Saurabh Jha: Britain’s junior doctors are not apprentices

Saurabh_JhaIt was Boxing Day weekend. The consultant surgeon summoned the on-call team. “We face a calamity,” he said. The house officer had called in sick. The locum wasn’t going to arrive for another 12 hours. This meant that I, the senior house officer, would have to be the house officer. The registrar would take my place. The consultant, looking tense, would have to be the registrar—i.e. a junior doctor again.

“Junior doctor” is a misnomer because it implies a master and an apprentice. Running the National Health Service (NHS) are apprentices who become Jedis very quickly, and without a Ben Kenobi showing them the ropes.

I’ll never forget my first night on-call in the emergency room (ER). I was one of two junior doctors managing a busy inner city ER in London from midnight to 8 am. Just a year earlier, I was an errant medical student bunking lectures. Now I had to see people with heart attacks, strokes, and broken bones. Seeing the terror on my face, the senior nurse reassured me. “Just look as if you know what you’re doing. We’ll handle the rest.”

This is the way it was, and had to be, in ERs across Britain. There weren’t enough consultants, or even registrars, to work overnight—when the sickest and most violent punters attended the ER. Guarding the hospital entrance, NHS’s sentinel guards, were junior (really junior) doctors. Today the juniors get more support. Even so, most physician care in the NHS is delivered by juniors.

ERs are consultant-run in the United States. The comparison with the US is instructive. Residents (junior doctors) are paid less in the US but they are treated like apprentices. Their training is structured. They are supervised. They get protected time for teaching, away from clinical work, every day. Importantly, their training is shorter. This couldn’t be more different in the NHS. It takes eight years to be a consultant in the ER in the NHS. It takes four years in the US. The difference is that junior doctors in the NHS spend time not being trained, but doing what consultants do in the US. Many patients never see a consultant in the NHS.

Jeremy Hunt wants junior doctors to work more for less pay. But junior doctors already save the NHS money. Ideally, hospitals should be hiring more consultants to lessen the workload on junior doctors, so that they can enjoy genuine apprenticeship. By taking on junior doctors, Mr Hunt will drive away the goose, which would have laid golden eggs for Britain’s healthcare, to places such as Australia and Canada. The NHS faces the prospect of junior doctors leaving its workforce in droves.

I am reminded of India’s nouveau riche who are penny wise and pound foolish. They undercut the rickshawallah but happily pay 10 times as much for coffee in premier hotels. The NHS breathes because of junior doctors. Not only do they do the bulk of the clinical work, but a lot of the teaching. I remember, as a medical student, a house officer who after a 36 hour brutal call still insisted on teaching. Our exams were a few weeks away and he felt we needed more practice examining patients. In return, he asked only that we buy him a drink. He had no obligation to teach. It was sheer goodwill—a quality abundant in junior doctors. Goodwill should not be taken for granted. Replacing goodwill will be very expensive for the tax payer.

I implore Mr Hunt to succumb to reason. Listen to the junior doctors. Be magnanimous Mr Hunt, and shred the new contract.

Saurabh Jha is an assistant professor of radiology at the University of Pennsylvania School of Medicine. Follow him on Twitter @RogueRad 

The views expressed in this blog are solely of the author and do not represent the views of the institution.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I would like to declare the following: I have received a speaker’s fee from Toshiba.