“Mummy, I want to be a doctor”. Is this simple role play, or a genuine career intention from my three-year-old? I look down at her playing with her doctor’s set and teddy bear, and I want to feel proud. But I realise something has changed. Getting some headspace on maternity leave, watching the junior doctor discontent bubble up again and seeing my husband quit his neurology registrar job for an infinitely happier career in research have all contributed to my unease.
Perhaps we should have known what we signed up for. I’ve heard senior doctors mutter that things were much harder for them, and our generation of snowflakes needs to be more resilient. But when you’re 17, how can you really know what you’re committing to for your lifetime? You’ve earned good grades, you want to make your family proud, and there is an element of vocation, challenge and nobility attached to medicine that is hard to ignore. You’re reverent of the senior doctors you meet on work experience. They are respected by their patients, proud of their contributions and live a relatively stable, comfortable life.
But over the decade that it takes to start on their ladder, things change. Yes, life was tough for the previous generation. GPs were on call all night, hospital doctors could work 120-hour weeks, career progression wasn’t guaranteed, nepotism was rife, attitudes to diversity were archaic – and life outside medicine was almost non-existent.
Now the European working time directive means we work less hours. But the hospital team is a skeleton of what it used to be, the camaraderie replaced by a revolving door of juniors. The rest spaces and canteen are often not fit for purpose, and hospital accommodation and parking are rarely provided.
Much of our free time is spent navigating clunky portfolios online. Exam fees, subscriptions and courses run into thousands of pounds. Cases like that of Hadiza Bawa-Garba, the junior doctor convicted of manslaughter by gross negligence in 2015 over the death of a six-year-old boy, have left us feeling under increased scrutiny and fearful of being the next victim of an underfunded system. Evolving technology allows us to work from home, but we are unable to switch off.
The nature of the day job itself has changed. More informed patients have led to a less patriarchal relationship with doctors. But the “on-demand” nature of everything else we consume in society has raised patient expectations. Fewer GPs are taking on more and more work. Consultants are increasingly subspecialised, and the generalists needed to manage an ageing population are a dwindling commodity.
Medicine has advanced so much, so there are more things that we can do for patients. But this has resulted in mounting prescriptions, more interactions and side effects to manage, and a flurry of waiting lists for even more procedures. The breakdown of nuclear families and communities, and the rise of conditions resulting from health inequalities, have also left us trying to fix problems for which there are no medical solutions.
And then there’s the money, the elephant in the room. Very few people choose this career for the salary, but things have changed. Pay has fallen in real terms for the majority of NHS staff over the last decade. The average starting salary of a junior doctor is £29,000, rising to £58,000 in eight years – but what’s often forgotten is the debt they graduate with. Tuition fees are now £9,000 a year for five or six years, and student loans are paid back at 9% of earnings over £27,000. So a young doctor won’t start to break even before they’re into their 30s or 40s, by which time many have started families and have the burden of childcare costs and soaring house prices to consider too.
Medicine is still a reasonably paid profession, but if we want to attract the best and the brightest school leavers from all classes in society, we need to think about what else is on offer. Will they think it’s worth it? Money isn’t everything, but it is one metric of how valued you feel. And if you also take away free parking, free accommodation, access to food out of hours, and consider rising exam costs, short-term rotas, inflexible annual leave policies and so many other basic needs, we can’t be surprised when bright graduates look elsewhere.
At its core, the relationship between a doctor and patient is sacrosanct. Behind a closed door, it is one person helping another in a time of need – and that is an absolute privilege. But so much of what underpins that is being eroded. A prominent GP once told me that we need to hit rock bottom before things can improve again. Have we hit that bottom? Is an upswing on the horizon? Juniors are speaking up, and more and more senior doctors recognise the need for urgent action.
Things have changed for our generation. As it will for my daughter’s. I look down at her playing doctor again, lost in the role play with her teddy. If she ever asks if I’d recommend medicine, I’d have to stop and consider what it might look like in a decade or so. Maybe, just maybe, I would recommend it: but only if the pendulum starts to swing back soon.
Nish Manek is an NHS GP, podcaster and blogger
