This week we meet a hospital doctor, who discusses changes to the medical career ladder
"I’m a junior doctor working in a reasonably big teaching hospital. My official grade is Core Medical Trainee Year 1 – it used to be a Senior House Officer (SHO), which people might be more familiar with, but the terms have changed and it’s now based on the number of years you’ve been working. I’ve been a doctor for three years. When you finish medical school you complete a two-year foundation programme and then pick broad specialties: whether you want to be a medic or a surgeon, for example. That’s the point I’m at now, and after a couple more years I’ll pick a sub-specialty.
Our training changed a few years ago through the Modernising Medical Careers (MMC) programme. There’s a lot of emphasis on continuous reassessment of doctors, and the way in which we apply for jobs has also changed. Some people used to get jobs through their mates and not be properly assessed throughout their entire career; but that was dangerous, so we now keep a portfolio and have it assessed twice a year. It can be annoying to keep up to date with the forms and formalities, but fundamentally I think it’s for the best.
MMC also aims to shorten the length of our training between leaving medical school and becoming a consultant, in an attempt to bring more consultants into the NHS.
This has been quite a fundamental change. You used to just apply for jobs of a higher grade when you wanted to; you could stay in an SHO grade for years, slowly pass your exams and work out what speciality you wanted to do after trying many specialties; then apply for a registrar job in that field. In the new system, though, everything has become very streamlined.
Junior doctors now apply for jobs simultaneously through a single system, rather than everyone applying individually on the basis of references. It’s quite stressful and very competitive, especially if you want to work in London. It also means that instead of people concentrating on doing their jobs well, they are trying really hard to jump through hoops and do their work in such a way that they can tick boxes on an application form.
It’s fairer, in that promotion is based on what you’ve done rather than who you know, but I don’t think enough emphasis is put on how you’re performing on a day-to-day basis at your job; whether your boss likes you; whether you’re the kind of person that people want to work with. Too much emphasis is put on whether you can score enough points.
Also, although it’s good to have made training more structured, it seems that learning for the sake of learning isn’t credited as much any more, which I think is a real shame. I’ve worked with surgeons who spent years as medical registrars, and they are amazing because they know their medicine really well. They know how to look after the patients brilliantly. Now that sort of experience is thought of as a negative; you’re thought of as indecisive.
The European Working Time Directive has also changed how we work. It puts a cap on our working hours, and has completely changed how our rotas are structured and how the teams work. There have been some issues as hospitals may not have been particularly well set up for it, and it has affected continuity of care. Although it has improved patient safety in the short term – doctors shouldn’t be putting themselves or other people at risk by working while absolutely exhausted – the combination of a shorter training timescale, and working fewer hours, means consultants will be making senior decisions with less experience, which may not be so safe in the longer term.
Overall, though, it has been a positive change, particularly from the point of view of a doctor who also has a young family: you can actually now be a junior doctor and a mother. Twenty years ago that would have been really difficult without a full-time nanny.
One thing I’d like to change is the storage of information within the NHS, which I think is really dangerous. Medical records are separate for each hospital. Although in theory they are centralised through GPs, this depends on people keeping files up to date and patients being able or willing to tell us where their records are. So we could have situations where patients go from hospital to hospital getting different care from different people, or seeking treatment they don’t necessarily need.
Other big employers manage to get everything centrally on to a computer system, whereas our records are kept in big folders in hospital basements. The NHS has been trying to change it for years, but every time people complain about data protection. People don’t realise it’s dangerous that we don’t have immediate access to your medical records. All health care professionals have had criminal record checks; they should be allowed access to your records centrally. We don’t have a private healthcare system: you don’t just go to one hospital when you’re ill. Under the NHS you could be treated in several different hospitals, so if you want to be treated by the NHS I think it’s reasonable to accept that your information should be available to the doctors who treat you."