The Heckler speaks out

Philip Smith, the junior doctor who infamously heckled Patricia Hewitt on questiontime, has kindly allowed me to publish his summary of the disillusionment felt by many junior doctors this year. This piece is his summary of events and has been copied with his permission from Doctors.net:

"A few weeks ago I heckled Patricia Hewitt on BBC’s Question Time over the junior doctor job application fiasco. This was not an easy thing for me to do, as heckling is seen as such a ‘un-doctor-like’ thing to do, in fact I was publicly criticised by a journalist in a national newspaper for being rude. Someone who had absolutely no insight into me, firstly as a doctor (‘Frankly doctor, your bedside manner stinks’) or the disaster befalling the medical profession and the NHS as a whole. Doctors are supposed to be apathetic and detached – ‘stiff upper lip’, ‘shut up and put up’ – aren’t they? They can’t care too much about their jobs, their patients, and their livelihood? I am not a politician or a public speaker, just an ordinary doctor. My passionate and emotional heckle that night, was prompted by anger and despair – but also by fear – that things would get worse. They have.

I am utterly heartbroken – and I got my first choice job. I do not use these emotive words lightly, but I am distressed to the point of distraction by the agony I have seen my loved ones, friends and colleagues go through. The jobs for the first round came out last week, and as I feared, thousands of junior doctors were not allocated a job with just over 6 weeks until the new jobs are supposed to start. In a nutshell, there are going to be thousands of unemployed doctors, thousands unhappy with no training posts, and thousands leaving the country. Very few members of the public realise that this is even happening!

In the past, doctors left medical school, completed their first year as a doctor and then could apply to whatever field of medicine and surgery they wanted to, in whatever area of the country, applying directly to advertised jobs in hospital trusts. Doctors would then have to complete postgraduate exams through the different Royal Colleges (e.g. Royal College of Surgeons) to progress, to ultimately become a consultant. This process takes many years in some specialities as experience counts, particularly in the surgical specialities! This didn’t fit with the Labour Government plan - more consultants are needed. Therefore, Modernising Medical Careers (MMC) was born, training for doctors would be streamlined so that the time to consultant would be clearly defined with scheduled training all along. ‘Time to consultant’ level would be less. The tool to implement this was also conceived, Medical Training Application Service (MTAS), all junior doctors would apply for jobs at the same time of the year via this online computer system and would be matched to jobs using it. Simple.

As with anything, behind the superficial façade lies the truth, which I will explain. Training budgets were cut this year, so millions of pounds dedicated to training junior of doctors, helped amass a surplus in the overall NHS budget. The European Working Time directive was being implemented – so the hours that doctors can work legally (and be covered with medical protection insurance) was slashed – so trainee junior doctors are getting less training! The idea behind MMC was already being exposed as being fundamentally flawed, less training funds, less training time, less training years doesn’t produce the same quality doctor – end of story. MMC is a tool for government to say ‘we have more consultants.’ Actually they will have ‘more very junior, inexperienced consultants,’ a very scary thought for patients, and for doctors.

Then came the implementation of the ‘master plan,’ ignoring the calls of the BMA and the newly formed junior doctor pressure group Remedy UK. In February of this year, MTAS was launched, despite never being tried or tested. This was the way junior doctors had to reapply for jobs, all contracts and jobs were cancelled from the 1st August 2007 as this system would allocate doctors to the most appropriate jobs. As a result of the implementation, junior doctors from the before mentioned ‘old training system’ would be directly competing with even more junior doctors who had already started on the MMC pathway. A ‘bottleneck’ situation was obvious. Doctors had to fill out all their personal details on the internet website (including sexual orientation), also completing multiple statements on the online form which would be scored on a mark scheme. Questions would include: ‘Tell me about a situation where your communication skills fundamentally impacted on a patients care,’ the doctor would have to explain in 150 words or less, this scenario. These answers were given more weighting in scoring than the more traditional tests (on a CV) of how good a doctor was e.g. such as previous research experience, prizes, degrees etc. They were designed to identify the best doctors. Doctors could only apply to four deaneries each within the UK. For example, to work in London you would not apply to a particular hospital within London, you would have to apply via the website to the deanery called London/KSS, meaning you could be allocated to any job in the whole of London, Kent, Surrey and Sussex. Large areas of the country! The website kept crashing, the consultants marking the forms were overwhelmed with work (on top of their duties to their patients), then the fun really started. The job interviews came out and it became apparent that thousands of doctors were not even getting interviews – thousands not getting interviews for jobs they were currently doing!

Very quickly, it was clear that MTAS had failed in many different ways and doctors were angry, they had only one chance to apply for a job per year, with only one monopoly employer for junior doctors (the NHS!). No interview meant no chance of any job, unemployment beckoned for thousands. Doctors marched thanks to the Remedy UK organisation (a superb group of ordinary doctors, standing up to the government), MPs up and down the country had despairing letters from doctors and their relatives. The government panicked, the goal posts changed, and changed again, the website crashed, Patricia got heckled, morale fell, then fell further and further. Patricia and Lord Hunt span facts about the NHS, ignored the anger of junior doctors, then apologised for incompetence, and again, and again, but things never really got better. Then everyone got interviews, thousands of further interviews, thousands of doctors hours lost. Consultants had to cancel lists, clinics, daily duties. Then, nearly 4 months down the line, MTAS was axed and the gallant Remedy UK were defeated in a court battle by the devious government (who forced Remedy UK to pay thousands of court expenses), and the first round of jobs were allocated.

This is where we are today. No happy ending though. No happy doctors. Just lots of tears and lots of despair. Thousands of doctors without job offers, with a second round that offers little more promise. Those that have jobs are not even happy, they have no idea what part of the region they will be in, what hospital, what speciality, what consultant etc. – can you see the trend? Furthermore, hospitals don’t know who they are getting or whether they want to work in that hospital, a classic case of ‘bums on seats,’ except with people’s lives to add to the mix. Many have been offered jobs with no training potential (no chance of being a consultant if they stay in that post), but worse still, many have been cruelly separated from loved ones in the MTAS lottery. I have been separated from my long term girlfriend because of this when even a spell on intensive care for me, has never separated us. She didn’t get a London job and I did, despite her being on a ‘gold circuit’ rotation already in London. If she doesn’t accept a job offer elsewhere, she will be unemployed and with our mortgage and £30000 each in tuition fees to pay, we can’t afford to do that. We’ll have to live separately for potentially many years, as the MMC master plan doesn’t allow you to move regions! One of my closest friends, a brilliant doctor, with all of the qualities you could ever want in a physician has been shafted by this incredible system. Not one job offer. I’m devastated for her and will never forget or forgive the government for the suffering she has been through.

The shocking thing is, is that so many are in the same boat as this, a situation that sickens me to the core. Anyone that is a doctor, or knows a doctor will know the sacrifices a doctor makes and continues to make to be one. Of course, sacrifice is not exclusive to doctors, and no one would say that, but, the incredible number of exams, stress, financial costs and years studying to name a few things, not just at medical school, but after qualification, is practically unmatched. You don’t become a doctor to be rich, I get paid £7.50 per hour with all the extra hours doctors do to care for their patients properly. You do it because it’s a vocation, and you love your patients. You look into their eyes and you know that you can help them; you want to help them in their most vulnerable hours often, a thought that inspires me even in my lowest moments. You are with patients at happy times but also at times of great distress – you can make a real difference. Competition is fierce even before entering medical school, and is nothing new for doctors. We are certainly not zealots adverse to change, it is part of every day practice. Being a doctor is not just a job, it is your life, many of us live and breathe it, worried about our patients when we go home at night. There is nothing wrong in being passionate and fighting for our jobs, I would want a passionate doctor fighting my corner if I was a patient, rather than an apathetic one. This crisis has devastated many junior doctors’ lives, devastated many of my friend’s lives, which is unbearable to think about. People are leaving the country, leaving the profession – good doctors - because this crazy system has pushed them to the brink. I don’t blame them, but it is a travesty of the highest degree and should not be allowed to happen.

Now, Patricia will spin out facts about the NHS that will make you think you’ve got vertigo. But let’s face facts, the reality if far away from the verbal diarrhoea she oozes. The NHS is in surplus financially – nonsense! The vast majority of trusts are crippled by debts (from Private Finance interest payments which they will pay off for many years) so that wards have closed, thousands have lost jobs, all ‘non essential services’ cut, wards understaffed because of locum cuts, the list goes on and on. Waiting lists cut – nonsense - ‘cherry picked’ procedures take priority over other patients – taking resources from one patient group, to give to another. In no way am I demeaning the patients awaiting these symptoms at all (they need their procedures), but by taking it out of the control of the doctors and nurses, reasonable decision making cannot be made on who needs the treatment immediately in a fair manner. In my cardiac unit, patients not on a government target list regularly have their procedures cancelled multiple times while the ‘waiting list patients’ skip past them. ‘The best year for the NHS’ – give me a break! Speak to the doctors, nurses, physiotherapists and other support staff whose morale has been destroyed.

So why should the general public be bothered? Apart from the obvious vast amounts of taxpayer’s money to train unemployed doctors being wasted (£250,000) and money wasted on the failed computer system being a monetary incentive. You should be upset that the government seeks to develop a generation of younger consultants with much less experience and training to meet targets (whose training budgets have been taken by government), think about that if you’re needing an operation in the next few years. You should be upset that YOUR doctors are being treated like this, we are here for you if you are having a heart attack, here for you if your baby needs delivering. The junior doctors are the frontline with the nurses and support workers. From a human point of view, you must see that this is wrong. There are no other employers for junior doctors, the NHS is it. Granted, many will say ‘no job is for life’, but if I was a journalist who did not get a job at one newspaper, I would apply to another. There is no such facility for junior doctors. Do you want doctors allocated to specialist jobs on the back of an unfair system? Do you want to be treated by a doctor so bemused and despairing, treated so poorly, that he can’t bear to be in work? Hopefully even the most cynical observer will see that all of these factors are ultimately not good for patients.

The really ridiculous thing is that I voted Labour in power in 1997, my first ever vote. I’m from a working class background, my parents never attended university, I went to a comprehensive school, fought for my life in intensive care twice in the last ten years because of my Crohn’s disease and even wrote a book encouraging people like me to go the medical school. The Labour government betrayed me and my generation of doctors over tuition fees, now for many unemployment beckons. All I ever wanted to be was a doctor. I’m sure there are thousands of doctors just like me that feel the same but whose lives have been ruined by this fiasco. This is a national disgrace and something that should not be allowed to be hidden under other bad news. Shame on you Patricia – ‘this is your legacy, this is Tony Blair’s legacy – leave now!’"