28 April 2016
Delving beneath the Junior Doctors strike
The case for the reform of medical education
by Trish Knight, Healthcare Workforce Specialist
As we work through a week in which junior doctors withdraw their support for those needing emergency care as well as routine treatment and many thousands of patients are, at the very least, being inconvenienced, perhaps we should stand back and look a little deeper. As other clinical professionals try to cover the gaps in cover, the media is beginning to realise that this is not a straight argument between the government and the medical profession about ‘seven day’ services. It is also clear that, when the dust has settled, the political landscape of medicine will have changed, with the power of the Royal Colleges and the BMA significantly reduced and the Government realising that they have been bruised by taking on the role of employer. It is to be hoped that the real employers, the Trusts, will quietly solve the problem by using the contract framework to negotiate locally acceptable arrangements with their junior doctors, but there are other less obvious issues that should not be swept under the carpet. Behind all of this lie the much more difficult questions of how we should educate our doctors, whether the present system is fit for a modern flexible health service and who is protecting the power base that comes from maintaining complex and lengthy training arrangements.
So how does it work? At present those with high academic qualifications and caring aspirations enter medical school and do their five year training at university. While this studying involves some clinical experience they do not actually qualify as a doctor until they have completed their first year of Foundation Training. This initial practical experience is followed by a second year and most will reach the end of that. It is then that the problems begin to emerge. The number of those who decide to take a break, go abroad or leave prior to Specialty Training is frightening, especially considering the time and resource invested in them. Reports suggest that in some regions only 50% now cross this hurdle and enter the long haul to become a Consultant (6 to 8 years) or a GP (3 years). Why this tremendous dropout rate? Is it the thought of those long years with little or no autonomy over their location or work/life balance? Many suspect it is. It may also have a lot to do with the tension that will exist in those years between the role of providing a ‘service’ and the need to learn and develop. As the NHS becomes increasingly stretched, the needs of the patient tend to predominate and this dichotomy can become intolerable.
The doctors in this long training period are the ones in the front line of the strike. They are paid a good wage and have exceptional training and supervision paid for by the tax payer. However, it is obvious that they are extremely unhappy, despite being offered an average pay rise of 13% if they accept that working weekends is part and parcel of their role, as many other clinical professionals, especially nurses, have done for many years.
So why don’t the senior members of the profession and the medical educationalists change the system and so solve the deeper problems on a longer term basis. It is within their gift to make the necessary changes but the will and leadership is not emerging. It would appear that there is a belief that such a change will lessen their professional and social power. Only a few are beginning to realise that, without change, the provision of medical care will become so stretched that other solutions will have to emerge to take up the shortfall. The medical profession has to provide an alternative to the long and highly resource intensive route to becoming a consultant. The solution is surely the development of a shorter ‘in house’ training route which allows safe and efficient practitioners but within a limited field of practice and subject to more senior supervision. This should not supersede the existing training pathway but run alongside it so that doctors have a choice. Those with family and caring commitments would undoubtedly welcome this option, allowing them a quicker route to practice in the profession they chose without having to take the full burden of the present day Consultant.
The medical profession needs to swallow its pride and accept that the care of patients will be greatly enhanced if they embrace this alternative, welcome the new found workforce supply and savour the renewed reputation it will give them.
Please click here if you would like a weekly email on publication of the Shaw Sheet
