Junior doctors in anaesthesia – the canary in the coal mine?

From February we have at least 12 vacancies on senior anaesthetic trainee rotas across my home trust. I know this is repeated around my region and around the country.  Some of these vacancies have occurred at the last minute and we have no hope of filling them by last minute recruitment into the gaps and I have a rising feeling of panic when I try to think how on earth we are going to cover the shifts affected.  

Contrary to the belief of some commentators in the media, anaesthesia is an acute 24/7 specialty. Emergency operations occur in the middle of the night, every epidural for labour in the small hours is inserted by us, trauma, resuscitation, pain relief, critical care – all are covered by anaesthetists.  The new junior doctor contract, which proposes to cut the pay for out-of-hours work, will therefore affect anaesthetists much more than many other specialties.

I work in North West London, and we are lucky that our anaesthetic training schemes are sought after and popular. Even here though, the number of doctors that are leaving the rotation is increasing, and has now reached crisis point. The hospitals involved have well organised training, generally perform well in the GMC survey of training posts, and yet doctors are leaving. Talking to my training leads many reasons are cited, but the most common are burnout, leaving the country for better pay and conditions abroad, leaving medicine altogether, and women choosing family life over a career in an emergency specialty.  Some have chose better paid jobs covering intensive care units in the private sector. Most also cite low morale and feeling undervalued by the NHS as a major contributory factor.

The doctors in charge of the training schemes routinely have junior doctors in tears in their offices saying they just can’t carry on in the current climate. They are highly intelligent, motivated, hard working individuals who could all earn an awful lot more in industry or in the City than the NHS pays them. There is also no allowance for the resignation rate in the training numbers recruited.  At least we are still able to fill those posts in NW London, other regions in the UK struggle to recruit more than half the doctors they require to maintain their anaesthetic service. 

How will we cover? The hospitals will advertise them as extra shifts, and consultants will cover the shifts that they can’t fill. The anaesthetic service has to cover the shifts to protect our patients, but the ability to cover routine work will invariably suffer. This is the consequence of unfair treatment of the workforce.  

This will harm patients much, much more than any strike. The NHS is not a bucket shop zero-hours-contracts employer. Highly trained, highly qualified doctors have other options – inside and outside medicine – and will follow those opportunities.  Maybe the NHS should simply be taken over by the private sector, then everything will be better won’t it? The NHS trains almost all the doctors that work in the private sector, it is a leader in quality improvement and the private sector frequently follows where the NHS leads.  A recruitment and retention crisis for junior doctors will hurt the private sector too.  The private sector cannot and should not replace the NHS. 

I ask the government please to treat our junior doctors fairly, come to a swift mutually acceptable agreement, and to start tackling recruitment and retention. They are harming patients by driving doctors out of medicine and particularly out of the emergency specialties.

Dr Helgi Johannsson (Imperial)

https://traumagasdoc.wordpress.com/2016/01/16/junior-doctors-in-anaesthesia-the-canary-in-the-coal-mine/