11 years later and I am finally done.
It’s been 11 years since I graduated as a doctor and first stepped on to the wards of a seaside hospital, terrified and trying not to show it. In the intervening years I have undergone ‘training,’ a word wholly insufficient to describe the crucible-like experience of being a junior doctor. What comprises ‘training’ in today’s NHS is a gruelling obstacle course of shift-work, exams and stress, lasting, at a minimum, half a decade.
My 11 years of time served included periods away from the pressure cooker, spells abroad or on maternity leave, but I always had to return to complete my training.
The coveted CCT
No more. I have earned my stripes with the coveted acronym of CCT, the ‘certificate of completion of training’ and am finally fully accredited. No more ‘junior’ status for me; I can just be.
Any momentous transition comes with a period of reflection and this one is no different. As I finish this part of my career, I can’t help but look back and acknowledge the people who influenced me. Like the end scene in Titanic, I see past figures, colleagues and some patients, as I walk down the staircase, back in time.
Training, by definition, means being taught, therefore, after 11 years I am left with an army of mentors. Some of my most formative were in my first few years of training, where, with little experience of my own, I looked to my superiors for guidance rather like a baby looks to its parents. I remember one formidable medical registrar from my first year as a doctor who took to the parental role like a duck to water. Gathering a brood of junior doctor ducklings under his wing, he would take us to the hospital Costa and then over Americanos and Red Berry Refreshers would impart his own personal take on how to practise medicine.
“Never forget it’s a job,” he said. “You do some work and then you go home, no different from any other person. There’s no point in staying late if you’re not being paid for it.”
I remember feeling incredulous at this. Us first-year doctors were regularly staying many hours after our shifts ended to get everything done. Downing tools at the day’s end may have been possible with other jobs but not with medicine, surely? What about the patients? What about being a good doctor? At the time, I ‘hmmmed’ politely at the registrar’s comments but dismissed them as that of an eccentric.
Today’s NHS is a shadow of its former self
And here we are 11 years later. The health system I work in is not the one in which my registrar waxed lyrical over a Costa coffee. It may still be the NHS but it is not the one of 2012. It is not even the NHS of 2020. It is a beleaguered institution being kneecapped whilst tied to a chair, a shadow of its former self. I recognise it, but in the way I would recognise a patient presenting after years of chronic disease: gaunt, frail, tired.
Tiredness. Yes, that’s the word. We are all so very tired. The country in general is tired of the state of the NHS. With little let-up between a pandemic and the plunge in living standards, no one had a chance to recover. People are dissatisfied and squeezed. Strikes (not just in health) are now so commonplace as to hardly make the news and years-long waiting lists are the norm. This is the healthcare system I now step into.
Medicine is a job
The registrar’s echoing words take on new meaning.
“It’s a job.”
It is. Medicine is a job. It can be found in any career’s directory, but those who go into it often regard it as something more. That is why most doctors will go above and beyond e.g. staying long after a shift’s end, to complete their job to the highest standards. The problem is, in today’s system, the job cannot be done to the highest standards. Access to timely specialist care is so much of a lottery these days, even if one practitioner works to the highest standards, they can only do so much in isolation.
As the system clogs, the workload falling to each individual practitioner increases. To do the minimum for all the patients on the list and crucially to practise safely, necessitates many more person-hours than are scheduled. Little wonder then, that clinicians, who have been under sustained pressure for years even before the pandemic, have finally had enough and are looking for jobs with better working conditions.
These are thoughts I turn to as I graduate into the next chapter of my career. Can I sustain another 40 years in a healthcare system like this one? What are the alternatives for me? As I go about my daily life I look at every working adult and size up their job, trying it on in my imagination. Could I become a stocks trader, I think to myself, seeing the fancy-suited business people hopping off at Canary Wharf? What about a librarian? Or a baker?
Not all careers are estimable. The other day I was watching a banal children’s video on YouTube at the behest of my three-year-old nephew. A presenter walked round the zoo, squealing at the animals.
“You know he’s worth millions?” says my sister. “He created it himself then sold it to the people who own CoCoMelon.”
I look disbelievingly at the man prancing on the screen and rue the choices that landed me as a medic as opposed to a multi-millionaire YouTuber.
Key workers treated with contempt
I trained for six years to become a doctor and I still believe the job is one of the most valuable in the world and yet, we have swung back to the pre-pandemic status quo. On one hand, public servants, previously lauded as key workers, are now treated with contempt as they strike for better working conditions and pay. On the other hand, a children’s influencer is worth millions.
“Why didn’t you do something like that?” my mother asks, pointing at the screen.
Although it’s said in jest, we’re all wondering whether it was the right decision to become a doctor as opposed to another career that has less risk and better pay.
“I was too busy getting a medical degree,” is my dry reply.
Not for the first time in these 11 years, I question my choices.