Junior doctors need to be empowered and supported within the system, to feel a part of it, and to feel supported in achieving their goals
Morale among junior doctors in the UK is at an all time low and resignations from the NHS are rising. Suicide among doctors is a huge problem. Two of my paediatric colleagues died from suicide in the recent years and there have been many reports of other doctors taking their own lives due to the pressures of their work. Female doctors are reported to be four times more likely to die by suicide compared to females in the general population, with complaints being made against them a risk factor. These problems need to be acknowledged and changes made within deaneries, hospital departments, trusts, and the wider NHS.
Much has already been written about the need to prevent suicide in medical staff. In a column in The BMJ, Clare Gerada wrote about the need to “Stop the name, blame, and shame culture that’s now institutionalised within the NHS; create spaces for staff to come together, to learn and reflect together in their teams—not in sterile spaces online but in real, protected places; and maybe create, at board level, a lead role solely to tackle the wellbeing of all staff in an organisation.” Support services and dedication trainee support leads should be rolled out across all deaneries to ensure that everyone is able to access help and support if they need it. Trusts could run training sessions e.g. safeTALK sessions, to help us identify those who are struggling and signposting them to accessible places for help.
As well as implementing some of these systems changes, we need to look at other reasons why morale among junior doctors is so low. Junior doctors usually begin their training full of energy and enthusiasm for their profession. But this can dwindle away. When Robert Francis was investigating the Mid Staffordshire Trust’s failings in 2013, he said that doctors had developed “professional passivity” This “passivity” comes from feeling that raising issues of concern receives no response, and being ignored leads to disengagement. Many clinicians conclude that “the system” has let them down. The fact is though, that we are “the system” and we must learn to engage with it in order to change and improve it.
To remedy this, junior doctors must be encouraged and enabled to be involved in professional development opportunities, including leadership and research. My colleagues are often not permitted to do so as service provision is the priority. This is short-sighted. The National Institute for Health and Care Excellence (NICE) recognises how important flexibility is in maintaining a doctors’ wellbeing. Developing non-clinical skills is important for the future of training and healthcare as a whole, but most importantly these skills are important to help clinicians make sense of the complex system we find ourselves in. Having the opportunity to develop leadership and research skills could improve trainee satisfaction, and therefore improve hence retention and recruitment rates.
Things are on the cusp of improving. Quality improvement is now strongly advocated among junior doctors. However, rather than being a “box ticking” exercise we need to learn about the managerial side of the NHS so that we can make beneficial changes. My current place of work develops these ideas with regular meetings with Head of Service and managers This enables all of us in the team to highlight problems and work with the managerial team to resolve them.
Some of the things that we are made to do, for example some of the “mandatory e-learning modules”, should be reviewed. Thankfully, one trust I worked in solved this by reducing the number of modules that needed to be done from twenty to three. The spare time could be used on useful activities, for example, discussing difficult cases or discussing ideas to improve departments.
Restrictive and inflexible training programmes need to be reviewed so that trainees can train more flexibly and shape their own training. It would mean that junior doctors would engage more and stay in posts that are beneficial to their career. Training schemes provide invaluable support and camaraderie, so the optimum solution would be to weave the concept of freedom of career progression into programmes. This would be preferable to the “escalator” approach where we automatically move from one stage to the next. Trainees should be allowed to find their own posts and perhaps interviews should be reintroduced for competitive jobs to encourage trainees to develop their portfolios to support their chosen career pathways.
Mentoring schemes are also hugely beneficial. I developed a peer mentoring scheme within my deanery and the engagement was fantastic. All of the mentees and mentors found it useful and would advise others to partake. Mentees feedback that it helped them feel more engaged and beneficial to their wellbeing.
Junior doctors need to be empowered and supported within the system, to feel a part of it, and to feel supported in achieving their goals. Levels of happiness in a workforce correlate with good patient outcomes. As Julien Warshafsky, the father of an anaesthetic trainee who died said, “Take good care of the carers and then the carers can and will take good care of patients.”
Nicola Storring, neonatal registrar, Paediatric Cardiology Department, Evelina London Children’s Hospital, London
Competing interests: None declared
Acknowledgements: Thanks to Coral Akenzua, Hilary Cass, Clare Gerada, Sethu Wariyar, Laurel Spooner, Claire Mearns, Sophie Sakmann for their advice, and comments on this piece.
References:
- Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery office. February 2013
- National Institute of Clinical Excellence. Mental Wellbeing at Work. Public Health Guideline. 5th November 2009
- Dr Hilary Cass, Dr Clare Gerada. RSM Podcast – Acutely Unwell Children, their Parents and the Crisis in Paediatric Care. Last accessed 8th of July 2018
- Nicola Storring. https://www.e-lfh.org.uk/programmes/medical-mentoring/. Last accessed 8th of July 2018
- Carolyn Wickware. Top GP Issues Mental Health Warning as 400 die by suicide. Pulse, 3rd September 2018
- LivingWorks. https://www.livingworks.net/programs/safetalk/. Last accessed 8th of July 2018
- Gregory Dodell. Finding Fascination in Medicine Again. Available: https://www.medscape.com/viewarticle/898550?nlid=123490_3243&src=WNL_mdplsfeat_180703_mscpedit_imed&uac=191469SY&spon=18&impID=1675501&faf=1. Last accessed 8th of July 2018
- Rod Storring. Staff Satisfaction Surveys. BMJ June 2009
- Clare Dyer. Julien Warshafsky: how this doctor died and what it tells us about the system that failed him. BMJ June 2018