Junior Doctor: TRANSACTION OR VOCATION?

98% of junior doctor’s voted for the 72-hour walk out over pay and conditions that will begin on Monday (13th March). Having been a junior doctor until late last year (and being married to one!) the outcome was not a surprise, but I must admit that the margin of support was.

Titles in healthcare can be very confusing but for clarity, a ‘junior doctor’ is pretty much considered to be any qualified doctor who is not a Consultant / GP. This covers almost 48,000 doctors, from newly qualified to surgeons with a global reputation who qualified over 15 years ago. These are people who matter and who are making the decisions that keep you and your loved ones safe, particularly out of hours.

So what?

This ballot result adds junior doctors to the list of healthcare workers taking industrial action. This can’t be a coincidence. In a world made up of vocational, caring professionals, what has caused this fundamental shift in the sector’s psyche? 

For doctors, has the 2016 contract put additional focus on the payslip? For example, a new line on the payslip is entitled ‘Exception Reporting’. This was introduced by the 2016 contract and results when a doctor electronically reports where the hours they work doesn’t match the work schedule on which their pay is calculated. The aim being that if this happened regularly, the department would have to revisit the rostering model. The outcome for the doctor is an extra payment made for the time worked, making doctors more aware of what their effective hourly rate is. Has the contract inadvertently resulted in making doctors hourly paid workers rather than salaried, vocational professionals?

Rota rules have also seen the end of the ‘firm’ structure. That’s where you work as part of a consistent clinical team: You know them; They know you; and they know what your goals are (personal and professional). The end of the firm structure makes it more difficult to foster a true sense of team ownership and belonging. I think I worked with my Clinical Supervisor once in my last 18 months. You are a name in a rota gap, not a valued doctor being trained to be a leading clinician in your chosen field. The result is a stretched workforce (physically and mentally) that is struggling to feel valued. Your sense of job satisfaction has gone. Has it become purely transactional? Perhaps to the point where value is now only felt in the pocket rather than through a sense of belonging, growth and job satisfaction? I can’t help but feel the balance of reward has shifted and the 26% sought-after uplift in salary could be lower if goodwill, training and culture hadn’t suffered as well. Does this signal another way out of this that isn’t purely financial?

Of course, COVID-19 has certainly exacerbated things. But I don’t think it created these issues. What it has done is force junior doctors to put their careers under the microscope and ask the question – how does society value what we do? Do I, as a junior doctor, need to value myself and my time differently?

How do you measure your own value? Is it different to how your employer measures it? Is there an ideal balance of pay (quantifiable) and goodwill/training/culture (non-quantifiable)? I would love to hear your thoughts.

#NHS #Workforce #JuniorDoctors #IndustrialAction #Strikes #Culture