Leaving medicine
It takes five years to train a doctor and costs the country upwards of a quarter of a million pounds. The basic medical qualification only qualifies you for more exams and more training, all of which you have to fund yourself. It will be another four years (minimum) and possibly many more before the new doctor becomes a consultant or GP.
As the NHS dumbs down further and further (see "Pay peanuts, get monkeys), working conditions for newly qualified doctors continue to deteriorate. It is not the hours or the pay. It is the career uncertainty, the lack of respect and, increasingly, the way young doctors are bossed around by quacktitioners with clipboards.
British trained doctors are leaving the country. Some are leaving medicine altogether.
Luke Solon (his real name) is one such newly qualified doctor. Luke Solon is leaving altogether. He has had the courage to explain why. I publish his letter verbatim and unedited.
Dear Dr Crippen
I and I'm sure many of my fellow doctors will be leaving the NHS this year. I myself am leaving medicine all together.
When I started my medical degree I was naive in the extreme with a romantic notion of doctoring that in my experience most medical students still have. I was going to help people, be respected by my friends and patients for what I did for a living, enjoy job security and be adequately rewarded for what I did. I have been a doctor now for 3 and a half years and all my idealism has been crushed out of me. The respect of my friends is still there, as for patients- most seem to respect the internet or the tabloids more than us. Job security seems absent although I still feel predictions of mass unemployment are unlikely to materialise. I've certainly never felt under-paid but then with EWTD and the political agenda seemingly very anti doctor at the moment who knows what the future will hold. Over supply of doctors and centralisation and privatisation of services will I'm sure lead to lower salaries.
The last year was tough for most junior doctors not to mention their families. My wife has a good career in London and so I applied to London and the 3 closest "UOAs" (a geographical region covering most of the South East of England). I was a strong candidate according to my supervisors and colleagues but didn't get shortlisted anywhere. The feeling of rejection was hard to take and impacted on my work- as much as some might have "tried tried and tried again" I became rather apathetic and negative about the future. Even when I secured an FTSTA (through the guaranteed interview we all received) my prospects still seemed gloomy. Surgery has always been competitive but seeing only 8 ST3 posts for the whole country this summer does not inspire optimism. Even post specialist training many will struggle to get consultant posts and in the NuLabour "consultant led service" will they still be working nights well into their 50s and even beyond? So not only were my prospects bleak but the light at the end of the tunnel is ever fading.
I started looking outside of medicine and I have been offered a wonderful opportunity with a top consulting firm. The interviews were tough but fair and extremely thorough. The job offer was made on the same day as my final interview and I had very little hesitation in accepting. The financial package is better than my current one but more importantly they see their employees as an investment for the future- THEY pay for my training! The HR manager who has been dealing with me tells me that she loves dealing with former doctors as we are always so grateful that in the private sector our training is paid for by the company. I will have regular appraisals and if I perform well I will be promoted as I deserve- meritocracy so lacking in many parts of the NHS.
Yes I'm sad to be leaving some great colleagues and a job that has both tremendous highs (to go with the recent soul-destroying lows) but on balance I am relieved not to be entering into the mad scramble for jobs this year and for the first time in a while I am optimistic about the future. I'm on nights at the moment, being ordered around by "Outreach Nurses" and hassled by A&E to meet their 4 hour targets.
I'm a doctor till the end of March then I become a Consultant- just not the kind I thought I'd become. And to be honest- I can't wait.
Luke Solon
Luke is not alone. And it is not just doctors who are leaving. Nurses (real nurses) are leaving too. Read reports from another junior hospital doctor (A houseman's tale) and from two real nurses. (The nurse's tale and the student nurse)
Those not offended by Anglo-Saxon can see what The Devil made of it all in “Fucking nurses.”
Something needs to be done, and the government it not doing it. Indeed, history may remember this government not only for the Iraq debacle but for the destruction of the NHS.
++++++++++
Labels: leaving medicine, Luke Solon
32 Comments:
The fact that Patsy is now cashing in hard (see post below) on her disastrous legacy makes me more ****ing angry than I know how I say.
The old adage that "when the NHS is good... it's very, very good" is getting harder to sustain - there have been some very grim scenes in my hospital over the last 48 hours. Put blunty, there's not enough of us to guarantee patient safety. If Patsy showed her face, I'd have to be forcibly restrained.
You are quite right, Dr Crippen, the Labour Government is destroying the NHS. Their current actions leave me in no doubt that in the next 5 years or so, we will see the Americanisation of our health care system, with the poor being treated at polyclinics and hospitals staffed by underqualified and overconfident numpty noctors, whilst those who can afford it see their private GPs (as for dentistry), and get referred to private hospitals for quality care.
"...than I know how to say."
doh, and I'm not even sloshed.
Dr Snuggles: acute care is being eroded in the name of (false) choice - the saddest thing being that it didn't have to be this way. No doctor or nurse I know actually asked for the idiocy of PFI, ISTCs, MTAS, PBR...
Dr Snuggles said.
Their current actions leave me in no doubt that in the next 5 years or so, we will see the Americanisation of our health care system, with the poor being treated at polyclinics and hospitals staffed by underqualified and overconfident numpty noctors!
****************************
Why blame nurses for the downfall of the NHS?
http://www.advancedpractitioneruk.blogspot.com/
mmm now the big consultancies and the false promises they make at interview, now theres something im an expert in, expect this ex-Dr to get a big dose or realism soon, but hey good luck to him
I don't blame nurses, I quite plainly blame the Labour Government. Some wannabe-doctor nurses are certainly complicit, but I don't doubt their good intentions, only their lack of insight.
I'm with anonymous - management/strategy consultancies are well known for promising big and giving small. If Dr Solon wants endless hours of souless work in crummy locations away from friends and family whilst partners cream off millions then he is off to the right sector. Hey he will probably be spending his time selling useless consultancy services back to the nhs - wonder how he will feel then?
Can anyone provide a list of these hospitals you docs wont be caught in - feels unfair not to be in the know.
If you don't like what is happening to our NHS, fill in the NHS silly survey. Most of it is very daft but staff get a chance to enter some free text so that you can tell them what you really think.
Those not offended by Anglo-Saxon can see what The Devil made of it all in “Fucking nurses.”
That post by the The Devil is pretty old now, so rather than replying to him directly, I'll reply here to his criticisms.
What the fucking hell is going on? Pray tell me, what the fuck are qualified nurses for again? Oh, hang on: is it nursing? Then why the fuck are they not being taught the fundamentals of the human physiological system?
On my nursing degree, which I finished last year, I certainly spent large amounts of time studying human physiology and anatomy, particularly in the first year when it made up a hefty chunk of the syllabus. There was considerably less of it in my second and third year, but in my case I'd begun specialising in the Mental Health branch at the beginning of the second year (so as to qualify as an RMN), hence there was less need for me to know the ins and outs of the kidney.
Why the hell are they not being taught about the effects of the drugs that they have to administer?
I'd have to admit that I would have liked more pharmacology lectures than I got, but to be honest I actually found that pharmacology (at least from a nursing perspective) was learned far more effectively and quickly out on clinical placement through actually administering the various drugs under supervision as well as seeing the effects first-hand (both good and bad) that they had on patients - it's the old "tell me and I'll forget, show me and I'll remember, involve me and I'll understand" thing.
One lecturer stated that it is not necessary to learn cannulation or catheterisation or IV therapy on the course as we can go on top up courses when we have qualified and found employment.
WHAT! Fuck you, cunty-balls; you learn at the fucking college: that's what the entire exercise is for, for crying out loud!
Yes, you continue to learn certain new skills post-registration. Learning stops on the day you retire, not on the day you qualify. What those skills may be will depend on what setting you're working in.
They could have taught me to cannulate while I was a pre-reg student, but it would have been a complete waste of time because I don't do any in my current role. Some skills are better trained in when you know if you're actually going to to do them or not.
We're all fucked. The nurses are fucked because they are going to have a hard time getting jobs, and we're all fucked because we will be receiving injections from someone who hasn't been taught how to administer one in the three fucking years that she was at college!
I promise you all I was taught how administer injections in my first year, and continued to practice it throughout the three years I was studying to be a nurse.
There, and I didn't use any Anglo-Saxon at all. Maybe my mother was right when she said swearing was for people who can't express themselves more intelligently.
I had massive amounts of university level anatomy/ phsyiology/ microbiology/ and pharmocology for years when I was at university majoring in nursing.
We had to perform clinical skills on our placements with our professor watching and if you screwed up you got kicked out. If you got below and 80% on any exam whether it was nursing/microbiology (or any scinece)/statistics/or english you got kicked out of the program.
In the words of my professor "if you are too stupid to handle something as easy as university level science and maths than you are too stupid to have a job that entails life and death responsibility. It's not 1865 anymore. Healthcare today is rough and complicated". He went onto say that healthcare is so complex these days that we would need to have nursing students in school for 6 years before they were anything close to knowing everything needed to function as a bedside nurse in charge of an assignment. That is why a good new grad program in a nurses first job is so essential.
But cannulations and administering IV medications by nursing students were not allowed due to legal issues. The most important thing was to protect the hospital from lawsuits.
When we graduated nursing school we had to take a state board exam. After that we were allowed to call ourselves nurses. Once we had that professional license we were allowed to get a job with a preceptorship program for new grads. It was then that the hospital allowed us to start handling IV's and cannulating.
It's called "hospitals covering their own asses"
In the UK, there is not enough staff around to teach and supervise students properly so from a safety standpoint it is probably good that they don't have rogue nursing students running around cannulating people. It's not good for the students but good for the patients.
In contrast to what Zarathustra says, I find myself emphasising with the letter from 'student nurse' mentioned above a lot more.
Too many soft skills taught. I'll be going onto my second placement soon having being taught a level of physiology reminiscent of pre-GCSE biology, and not in any applied sense.
Meanwhile, the course is held back by students and lecturers who can't find the on button to a computer and who are still forced to go through with a disastrous switch to computer working. Probably trying to prepare them for the bigger catastorphe within the NHS.
I agree with Zarathustra that learning is a constant process, but with he/she being a MH Nurse and myself working in Adult I can't relate with some of the issues. If I'm not taught something about IV therapy before I qualify, I'll worry.
I met a newly qualified nurse on my last ward who didn't know how to use non-touch technique or how to set up an IV machine, which required valuable charge nurse time teaching them. Teaching them something they really should've been familiar with before becoming an RN.
I'm going to be a good nurse, because I'm going to put the boatloads of extra-curricular time in to make sure I am. Can't say the same for everyone else.
You are not going to walk onto the ward as a new nurse already knowing everything you need to know. That is impossible. Just wait.
There is little, if anything, inspiring me, and many of my 5th year collegues, to become part of the NHS when we graduate. I know some who are already looking for jobs elsewhere outside of medicine. I can't say I blame them - what have we got to look forward to?
- Working to the EWTD meaning we'll get little if any on-call training.
- Lower salaries because of the above.
- Potentially no accommodation as an F1 which equates to a £6000 pay cut.
- The possibility of no being unemployed in 2 years time when we've finished foundation years.
- The prospect of entering the huge mess that is the NHS.
- The probability that we won't actually get what we want to do as there won't be enough training posts.
- Being blamed by the government for anything which goes wrong
Yip-fucking-eee
I am a proper nurse and I learn't how to give an injection while I was a student although I have to agree with student nurse as well.
I trained in 1994/ 97 (Project 2000 diploma) and the course I did was full of "soft skills" communication studies etc etc with very little emphasis on physiology or any other hard science.
OFMN
On the issue of anatomy and physiology lectures in nursing, a lot of it really will be "for beginners" and always will be unless universities require a biology A level of prospective nursing students.
To be honest though, I actually found that on the more physically-oriented mental health placements (dementia care, neuropsychiatry) I didn't feel that lack of biological knowledge was a major problem. And if there are gaps in your knowledge then hands-on clinical experience is often the best way to fill those gaps.
Remember that if you're nursing, say, a Type 1 diabetic, you don't necessarily need to know a great deal about how the pancreas functions. What's more important is to get to know the different types of insulin, what a hypoglaecaemia looks like (and of course, what to do about it) and so on - the practical applications, not the in-depth anatomy.
Anything more complicated than that, and you probably need to refer to the ward doctor anyway, and the more clinical discussions you have with doctors, nurses, OTs and so on, the more your knowledge will grow organically.
I have a lot more to say on this subject, but rather than repeating myself I'd invite people to read this post here that I wrote not long after qualifying.
I trained in 1994/ 97 (Project 2000 diploma) and the course I did was full of "soft skills" communication studies etc etc with very little emphasis on physiology or any other hard science.
On the subject of Project 2000, it's worth mentioning that Project 2000 was abolished in 2002. The reason it needs mentioning is that so many people who comment on this blog seem unaware of that fact. The current syllabus is now called Making a Difference in England and Fitness for Practice in Wales.
The reason P2000 was abolished is because of some of the very criticisms being aired here - that it was too lightweight and wasn't sufficiently linked to clinical practice. Certainly most of my nursing lecturers seemed to regard the new syllabus as a big improvement on P2000.
That doesn't mean that the current syllabus will teach a nurse everything he/she needs to know, but that's simply because, as Nurse Anne points out, there's just no way to cram all of it into 3 years.
A final point I'd like to make to OFMN.
Meanwhile, the course is held back by students and lecturers who can't find the on button to a computer and who are still forced to go through with a disastrous switch to computer working.
Sorry, but they're just going to have to get used to computers. The entire world is increasingly IT-based, not just healthcare. Like it or not, as time goes by any healthcare professional - actually any professional in more-or-less any walk of life - who can't use a computer is going to become more of a liability.
I'm not denying that the shambles surrounding the Spine etc, just pointing out that anyone who thinks the NHS can ignore the IT Revolution is living in Cloud Cuckoo Land
"The current syllabus is now called Making a Difference" - how very vomit-provoking.
Don't blame me, I didn't name it. Personally, I prefer the Welsh title.
Having known Luke at med school, I'd put him in the category of 'doctors you'd allow to treat your family'. It will be a loss to surgery and medicine, butI don't blame him one little bit. Personally, I may not return from New Zealand if the current situation continues (so that's potentially £500,000 of training lost to the NHS from me and Luke alone)
I find it interesting to see how many juniors i know are doing USMLE/Canadian/Australian Exams or visa interviews.
The people who were on the fast track to be surgeons etc who got totallt derailed last year are leaving as there is now little hope of them ever getting back into the weird system.
Zarathustra:
I completely agree with you. Part of my background is in computers, and furthermore I quite like them, which makes me such a boon to some of the lecturers (although I don't see why I should teach them something their hefty salary should cover). Just because people don't like it doesn't mean they should bury their heads in the sand, but that is - sadly - what some students and lecturers are doing. Silly when any person who works in a hospital knows how vital a modicum of computer knowledge is to get through a day.
Little medic - don't worry about lack of training due to the EWTD; no one seems to stick to it, at least in my F1 boyfriend's hospital. They just get paid according to it. He's just finished 7 nights on call that was timetabled as 12 hours on, 12 hours off, but in reality he was working much longer. By the time he'd got home and gone to bed it was time to get up and go to work again - yay! I'm getting fed up already of picking up the pieces he's left in after a shift, not just because of the hours, but because of the lack of time for teaching due to understaffing and patients being spread all over the hospital so ward rounds take hours. He's already talking about giving up medicine because he's so disillusioned with how it all works (or doesn't). Not to mention all the portfolio filling-in that he doesn't have time to do and consultants who tell him to make up his own assessments! I'm going away to the other side of the world for a month in a couple of weeks to do research for my PhD, and I'm not sure how he's going to get on without me. He's just too exhausted by work to look after himself properly.
It is really hurting to know that Medicos are leaving their professions because of insecure job nature, and less pay. Like Luke others also could find a better job, we people are going struggle without well medical facility...
Car Breakdown Cover
What a sad letter. Unfortunately, I also have friends who are in the same boat...some are trying to stick it out, others are looking to Australia and Canada.
As for the state of nurse training. Hmmm. As an old fart, I trained in the 1980s. We were regarded as apprentices- were paid a wage, had cheap accommodation on site and were expected to work a normal 42 hour week and fit our studying around this...lates, earlies, nights, weekends and bank holidays. We were never "supranumary" and were often just left to get on with it. We were certainly expected to be able to do basic nursing care (washing, dressing, feeding atc) plus administer injections, pass urinary catheters (female patients only), put in NG tubes, dispense medication etc etc. We were not allowed to give IV medication although we were allowed to change IV fluids under supervision (no machines were involved then, just learning how to calculate drip rates) and also prepare IV drugs(antibiotics for example) for administration....by law, we were not allowed to give IV drugs until we were qualified. However on qualifying, you attended a 3 hour course and then had to be supervised until the sister/charge nurse deemed you to be competent. The same went for venepuncture/cannulation- not all wards will require nurses to do these things as it can often be counter- productive...As for anatomy/physiology...I feel we did get a better grounding in these- P2000 opted for less science and more sociology as it was felt that nurse training concentrated too much on a "medical/disease model". Madness, as far as I am concerned...it quite rightly died a death. A neat idea imported from the USA that was then butchered. If you wanted to be really cynical- it cost alot less. You could train 3 P2000 nurses for the price of one of me (bursary £2000 a year vs salary around £490 a month, freeish accommodation at £40 a month with no gas/electricity bills/laundry bills/sick pay as you were a permanent employee, pension contributions etc etc). The bursary for the Diploma nowadays I believe is around £5000 a year, whilst the degree students are in the same boat as all uni students.
I left nursing school with my RGN certificate and UKCC registration number. Later, I went back to university part-time and did a physiology and biochemistry degree for my own interest/self development.
Current nurse training- I come into contact with lots of students and am amazed at the differences in experience that they have had. Due to student numbers, it is not uncommon to find a third year who has had all their placements in either clinics or nursing homes. They are taught communication skills in abundence but not always the relevent practical skills. I try to pair each student off with a staff nurse mentor plus a good HCA as an additional point of contact. I try to work alongside each one whilst they are with us. Unless they are on a management placement, I will have a day with them when I am not in charge and hope that this emphasises that we are all there to provide basic nursing care. We also have a structured teaching block that tries to bring them up to speed with acute medicine from a nursing prospective. This includes a list of common drugs that they are expected to find out about.
During my own training, we had a much more structured course (quite inflexible at times). The first ward I was placed on, I spent the first few weeks doing nothing but bedbaths and basic patient care. By the second year we were still expected to maintain these skills and were also starting to become involved in drug administration/team management/arranging discharges home etc etc.
The "Nurses Tale" struck a cord...even in the late 80s the staffing levels on wards were becoming a problem...one of the reasons that I hot-footed to ITU/HDU. At least here you could control the number of patients under your care and feel able to care for them properly...neither ward had any HCAs/Auxillaries so qualified nurses were always performing basic care.
Nursing is cetainly becoming more technical....does this mean that it will need to become a totally degree-based course (like physiotherapy and radiography have become)? Thats a tricky one. One of the best nurses that I trained with/worked with had left school with no formal qualifications- she took the basic maths/english test that was required back in the 1980s (not sure what this was called). She qualified as an Enrolled Nurse and then converted to an RN by completing a degree about 10 years later. She is still working for the NHS and is a senior sister on an elderly care rehabilitation ward (dealing mainly with stroke patients and those with dementia).
As an ageing biomedical science lecturer I had to snigger at the comment from OFMN about lecturers' "hefty salaries". I've been a lecturer exactly 21 years (after a BSc and PhD, 6.5 yrs total) and I earn about the same as a 25 yr old FY2 doctor with a 50% supplement does. While I'm not complaining about what I earn for what I do, it is not what I'd call "hefty" remuneration.
Concur with Zarathustra about the "contraints" on the level of teaching for things like anatomy and physiology. If the Nursing Depts admit a large chunk of their students without even A level science then of course the stuff will have to be delivered at rock bottom basic level. I have come across some notionally "science-based" Nursing degree courses where the students don't have to have even a single science-based A level. Personally I would have said the obvious solution was to send such students down to the local college to do an accelerated science A level(s) year. But then again the Nursing Dept PC-apparatchiks argues that such focus on science is "exclusionary"... and on the other side I have medical Professor friends who say that "nurses doing actual nursing don't need any science at all".
It just leaves the ageing hacks like me that have to teach them the physiology and pharmacology utterly confused.
A nicely penned letter and good luck to that chap. I'm in precisely the same position, albeit two years junior. I too would've liked to have put my thoughts down but I've been too busy filling in application forms for pretty much every part of the country as I'm so paranoid I won't get a job.
My girlfriend and best mate asked their companies (a bank and a consultancy) about me joining. They said quite similar to what Dr Solon was told. But, and whilst I wish Luke no disrespect, some of us really don't want to quit medicine. I know that being a doctor is what I am supposed to do, it's what I'm best at. I would hate working in an office. I don't mind long hours at all and I enjoy a job that uses my brain and hands.
Unlike many friends, I can't leave the UK, for family reasons.
So what option am I left with?
If you can't take the heat...
"the Nursing Dept PC-apparatchiks argues that such focus on science is "exclusionary"... and on the other side I have medical Professor friends who say that nurses doing actual nursing don't need any science at all".
Hmmmm.Unfortunately this type of thinking does seem to have taken over nursing schools at the moment. Personally, I am glad that I trained before this type of madness took over. When nursing degrees were in their infancy, they were originally 4 year courses with a much bigger emphasis on science. I myself decided to do a physiology and biochemistry degree rather than the nursing degree and am quite glad that I did. I feel alot more confident explaining, for example, how to interpret blood gas results, how a ventilator works, why a certain treatment was selected by the medics, because of this. The friend that I referred to in my previous post did in fact go back to college first to do an accelerated science A level course (biology and chemistry). The EN course was originally scrapped because the powers that be wanted to move away from a two-tier system. Now we have HCAs that are being turned into budget-class ENs- less formal training and no accountability. Personally , I think we need to insist on A levels in at least biology and follow our US cousins by offering nursing degrees that allow candidates for general adult nursing to graduate with degrees grounded in physiology/pharmacology, rather than sociology. Don't even get me started on maths skills. For the less academically able, bring back a diploma level course that will have the same constraints as the EN course did- as long as there is an option at a later date for these individuals to "top up" to the degree, if they are able/want to. It might not be very PC but at the end of the day as nursing advances, we need to be producing individuals who can take on the responsibility. PTs and OTs realised this a while ago.
so quit the system. fine. that's the real problem with doctors. highly trained and highly arrogant bunch of people (most).
Stay in the NHS, stand up and FIGHT!
Not for your friggin' money but for your patients!
You belong to the working class in the NHS so start the struggle!
PhD Scientist
Arguments about the size of lecturer paypackets aside, University staff should be fit to do the job they're employed to do. It's the 21st century, so that job involves a knowledge of how basic computer software works. If it's wrong of me to feel embarrassed and disgusted when a lecturer wastes half an hour looking for the volume control, then - as the old lyric goes - I don't want to feel right.
As for the point of soft skills, they are, of course, important. But if I don't learn any of the bread and butter physiology and pharmacology I also need you're not delivering complete care.
I, for example, recently spent time on a Neuro ward. I had to quickly find my feet and make sense of the physiological issues using the knowledge of my mentor and other staff. I have a feeling this is going to become more of a norm throughout the course.
Hi Ofmn
Surprised about your computer-inept lecturers. Science is so PC-based these days that almost all science lecturers I know are pretty computer-literate. Though lecture theatre lectern controls aren't exactly computers - it's more like wrestling with an intransigent microprocessor-based "smart dishwasher".
I am a physiologist by trade so I'm down with teaching anatomy / physiology / pharmacology etc... "It's m'job". It certainly can be done within PBL curricula (for medicine or nursing) provided you have the right curriculum / case design / teaching staff. But I suspect the quality control in the Nursing degrees is variable, especially given the rate at which the courses are springing up. And we science types don't "own" the nursing degrees (we are the "hired help") so the Nursing Depts set the syllabus. And it is also them who decide if it will be "policy" to admit people without A level Biology or Chemistry. We science geeks might think it's idiotic, but it's not "our" degree.
oh boy it just gets better doesnt it
I often think about leaving the UK but I tried it and I found the culture shock in NZ a bit too hard to take on my own.
Its different if you go with someone I think.
Also I went flat broke and that taught me a lesson
You only move abroad when you have plenty of money saved at least one years gross salary to cushion you starting up in a new place and to be able to afford a plane ticket back if it goes tits up.
You dont sell your house here you rent it longterm and you get a good managing agent and you keep it as a pension accessory
Im trying to get back into work after 9 months industrially injured by the NHS by bullying
Its not an easy road I often think I would be better flitting off to South Africa and setting up a private GP practice which I could do despite not having done the VTS and because Im good at both psychiatry and general medicine would be so easy.
In fact its a plan for me the moment I can get out of here.
The moment I reach the magic figure of the savings Im leaving
Yes South Africa may be a little dangerous but at least no one bothers you if you settle in a decent area and you avoid certain districts of Joburg
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