Sunday, March 04, 2007

Save The White Coats!

‘Thought of this week’ has to be awarded to doctors. As a psychiatrist I often have the job of being an advocate, and this week my advocacy skills have been an essential part of supporting my own colleagues. Junior doctors are the engine of every hospital and without them the NHS would grind to a halt. However, this week they have all been subjected to a job application procedure under Modernising Medical Careers (MMC), that many have called an ‘unethical double blind trial’.

To give a brief summary, all doctors in training were asked to re-apply for their jobs via a computer system. Some have since been offered interviews, but about 5,000 plus doctors who have not, now face unemployment. I have seen at first hand some extremely talented and dedicated doctors not being offered a job interview, yet absolutely no explanation has been given as to why not. Others have been offered jobs in other parts of the country and are now facing up-rooting their entire family to relocate to another district. The unaccountable application system is being challenged by Remedy UK and I have offered them my support.

If you would like to also support these doctors there are several things you could do:
1) Join ‘the white coat March in March’ on the 17th March, which will start at 11am at the Royal College of Physicians.
2) Sign the Early Day Motion 737 (Junior Doctors Training)
3) Pass on this information and please do post a comment of support – I know many doctors this week who are in need of support.


jmb said...

Hi Michelle,

I had read about this previously over at Trick-cycling for Beginners. It just sounds too incredible to believe. 5000 doctors trained at incredible expense and personal sacrifice thrown away. Of course, this insane system will never work and ultimately it will be changed when saner heads prevail. In the meantime these individuals are subjected to the incredible stress of the process.
I do hope the measures to fight this are successful and it never actually happens, but unfortunately "slow learning" often affects decision makers.

Best wishes from Canada

David Anthony said...

This seems crazy to me. My mother works for the NHS and she told me about this last week, no one on the front line of services understands it.

If all junior doctors went on strike tomorrow it would cripple the NHS. I know they won't because they are professional and caring (why they went into the NHS in the first place).

More mismanagement from the government and now no support for their own mistakes. this should be bigger news than it is. thanks for bringing it up.

Maalie said...

Has the country, in fact, trained more doctors than it needs?

Whatever the answer, there appears to have been some mis-management somewhere along the line. I heard the Prime Minister in PMQs asserting that the Government has been responsible for an increase in the numbers of doctors and nurses. Has there been an error of judgment somewhere?

QUASAR9 said...

hmmm can I play devil's advocate

Since doctors and the pharmaceutical industry are so cavalier about condusting trials on patients - (see link on previous post) - then perhaps doctors can also be submitted to ‘unethical double blind trial’

What I don't understand is why the relocations? were they due to be relocated? - In the forces you don't get a choice, if they need a field doctor in Iraq, Belfast or Cyprus .. you go where they send ya

And I don't understand the 5,000 not offered a place. Do we have a surplus of doctors, or did they not make the grade?

If students don't get their first or 2nd choice at Uni - then they get a 3rd choice

Anonymous said...

Junior doctors have a voice and although they may be inside the hospital most of the time - we must all remember to 'care for the carers'.

Dr Michelle Tempest said...

THANKS to all of you who have posted here tonight.

jmb - Remedy UK are putting up a good fight and the battle which rumbles in every hospital is certainly not over.

david anthony - Doctors don't go on strike, although I have heard that they are thinking of not signing death certificates as a protest, which would cause the mortuary to fill up. Lets hope they get listened to before then.

Maalie - We were very short of doctors and have subsequently thankfully trained more over the past few yars. As a country we also recruited doctors from abroad. We needed more doctors to help us comply with the EWTD (european working time directive). Working at the coalface of the NHS, I can assure you that we don't have an excess of doctors.

Quasar9 - Doctors did not join the army, they joined the NHS. It is not that these doctors did not make the grade, many of them have passed very difficult membership exams. Infact the computer forms they had to fill out were not meant to highlight previous experience - yet experience is a good thing. I am not sure what will happen, but the doctors involved are understandably baffled by the relocations.

Abi - thanks for support.

Thanks so much for reading the blog.

Midwife with a Knife said...

This system is crazy. I hope there's some help for the docs left in the lurch. I think that the not signing death certificates is a great idea (although I hope it doesn't come to it). That's a great way to get the point across without sacrificing patient care.

Steve & Barb said...

Michelle and my other colleagues on the other side of the pond--

This whole business sounds pretty insane, but I am still trying to figure out the terms, which are different than in the US.

I still can't figure out the American equivalent of a "senior house officer" and of a "junior doctor". And what is a "specialist registrar" and a "foundation trainee"?

make it simple for this psychiatrist:

med student
practicing doc


simon said...

We are very short of Doctors here in Australia.....

Dr Michelle Tempest said...

Thanks for the comment midwife with a knife.

Thanks Simon - Many British doctors are thinking of going to NZ or Australia - many of us been offered jobs there. However, we also need them here and we are not valuing them!

Roy - thanks so much for the comment. I am a little unusure as to the US system. But I think the US to UK words go:
intern is a PRHO
resident is an SHO
fellow is a Registrar

So the 'junior doctors' re-applying for jobs, are not really junior at all.... they are the specialists. They are after their intern years are akin to residents and fellows. So they really are the power house of medical knowledge and I for one don'e want to loose their skills from this country.
Thanks so much for your comments.


Anonymous said...

I'm signing up to the 'save white coats campaign' - thanks for the post Michelle.

QUASAR9 said...

Michelle, this argument always sounds peculiar if not down right strange to me.
We are importing doctors from European Countries, with the additional cost of relocation expenses, we are importing doctors from Africa & elsewhere from the ole Empire ...
and yet we cannot offer junior doctors a place when they qualify?
So they look to New Zealand & Australia.

Maybe it is just that they can get a decent sized house and a decent garden and a large car with no parking fees or congestion charges or high priced petrol ...
They can't be getting offered higher wages than we are offering EU doctors in Britain.

I guess it's all down to what you want from your career or life.

But I think with doctors, since they are in a privileged position, there are only so many places in training (whether you can pay or not) - the least they could do is work for the nhs for a few years.

Could be we are shifting the focus away from patient needs, to doctors needs, but alas - that has been the criticism since 'people' had to have a licence to practice.

There is something perverse about healers & surgeons - being motivated by student debt or size of mortgage to choose where or what to practice.
This is the real disease in the NHS

If they were not burdened by medical school fees and coulf get a four bedroom council home for a £100 a week, their NHS wages would be fairly handsome reward, more than enough but for the greedy.

You can put whatever spin you like on it. But that is where The Rub Is.

Anonymous said...

Good to know you support us Michelle. Thanks STR

Midwife with a Knife said...

Roy: A british student goes straight from their version of high school into a (I think, I may be wrong here) 6 year medical school which is the equivalent of US undergrad/premed and medical school combined. Then they go on to their PRHO, SHO etc postings for their equivalent of our residencies. What seems a little weird to me (and this is just what I gather from reading blogs) is that they seem to seek the positions out themselves and may do their residencies in multiple institutions. From what I can gather, they don't have an equivalent of the U.S. residency and fellowship match, although this MMC/MTAS seem seems a lot like a botched implementation of the National Resident Matching Program. I have to say that even in the US, the match seems kind of like a weird system for allocating jobs. But as current matters in Britian prove, I guess it could be worse!

Steve & Barb said...

Thank you, Michelle and MWWAK, for the interpretation. Regarding the US Match, it is a bit weird, but I understand how it got to what it is.

It used to be that in the 4th (final) year of medical school (this is after 4 years of college), they'd go all over the country interviewing for 3- or 4-year residencies for combined general and specialty training, or 1-year internships (general training) prior to committing to something more extensive. However, what would happen is that they would agree to take on positions at more than one place, finally holding on to the best one and ditching the rest.

This resulted in a lot of chaos for 2nd tier training programs (and even the top notch ones... imagine committing to both Hopkins and Harvard). The result was the Match system, where all the 4th-yr students create a priority list of where they want to go, best one at the top. The programs also create a list of the candidates they like the best.

Finally, the lists are put into a computerized matching program which is designed to maximize the chance that students and programs get the highest choice in their lists. That day is called Match Day, and is held simultaneously on March 15 every year. All participants agree to go to whatever program they match with. The idea is that you only list programs that you would be willing to move to. Most people probably list between 3 and 10 programs and interview at an average of 12 or so programs.

There are always a small percentage of students who do not match and program slots which do not fill. There is a mad scramble for a couple days until they get settled as well. I don't recall how the international medical grads fit into this system, but they do fill a substantial number of slots.

This MMC thing sounds like it is more one-sided. And, it sounds like it happens towards the end of one's training, not at the beginning. That's just not fair.

Dr Michelle Tempest said...

Quasar9 - thanks for your comments. I am pleased to say that most doctors do seem to work for the NHS, and they have been applying to continue working there.

MWWAK - thanks for explaining the US/UK differences more clearly.

Roy - thanks for the comment. Perhaps we should adopt the term '1 sided Match Day!'

Thanks for the comments