Although I’m a BMA member, as I suppose we all need protection, I try to avoid the British Medical Journal, a truly PC rag, although it very occasionally prints something of genuine interest. Hence I rapidly flip through the back copies from time to time, and this piece caught my eye.
It’s the best summary of the junior doctors’ issues – and the strikes – that I’ve seen, and having been written in early January, it’s already proving prophetic. The NHS is the UK monopoly employer, and these fresh medics are not all going to go to Australia. The proposed increase in medical school places is a good idea too, though it won’t happen. My beef is how many places go to non UK students (a lot). I would make it a postgraduate degree, if I could.
The author is slightly maverick Glasgow GP, Des Spence, who usually tells it like it is. He works in Maryhill, home of such gems as Munns Bar, and I would imagine he’s a very busy clinician. Certainly a grounded one. A separate BMJ profile of him is enlightening:
Who’s been the best and the worst health secretary in your lifetime?
No one. It makes little difference in the reality of day to day. The work is the same irrespective of the government.
If you were given £1m what would you spend it on?
I could pretend that I would give it all away to fight for world peace and combat global warming . . . but we all know that’s bullshit; that’s not how people really work. I’d have a big party, give some away, save some, buy a black Jaguar F-Type, and generally spend it irresponsibly. Life is for living.
The title of the article is “The strike is a bad idea”, and it is one of the few contrary arguments to the whole strike thing in months of BMJ’s. There are, inevitably, tons of counterarguments by juniors which tend to be a bit solipsistic, though they would deny that. Here is Spence’s timely piece:
I have significant sympathy for Junior Doctors and understand why they have decided to strike. Older Doctors might moan about how it was “tougher in our time” but comparing the past with now is an apple to oranges affair. Expectations are different, shifts are different, the generations are different and our societal culture is different. Striking, however, is the wrong course of action. Consider.
Could evening and weekend care be improved in Hospitals and in General Practice? The answer is yes. And the pressure to provide a 7 day style NHS service is an unstoppable cultural juggernaut of expectation, in tune with so many other services we now take for granted in modern society. Doctors would be best to simply accept this as the new cultural norm and negotiate from this position.
And will striking for a few days make any difference? We are employed by the state. Our employer can at any time change our conditions of employment with reasonable notice. This happens all the time in the public and private sector. Unless Doctors are truly willing to strike for a sustained period, we will not change the resolve of our employer. This Strike is a protest only. But will this protest curry favour with the public to force the government to change?
Many of the public do have great appreciation of what doctors do. But do they have sympathy for our working conditions and pay? (which ultimately is how this dispute will be presented in the media). Doctors might loathe the Daily Mail, but the Daily Mail does not lead public opinion but reflects it. Many of the public consider us overpaid, with great job security, being largely trained for free, having a gold plated pension (unimaginable to most in the private sector), enjoying a high status, and all this paid out of their pockets through taxation. Do we really expect any sympathy for the strike? Regrettably the strike will serve only to inconvenience the public and undermine our professional standing. The strike is simply out of step with the current mood of many in the country, coming out of a sustained period of austerity. Ultimately employers can and will impose a new contract. And Doctors won’t leave in high numbers for there is still lots of milk and honey in the NHS.
The real solution is this. Doctors don’t want to work 50 hours a week. Life/Work balance is more important than money to the current generations of Doctors. And currently we have widespread medical staffing shortages across the NHS. So we need to train perhaps twice as many more Doctors as undergraduates. This costs around £250k per Doctor, but is a notional expense to the NHS which currently spends annually £3.3 billion on agency medical staff (enough to train an additional 12 000 Doctors a year!).
Vastly more Doctors would improve work life balance, broaden the diversity of our bland homogeneous middle class profession and reduce the unhealthy status and entitlement that blights so many lives. The law of supply and demand would certainly reduce pay in time but most would find that an acceptable trade off. Medicine took most of my young adult life, a situation that we no longer have to tolerate. Dear BMA, call a strike for a doubling of doctors in training. Now that would be worth picketing for.
Hard to argue with that.