Covid-19: Junior doctors are worried about their physical and mental health

Rachel Scott, Rory Heath, and Emilie Lostis explore how trainees are feeling at this time of change and uncertainty

Covid-19 has rapidly forced the NHS to reshuffle its facilities and workforce to cope with the impending influx of patients. The new measures are already having an impact on junior doctors; job rotations have been suspended, study leave, and teaching programmes have been cancelled, and many trainees can expect to be mobilised to high demand departments.

We recently collected a range of views from foundation trainees to see how they are feeling about working during the pandemic and any concerns that they have. 

Firstly, junior doctors are worried about their health. Trainees reported concern over working longer hours and the likelihood of contacting suspected or confirmed cases of covid-19. 

Working longer hours will be necessary to cover inevitable staff shortages resulting from sickness and staff self-isolating. Concerns about working with large numbers of patients with covid-19 have been exacerbated by fears of inadequate supplies of personal protective equipment (PPE) in hospitals, despite government assurances that the UK has stockpiles of such equipment.

Trainees are even more concerned about their mental health than their physical health. Anticipation of an overwhelming workload, loss of senior leadership through staff shortages, difficult ethical decision-making and clinical uncertainty were among the issues raised by respondents.

Unfortunately, the risk of becoming unwell with covid-19 naturally extends to doctors’ families and close acquaintances. As a result, the majority of the junior doctors that we heard from said they had avoided seeing older or unwell relatives. While isolation has become necessary and commonplace in the UK, it cuts off already stressed doctors from support.

Trainees, however, were most anxious about the uncertainty regarding their jobs. The majority of junior doctors around the country did not rotate on 1st April. In spite of this only 23% of the doctors we surveyed were certain which department they would be working in on 1st April.

When asked how informed they felt about changes to their job in the weeks to come, the majority said they felt “not informed.” In addition, all previous rotas and annual leave agreements are now subject to significant change. 

The lack of rotation means that doctors who have just worked jobs with a high burden of out of hours shifts, such as emergency or acute medicine, are now expected to maintain this demanding work pattern for at least four more months. Others, who had looked forward to gaining experience in general practice or academic medicine, are now being drafted in to work in the acute hospital setting.  

There has also been a hit to doctors’ postgraduate medical education. Half of the trainees we spoke to have been informed that their postgraduate medical education programme has been suspended or reduced during the next month. Conferences, regional teaching days and postgraduate exams have been cancelled to avoid large gatherings.

When we spoke to our colleagues, they had not been informed of reciprocal changes to the Annual Review of Competency Progression (ARCP) criteria, under which all trainees’ performance is judged to allow progression to subsequent training programmes. 

These views provide a snapshot into the minds of junior doctors, preparing to adapt to a new working environment. 

It is important to recognise that measures are being taken by healthcare bodies to keep doctors informed of the frequent changes to jobs and clinical policy. However, it is crucial that they recognise the uncertainty still felt by trainees and alleviate these concerns by providing clear up-to-date guidance on changes to jobs, concessions for training programme assessment criteria, adequate supplies of PPE, and robust welfare support measures. 

Rachel Scott is a doctor in the second year of foundation training.

Rory Heath is a Foundation Year 2 trainee. @roryjheath

Emilie Lostis is a junior clinical fellow in trauma and orthopaedics.

Competing interests: None declared