Rachel Clarke: Cheap, undervalued, expendable—junior doctors in 2017?

NHS trusts are still treating junior doctors as if they are expendable at a time when low morale should be a priority

A family friend isn’t happy. Fresh from graduation—and only days from beginning his first proper job—Sam has yet to set eyes on a contract, a rota, or even basic information about what he can expect to be paid. And no, he isn’t embarking on a career as an Uber driver, Deliveroo courier, or some other ad hoc entrant into Britain’s burgeoning gig economy. Sam is a final year medical student. Five A-levels, a degree in medicine, and another in science under his belt: he is the kind of graduate big firms would leap at. But the employer failing him so dismally—before he’s even started life as a doctor—is Britain’s biggest, the NHS.

Sam’s experience is far from unique. As is depressingly usual for July, junior doctors and medical students have been peppering social media with forlorn posts asking their peers what to do about their new employers, the NHS trusts flatly ignoring their pleas to provide them with a contract, rota, and confirmation of their salary in advance of starting work.

These requirements are hardly outlandish. In what other job—graduate entry or otherwise—are you expected to sign a waiver opting out of the European working time directive and start work without being given any information whatsoever about what you will be paid or what your working hours will be? It says something about doctors’ capacity to accept their lot that any one of us tolerates being treated with such corporate disdain.

A colleague, only three years into her training, summed it up to me like this: “I just assumed this must be how it’s done in medicine. Whenever I’ve asked medical staffing for a contract and salary details before starting work, I’ve been made to feel like I’m doing something wrong just by asking. The implication was that I should be grateful I had this opportunity to be a doctor, so just stop being so demanding. When you look back on it, it’s madness.”

Madness indeed. Another colleague describes being called out of the blue by his HR department shortly after being signed off sick for a fortnight. Despite having informed his seniors of his absence for serious illness, HR informed him that they expected him to find his own locum cover, that the rota gap was his own fault, and that it was unprofessional and unacceptable that he had not himself somehow filled it. “It was humiliating,” he told me. “I was vulnerable. But they expected me to email my colleagues, explain my health problems to everyone, and persuade someone to cover for me. It made me feel as though I wasn’t valued in the system at all.”

One of the glimmers of hope emanating from last year’s dismal dispute between junior doctors and the government was the unprecedented chorus of pledges from every powerful institution within the medical establishment to tackle the problem of rock bottom morale among doctors in training. I thought—perhaps naively—that this would mean proper action, not mere words. So how is it that a full year later, in July 2017, NHS trusts are still getting away with treating their newest doctors—the ones filled to the brim with hope and enthusiasm—with such frank disdain?

Is it really beyond the combined might of the health secretary, NHS England, NHS Employers, the GMC, and Health Education England—all of whom have promised to get serious about addressing low morale in an alienated doctor workforce—to ensure that trusts can no longer exploit their youngest and most vulnerable medics in this manner? And, at least as pertinently in an era of unprecedented NHS staff shortages, can any of them really afford not to? Around one in 10 specialty training posts were reported unfilled this year. So on basic economic grounds—if not those of decency—ensuring that juniors aren’t made to feel cheap and expendable ought to be a top priority.

Responsibility rests most obviously with individual employers. There are 152 acute hospital trusts in England. That means there are potentially 152 trust CEOs who are either choosing to turn a blind eye to or—worse—simply not caring about the fact that the institutions they lead are failing to provide their junior doctors with such basics as a contract, a rota, and a confirmed salary before employing them. There may well be individual trusts who can confirm that none of their junior doctors are being treated in this manner. But can all trust CEOs guarantee that from this point onwards, none of their junior doctor employees will be subjected to these practices—and if not, why not?

Rachel Clarke is a specialty doctor in palliative medicine based in Oxford. Twitter @doctor_oxford

Competing interests: None declared.