too.
Sue and Dave must have sent Sarah a copy of the most frightening NHS document that Dr Crippen has unearthed. Getting a picture of the night at Arrowe park hospital is a blue print for medical care without doctors.
Maybe Dr Crippen has been unfair. If 70% of junior hospital doctors are going to be on maternity leave or back packing holidays, we may yet have need of Sue and Dave.
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And see Dr Rant's take on this
Labels: maternity leave, part time doctors, women in medicine
43 Comments:
A couple of decades back, IIRC, residents in the US decided to commission an independent study about the length of time they were on-call and the incidence of serious error in diagnosis and treatment. What they wanted was to reduce the number of hours--in those days 36 hours on-call and 12 off was the norm. The results surprised everyone. After 20 hours continual on-call the ability of even senior residents to make proper decisions declined drastically because of sheer exhaustion.
I don't think anyone disputes the value of experience. But marathon on-call sessions really just show how long you can prop your eyelids open and how much coffee you can consume without showing the effects of caffeine toxicity. In both sexes.
Perhaps she would be willing to do the hours spread out over a longer time and therefore not to have a chance of becoming a consultant until a later age?
Was it not possible under the old system to take a staff grade job, not necessarily involving a lot of on-call, for a year or two, and then get back into a "proper" training job again later, with a commensurate delay in being eligible for a consultant position? Or didn't it work like that?
There are jobs, and careers, in hospital medicine for people who work sensible normal working hours, 8-4 or 9-5 or 11-7 with no on-call.
They are staff grade, career grade and trust grade posts.
Perhaps someone should be having a work with some of these mildly deluded UK graduates and point out to them that they have no automatic right to become consultants, but equally that there is no shame in practising medicine as a staff grade or similar.
The idea that every graduate from a UK medical school is automatically "entitled" to be trained through to consultant level, or to end up as a GP partner, is part of the current problem.
A couple of things here -
At no point does "Sarah" say she wants to be a consultant. She wants to pursue a career in hospital medicine, she wants to train, and she wants a life away from hospital. How are these mutually exclusive goals?
As you say, stat, there should be no censure involved in choosing a non-consultant career post. But MMC insures that the people who would have previously been highly trained and experienced before taking on these posts will not exist in future.
The future of medicine is female led. We're here, we're going nowhere. And there is nothing wrong with deciding to take longer to train in order to allow a quality of life away from the job.
Just for the record, I work full time. But I have no children and my respect for female colleagues who juggle clinical commitments, family, educational needs, and the rest of the balls they each have in the air is huge.
Also, a slightly different point, anyone who looks closely at teh working patterns of flexibly working doctors will swiftly realise that they all do more than they are contracted to. As an example a femal consultant I know on an 8pa contract (ie 4 full working days/week) actually works more like 50 hours/week than the 34 she ought to. So as training time is reduced, taking a flexible contract and stretching the 5 years to 10 might actually provide a lot of the experience you would otherwise miss out on. Not so shabby for the "girlies."
I agree stat said and potentilla.
Oldies like me cannot argue that 100+ hour weeks were or could be a good thing and questions should be asked about the quality of all 36000 hours previous Orthopods exxxperienced but nor should we acquiesce in our profession being dumbed down to the degree where Consultants are not worthy of the title.
Fewer hours per week should mean more weeks worked to gain the necessary experience to be a Consultant with the alternative of a career as a Staff Grade/sub-consultant or whatever people want to call it.
And it's nothing to do with gender.
Don't get me wrong, grumpy med reg, I feel strongly that it should be possible for women to pursue any specialty within medicine. Remember, Mrs C is a consultant and we have 4 children.
We have over the years had some very taxing juggling to to, and had a nanny for 13 years. It was not easy.
But Sarah's whole approach,as reported by the Beeb at anyrate, makes me cross. Medicine does not owe her a career. Her suggestion also that doctors should be able to take time off to go on long holidays is naive. Any hospital doctor is at liberty to take a year off, or any amount of time, but he/she does NOT have a right to a specific medical career. If for example he is training to be a surgeon and takes a year off he is going to lose skills. Inevitably.
There are many successful women in demanding careers : industry, the city, the professions and so on. But medicine attracts women like no other profession and they are now in the majority, and that majority gets larger every year. And many of them want to be part time.
I don't want to operated on by a part time doctor.
Juniors have has a shitty time wit MTAS and MMC but that is a separate issue. This is about balance. About the time it takes to train to be a doctor and the provisions that should be made for career women who want to have a family.
I think the balance is wrong at the moment. That is all.
If Sarah wants to be a part time clinical assistant in the dermatology clinic with no on call, that is fine.
And you are right, she does not specifically say she wants to be a consultant.
John
And it's nothing to do with gender.
(above)
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Of course it is.
There is a demographic time bomb ticking in medicine. In a few years time, the profession could well be 75% female.
I do not say that is a bad thing.
BUT it is a big change, and it has profound implications for the economics of medical care.
A significant number of these doctors will want to work part time, therefore we will need more doctors.
My feeling is that women going into medicine assume they have a right to part time employment. Women going into other professions do not make the same assumption.
John
"And it's nothing to do with gender."
"Of course it is."
OK obviously a factor,
but an increasing number of young male doctors do not want to work full time, they want time with their families, variety in their career, years off to travel.
In my area the majority of principals still working in the OOH service are middle aged, male and (admittedly to a lesser extent) female. The principals in their 30s, both male and female have opted out fully.
Meanwhile quite a few of the locums in their 20s or early 30s do not want full time posts or partnerships and this also applies to men and women.
I think part of the problem is that as our hours have become more humane - which they had to, the old system was bad for doctors, patients, and anyone crossing the street when we were driving home after 56 hour on calls - people have joined the profession who would have been scared away in the "old days."
And that means that our careers look superficially more like those of our non-medic friends. So if they can have evenings and weekends with family why can't we? Obviously if you want to excel in this profession, you must sacrifice. But the degree of sacrifice needs to be an individual choice.
If people are willing to take longer to train by working more flexibly, then I'm all for it. And gender has nothing to do with it.
Oh - and juniors don't have the option of a year of travel anymore. MMC/MTAS are relevant to this debate as they are changing the career structure.
Incidentally - this may actually feed you side of the argument but what the hell - watch out for a huge need for maternity leave locums in 9-10 months. Traditionally women get pregnant once they have a number, and ST posts provide the necessary job security so sit back and watch the ladies sprog!
"Dr Crippen spent five precious years of his life working 100 to 120 hours a week": cissy. My wife met a Consultant's wife who said her husband worked a 200-hour week.
It was the head of the royal college of Physicians (Carol Black) who stated the feminisation of medicine was going to lead to major problems.
It has been debated at my medical school that problems with less women wanting to be part of profesisonal bodies outside of work time may well also lead to loss of influence of the profession (if we still had any).
Are any of you arrogant 40-50 something "I had it hard so why shouldn't everone else" types (quite similar to the mentality of child abusers incidentally!) aware that a normal working week is 40 hours a week in all professions bar medicine? I would have thought you would be, but you don't sound like you are. A normal working week in medicine is 80-120 hours, often with continuous shifts of 50 hours plus. When the phrase "part time" is used in connection with doctors, it generally means approx 40-50 hours as opposed to 100. Hence they're still working MORE than a FULL TIME worker in most other professions. A woman doctor I know was forced by management (and consultants with this derogatory attitude more suited to managing a circa 1950's sweatshop) to work gruelling hours throughout her pregnancy, eventually miscarrying halfway through a 60 hour continuous shift with no break and having to take a long long break subsequently, probably longer than if anyone had treated her like a human being in the first place.
For the record, I am a female childless junior doctor, not working in the UK and the EWTD is an hilarious pipe dream in the country I live in. I am soon leaving med for another, better profession whose members are treated like real flesh and blood people. I was by no means under the impression that I was somehow "entitled to part time work" while in medicine. However, perhaps misguidedly, I AM of the impression that I am ENTITLED to be treated like a human being. I deserve to sleep at some point every 24 hours, whether it be at night or in the day. I deserve regular meal breaks, or at least ONE in every 24 hours. I deserve to have maternity leave entitlements and sick leave if needed. I also deserve to make it in my career by working 40-50 hours a week. If it takes a few more years then fine by me. But attitudes like Dr. Crippen's, (which frankly I am surprised at, I am a huge fan of this blog) were a huge factor in my decision to leave medicine. I agree wholeheartedly with Dr. Rant on this one.
Ummm... I really really hate to agree with anything John says on this subject because I think he's missed the point os completely but -
a normal working week in UK medicine used to be 80-100 hours with 40-50 hour continuous on calls. It's not anymore - there are exceptions but they are rare. These days I work an average of 60-70 hours a week and th elongest shift is 14-15 hours. This is significantly more than I'm paid for but I choose to put in the hours to feel I've done my job properly. And yes on a bad day breaks, meals, hydration, and sanity are pipe dreams but it's all much much better than it was.
That doesn't mean I think we "girlies" should fade into the background or only tackle the "girlie" specialties like dermatology, Family Planning, or whatever else John thinks appropriate for our delicate wee brains (really Dr C I do expect better from you!) but we aren't as badly off as we once were. Perhaps the feminisation of the profession can take some credit for that?
Ahh....
“Before you contradict an old man, my fair friend, you should endeavor to understand him.”
George Santayana
US (Spanish-born) philosopher (1863 - 1952)
I knew this was going to happen!!
I am not as un-PC as you think.
"That doesn't mean I think we "girlies" should fade into the background or only tackle the "girlie" specialties like dermatology, Family Planning, or whatever else John thinks appropriate for our delicate wee brains (really Dr C I do expect better from you!) but we aren't as badly off as we once were. Perhaps the feminisation of the profession can take some credit for that?"
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Oh dear.
Let me cross post a comment I have just put on the excellent Dr Rant foundation, which probably explains better how I feel about this:-
I agree entirely that the system in which we were brought up was exploitative, absurd and at times dangerous.
I agree entirely that there should be proper provision for women in terms of maternity leave and creches and so on.
I agree entirely that working conditions should be improved.
There is a balance to be struck between the needs of the job and the needs of the employees. A line has to be drawn.
I have some experience of the legal profession. Trainee solicitors working in the big London firms are regularly working 80 hours a week or more. That is far longer than most junior doctors work.
But we don't hear them moan, do we?
Why not?
Because they are looked after. They are valued. They are paid far higher salaries with the prospect of partnership salaries that no doctor could approach. As well high salaries, they get a portfolio of fringe benefits:
full BUPA cover
gym membership
paid taxi home if when have to work late
training costs and exam fees paid for
I was talking to one of these young solicitors last week. She feels her company wants body and soul; she has to work evenings and weekends; but she feels valued, trusted and properly rewarded.
When the time for children comes she will have to make decsions about balance, about whether to go the nanny/fulltime work and progress to partnership route...or whether to down size her ambitions to a less demanding and less financially rewarding legal role in a different company. She does NOT expect her firm to redesign their working patterns to meet her needs and requirements.
Compare this with a friend of mine who has, as an eminent consultant, left medicine at the age of 48. He says it is only now that he realises how undervalued he was.
Think about it.
When did a hospital chief executive last call in a doctor and thank him/her for doing a really good job? When did a politician last say, "God, aren't our doctors doing a wonderful job for the NHS"?; when,as a doctor, did you last feel trusted and valued by the NHS?
So instead we react like all employees of state state owned Stalinist monopoloies. We do not feel valued, indeed we are not valued.
We moan about working conditions, and try to get the commissars to treat us better. The commissars meanwhile try to tie us up in protocols and non-professional contracts.
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Success in demanding and highly responsible jobs means personal sacrifice in the early years.
Imagine an NHS in which female trainee surgeons were paid properly; where consultant surgeons were paid salaries good enough so that they would not need to do private work; where as trainees they had all their exam fees paid, proper paid study leave, gym membership, taxis home after a late night and so on. And, of course, maternity leave and creches.
Think about it. Imagine a registrar, tired out after a night on call, asking the hospital to pay for a taxi home to save her having to get a tube and two buses. Ha! Ha! Ha!
Imagine a system in which consultants had bright, modernly furnished, air conditioned offices, with their own secretary. Instead all they have is a shared cubby hole, a faulty dicataphone and a weekly SAE with the address of a typing agency in New Delhi on the front.
And not only should the consultants have offices and secretaries, so should the registrars.
Can you imagine a 30 year old solicitor at Clifford Chance not having an office in which to work?
Can you imagine the reaction of the hospital administrators if a similar 30 year old senior SpR asked where her office was?
Ha! Ha! Ha!
Let us have all that, and stop going on about sabbaticals and back packing holidays.
John
Sorry - another cross-posting - Do 30-yr old solicitors below Partner level really get offices, do you think, Dr C?
I wonder.
When my best friend from Uni was a junior Management Consultant at one of the big UK consulting firms ten yrs ago, there were no individual offices for anyone below Partner. The number of spots in the shared "hotdesking" office was deliberately set at slightly less than the number of people typically working there on any given day. This was designed to encourage the junior consultants to get there 30-45 min early to bag a spot.
My ex- works in investment banking (as do several of my friends). They all do more hours than any junior Dr i know now.
They get paid way beyond anything other than consultant wages as "juniors" in their proffession
and believe me they all have some office space.
The UK may still be a bit off from ideal hours but it's not nearly as bad as it was.
We are getting to the point where to do any less hours in the NHS as a Dr will mean loosing experience and de-skilling.
I can speak from personal experience in that on some wards now there is NOWEHRE for the juniors to work.
Offices are now ward managers/ matrons/ etc staff and are locked with signs up syaing "not a doctors office". It was just a place to check blood results and leave a bag nice and secure as well as do that oh so un-important paper work.
It's hard to feel valued when your being told the only work space on some wards should be empty rather than let the juniors use it to work in.
Funny Pseudonym
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Absolutely right; I know some young people in investment banking as well. Body and soul; all hours of the day and night; BIG salaries
If they asked their bosses for time off for a back packing holiday, they would be shown the door
John
The "normal jobs have a 40 hour work week" statement above is a load of rot. No professional, entrepeneur, or small business owner who wishes to succeed works a 40 hour week. Most mid-level managers who expect promotion work more than a 40 hour week. You want to make money and be your own boss, bust your ass, full stop. If you "want a career in health care" and want a 40 hour week, be a nurse.
Bladedoc:
"If you "want a career in health care" and want a 40 hour week, be a nurse."
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Tush!
I hope you have your tin helmet and flat jacket on!
John
BladeDoc (sounds like a name for a male surgeon, so I can hardly be surprised at your attitude really)there is every difference between working hard maybe up to 50-60 hours a week, when you can,at your discretion oftentimes, maybe late into the night once or twice a week but always going home to bed for a few hours, and being rostered on for 50 hours straight with no sleep or meal breaks as part of your overall working week. How has that helped my career? It hasn't. I'm there because in my "training" contract (don't make me laugh) there is an unrealistically high level of basic service provision expected. If I only worked the hours I was "training" in, I would work less than 6 hours a week. Yes, if you own and run your own small business or you are an entrepreneur, then yes, you might work a LOT for a while. My bro in law has recently opened a restaurant, it's taking off very well, and he has been working 7 days a week for the last few months, recently he has been able to take off Mondays as he has more staff now. (He's still less stressed than I.) But to require employees on a shared rota system to work unhealthy dangerous and unsafe hours in a hugely stressful environment where the consequences of a mistake can be catastrophic and fatal? That's just plain stupid. You can't compare running your own business to hospital work. And for the record, you probable alpha male testosterone soaked merc driver, yes, I am entirely correct in saying that MOST NORMAL job hours are about 40 hours a week. To be honest, anyone who works 80 hours a week is bloody stupid, in my opinion, or dangerously obsessed with what they do. My friend is an actuary, makes twice what I make, and works a 39 hour week. Two other friends are senior hospital pharmacists, make more than me and work about a 35 hour week. Are they "failures"?They sure don't look like it, they drive nice cars, own property and take great holidays, I don't do any of the above. Personally I feel like the failure, having been stupid enough to put myself through all this for the last nine years to discover that I don't have the physical stamina, my health is suffering and I have to retrain (and come up with the money to do so). And are you actually devaluing nurse work by saying that it cannot be perceived as a success because they only work 40 hours a week? Um, good luck with that line of reasoning. You should probably have said, "If you want a career in healthcare and a 40 hour week, be a nurse, physio, OT, Speech & Language, pharmacist, hospital manager, lab tech, or otherwise allied health professional. In short, be anything but a doctor as their union sucks elephant dick". Seems that would sum up the situation a lot better. I would consider myself a success if I worked a reasonable amount of hours at a job I liked and was treated well at, if I saw my friends and family regularly, if I was able to pursue my hobbies (if I had hobbies), if I had suffient job security to be able to buy a house and know that 1) I was very likely to continue to be employed to pay for it and 2)if I knew I was going to work within a 50 mile radius of said house so it was worth my while to purchase it in the first place.
Working 80-100 hour weeks and feeling ill with fatigue and nothing to show for it? Wow, how successful am I?
The above should read "sufficient job security", sorry, being incandescent with frustrated rage does nothing for my grammar, punctuation, or spelling! Apologies.
I'm far from being a testosterone soaked surgeon, but I am approaching 50 and went through training before EWTD and GP before co-ops (1 in 3 for 6 years) and it was exploitative and at times dangerous for both me and the patients and lots of it had no traininig value. But lots of it had valuable training value and I emerged with a broad knowledge of managing a huge variety of situations, with a particular skill in managing uncertainty safely and all in the space of four years of training/apprenticing.
I certainly wouldn't disagree with the majority of burnedoutdoc's views but I just wonder that while some of my younger colleagues want to rightly do away with the exploitation and abuse, they are not prepared to accept the other side of that coin, that it will take longer to gain an equivalent level of experience.
As to job security and working within 50 miles of home, great when you have the experience but when you are gaining that experience you may have to move around to gan it. A friend in banking has just been shifted to Brussels for 6 months, with 4 weeks notice. No he doesn't have to go but if he wishes to work at the level he aspires to and earn the very considerable rewards which accompany it then he has to go. And he works 70 - 80 hours per week regularly. Another friend trying to forge a career in the media has been working for nothing to get the training she requires. All desirable well paid careers require some sacrifice at least in the early stages, medicine is no different, better paid than many, worse than many.
I get back to my belief that a sub consultant career should be more acceptable, with lesser training requirements, lesser responsibility and a lesser salary but still utilising valuable skills and offering job satisfaction and being easier to achieve with less upheaval, fewer exams etc. and doctors should choose and compete for what suits them.
If someone offered me a 10+ year training contract of 40 hours a week in the specialty I was interested in (neurology) before I had decided to pack it all in I would have jumped at the chance, rather than 5 years of 100 hour weeks which I am physically incapable of doing (have collapsed twice at work in the last year on continuous shifts and my colleagues have had to pick up the slack). But no one has ever asked us juniors here if this would be acceptable. No one has ever made this an option for us. The old school macho types make these decisions in the Royal Colleges and we suffer the consequences. As either Dr. Crippen or Dr. Rant said on one post, (I forget which) , "funny thing about us highly intelligent highly trained types, we can do other things, so our answer is often 'fuck you'". I'm only one of swathes of docs that are leaving in droves, some to Oz or NZ (I notice these countries are not actually mass producing inferiorly trained docs despite them working no more than 55 hours MAX per week, hmmm....) some fleeing to other careers, and the rest flocking to Occ Health, GP or some other sensibly structured specialty. Do you know, your idea of a "subconsultant career with lesser responsibility, training and salary " is actually highly insulting? Do you know who would end up in these inferior posts? Women, primarily. How about providing creches, more flexible training, realistic working hours not in contravention of the Geneva convention, and PROPER training so that training doesn't take 15 years because we're so busy putting in cannulae and catheters and giving IV antibiotics all night long? I guess though the above implementations would severely disrupt the old boys club that hospital medicine is at present. God am I glad to be leaving.
"subconsultant career with lesser responsibility, training and salary " is actually highly insulting?
Why?
not all teachers become heads, not all solicitors or accountants become partners.
Again, It does not have to be a gender thing, any doc would be free to make a choice based on his or her own ambition, priorities, family circumstances, health etc. etc. Do I want to sacrifice a lot for a more senior post in the longer term or do I want to sacrifice less, have a better life now and a more limited future.
It's the kind of decision we all make in all fields of our life at times.
Why should junior docs be different? They weren't in the past, I know lots of people in second choice specialties as a result of life events and choices, oerhaps a sub consultant grade would expand the choice available.
As regards 10 years @ 40hrs v 5 years @ 100hrs, I agree totally but I believe some juniors want 5 years @ 40hrs. Am I wrong?
there is a politically correct "equal wage" movement ongoing in many areas, encouraged by the union negotiators etc who are going way too far, i know of one big business which is implementing "equal" pay for men and women - which ignores that the men i) work longer hours ii) work longer periods away from home iii) have not had years off for materinty etc iii) regularly get called out in the middle of the night
really fair pay for equivalent work is fine, the problem is the way the typical HR dept measures these things is so far removed from reality, and encoraged by the politically correct unions and social commentators
what happens? the men get cheesed off/demotivated/leave
as in much of the rest of life here political correctness has gone too extreme and is no longer "fair"
same is obviously happening in medical world, no surprise there
no one
Anonymous, you cannot include iii) years off for maternity (years???). It is against the law to discriminate against anyone for becoming pregnant and it cannot be held against them in matters of pay or anything else. As regards maternity leave, in Sweden they have the best system EVER, the man gets almost as much time off as the woman and can take it whenever he wants, usually when the woman's leave is up, so he gets to spend time with his kid and the kid doesn't get dumped into a creche at an early age. It makes everything fairer and certainly it decreases the level of derision aimed at working women who have the audacity to actually get pregnant (who do they think they are at all?) and allows them to be treated equally to the men in the workplace as far as this is
concerned.
Men working longer hours??? I work longer hours than any non medical man I know, and actually, longer than some of the medics. (my reg regularly takes a half day post call and I am left to carry the can, and his bleep). Yet he will no doubt get better job offers because he isn't guilty of having a functioning uterus.
"Why should junior docs be different? They weren't in the past, I know lots of people in second choice specialties as a result of life events and choices, oerhaps a sub consultant grade would expand the choice available."
Yes, but instead of making an "inferior grade doctor job for the ladies with kiddies, awww.." because no matter what anyone says, that is primarily who would be working in these posts, why don't we have, like Dr. Crippen suggested, creche facilities, proper maternity and paternity leave, training with safe and appropriate hours with flexible options that take different amounts of time to complete. In short, support for working parents of both sexes. I suppose though it is easier to just discriminate against women in the workplace by levelling criticism at them for being the ones to get pregnant, and usually, the ones who are expected to do the majority of the childcare and rearing of the children while the men go out and make their more worthwhile contribution to the workplace.
BurnedOutDoc - why are doctors expected to do 100-hour week which makes them collapse?
K
I agree in principle, burnedout, but there is always going to be an argument that taking far longer to train, because of (e.g.) part-time working, basically means that the system will get less working years out of the training of that person in the end. Some reasonable compromise must be possible, but as ni gp says you can't really have people on short hrs (compared to the old system) and claim the people are as good, at least in terms of accrued experience.
There is also the argument about the "service" needs of the system, and how they are to be dealt with if everyone is working less hours, since the old-style 80 hrs / wk SHOs did a lot of the service stuff. I think you and I once went through this conversation over on Dr Grumble's blog.
I know lots of people (of both sexes) who used to be in hospital medicine but eventually made the choice (for all kinds of different reasons, again as per ni gp's experience) to head off to other things, whether non-acute on-call-free specialties, General Practise, research or whatever. Don't think anyone except the odd bigoted old buffer thinks any the less of them. For instance, there is lots of work in neuroscience research, both in academia and industry, for people with neurology type skills. The money isn't great in research but it is free of on-call rotas and no-one expects 80 hr weeks or 48 hrs on your feet
Then can someone please explain to me how Oz and NZ docs are being trained to consultant standard (their consultants are of a very high calibre) on 40-50 hour weeks? Are Northern hemisphere docs just a lot stupider or something?Maybe all that sun and seafood makes the 'ol neurones fire a bit faster or something...
Something about it all STINKS here. In the USA even one can be a consultant in the specialty of your choice in a guaranteed 5 years. GUARANTEED. So somebody is doing something very wrong over here......
burnedoutdoc- Almost everything you write is incorrect.
Disclosure: I still occasionally work 100 hour weeks, but I am fortunate; I enjoy my job.
I'm a woman and a junior doctor. I have made the decision that I don't want children. Whenever I have discussed careers and training plans with tutors/mentors/seniors, I am invariably greeted with the response that I will "probably change my mind", despite the fact that I am an adult and have fully explored my own feelings and opinions on this matter. It seems that I can reiterate my position until I am blue in the face, but unless I adopt the dishonest approach and state that I can't physically have children then I am unlikely to be believed.
I don't like the idea that I may be up for a job interview in a competitive speciality that requires long hours to train against a male of the same age, with the same (or perhaps even inferior) qualifications as me in the future and the assumption will be made by those interviewing that I will want to go off and have children at some point. Despite assurances to the contrary being female will probably count against me to the interview panel, even if it is only on a subconscious level.
Personally (and unsurprisingly, given my lack of desire to have children), I am happy with the idea of working hard early on and training to consultancy quickly, however I fully support the idea of women and men being able to train to consultancy flexibly - same number of hours required, but over a longer period of time, not this MMC rubbish. Flexible training is inevitable and necessary given the massive demographic shift in the medical workforce. However I do not just support this approach for altruistic reasons. If flexibility in training were an accepted norm and there were greater parity between men and women in terms of maternity/paternity leave (as in Sweden), then assumptions and discrimination based on gender becomes less of an issue.
At the moment as a woman it appears that you are damned if you do want children and damned if you don't both in medicine and elsewhere. It is not just the medical profession that needs to change its approach, however this issue is likely to become pressing within medicine sooner than in other spheres.
i actually think its men who are routinely discriminated against at the moment in most careers
"oh we cannot send sally to work in *random foreign city* for 6 months, shes a girl with commitments at home, lets send fred" etc etc etc
maybe not politically correct, but in many many examples i have seen up close and personal its the men who get the raw deal
"Dr Crippen spent five precious years of his life working 100 to 120 hours a week": cissy. My wife met a Consultant's wife who said her husband worked a 200-hour week."
Dearieme, Saturday, June 23, 2007 5:43:00 PM
How? 1 week = 7 days, 1 day = 24 hours, 7x24= 168 hours...or maybe he was "The Doctor"?!
Dr. Crippen, I thought you trained as a lawyer.
You're complaining about doctor's hours in training? That's nothing compared to lawyers.
Judging from their billing, they all work 48-hour days.
...........arf
Maven: What have I written that it incorrect? Please elucidate and provide specific examples rather than sweeping generalisations that are, understandably, hard to reason with. I do not work in the UK, as I have mentioned, and the treatment I write about is not that of UK docs. Maybe this is the source of confusion? Everything I have written is correct, insofar as the facts I have laid out are correct and the opinions are my own, neither correct nor incorrect but simply there.
Using that logic, I could say everything YOU wrote is incorrect.
Just one comment - I worked up until last year as a SG in A&E, I must have been very stupid. All the staff grades were working weeks of nights (74 hours total). The SHOs got paid more for 40 hours. I didn't realise that SG was actually the easy, daytime only option. Silly me.
You might find that the whole question of "working mothers" starts to take on the sheen rather of "working parents". I hate the fact that a woman with a child and works is seen as some strange and odd creature, whereas a man with a child is just normal. It should certainly the case that if/when parents take more equal roles in looking after their offspring then this idea that women with children as strange, demanding alien creatures will cease.
Personally, I'm extremely glad that junior doctors don't work ridiculous hours. I also don't really care if it takes a doctor longer to get the experience. Nor do I care if they are called "consultant", "registrar" or any other variant. The labels don't actually mean a damn thing.
"The work-life balance of the UK's lawyers is to come under scrutiny as part of a Law Society review to see why record numbers appear to be leaving the profession.
Some say the popular belief that the life of a City lawyer is all about big bonuses, expensive holidays and flowing champagne is misguided and, in fact, the career is more likely to end in emotional or physical breakdown."
http://news.bbc.co.uk/1/hi/uk/6241076.stm
K
I personally would much rather be treated by a doctor who hasn't been up for 20 hours, or working 60 + hours a week and is bitter and exhausted. People make better decisions when rested. More flexible working hours may reduce the overall hours of experience, but I believe the number of mistakes would also decrease.
I wonder when we will apply to much vaunted lens of evidence based medicine to the assumption that more hours = more capable Doctors. The only studies I am aware of had to do with mistakes after x number of hours, which is kind of a no brainer. Why do I have no credibility when I recommend a healthy, balanced lifestyle? Hmmm...
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