Tuesday, 8 April 2008

Have the BBC Missed The Point?

This story appeared quietly and with little fuss over the weekend. Afterall, unless its about £100,000 salaries or patients dying, nobody seems to care what happens to doctors.

The BBC story highlights an important point, although I can't credit the BBC as the remark originally came from a professor at the Royal College of Physicians. With the complete introduction of the European Working Time Directive (EWTD) from 2009, all professions, including doctors will be limited to working 48hours a week down from the current 56 hour limit. Now I don't know about other professions but this has some pretty serious consequences for doctors and perhaps more so for patients.

The BBC article states that patient care will suffer because there will be less staff available, this clearly makes sense as if all doctors are working 48 hours rather than 56 each doctor is working 8 hours less. Who is going to cover those lost hours? Patients are still going to get ill 24 hours a day, 7 days a week. Who is going to be there when Mr Jones arrests but Drs Smith, Brown and Wood have all worked their 48 hours this week? Of course, everyone knows that the vast majority of doctors are still going to work more than 48 hours a week, they just won't get paid for it as it is effectively 'illegal'. When it comes to auditing hours, these doctors will be 'encouraged' to lie about their hours to make the trust EWTD compliant. So patient care probably will suffer in the short term, but Dr Smith and his colleagues won't leave Mr Jones to die, they will ignore the EWTD, safe in the knowledge that what they are doing is illegal and they're not getting paid for it. Another solution to this problem is the use of night nurse practitioners and such like. I'm sure Dr Crippen wouldn't approve and to be honest, I know who I'd rather be looked after in the middle of the night during an emergency.

Anyway, I think the BBC have missed the point, it isn't the short term, immediate care of patients which is at risk. I'm far more worried about the implications for the future in terms of training. Talk to a doctor who qualified 5, 10, 20, 30 years ago and they'll tell you about the 'good times', the 100-120 hour weeks, the 48 hour shifts without sleep. Strangely, most of them will tell you they enjoyed it in a sadistic kind of way. Not because they get a kick out of working more hours than there are in a week, but because of the experience they gained. Most doctors will tell you that on call, during the night is where they learnt the most.

Lets consider for a second Mr Bone, a consultant orthopaedic surgeon. He became a consultant within about 11 years of graduating from medical school. When he qualified, he worked 100 hour weeks as a house officer and similarly throughout his training. That is about 50,000 hours or so of training.

Next, lets consider me (or equally one of my colleagues) who, having studied a PBL course doesn't know all that much to start with. If I were to become an orthopaedic surgeon about 11 years after qualifying having worked no more than 48 hours a week. I would have received about 25,000 hours of training. About half that of today's consultants. It certainly won't be considered acceptable to double the length of time it takes to become a consultant and so we're left with one scenario.

In 10, 15, 20 years time, the 'consultant led' NHS is going to be staffed by doctors with roughly half the amount of training their predecessors had.

Who would you want to replace your hip?


Murk said...

As a "baby medic" just started medical school, I can only imagine what they will have done to the profession by the time I stress about finals. I applied knowing full well that I could have to give up an enormous amount of time with little recompense, though the EWTD seems to mean I will be effectively working for free.

We chose this job, and we can not, will not watch patients suffer. Yet this seems to be a quality that is being most cynically exploited in this case.

Btw, I hope that you found somewhere to stay for your F1, since I just got an email from my BMA rep about removal of free accomodation for Foundation docs without any reimbursement.

Anna said...

Frightening isn't it?

The whole profession is going down the pan, and I am no longer sure I want to be part of it. Starting in a job in August does rather feel like alighting a sinking ship.

The Angry Medic said...

Same here mate. I remember when the EWTD was going to make us work 80 hours and consultants were losing their hair over it in the papers; the arguments back then were scary enough. Imagine what's going to happen now.

And ditto murk up there - I also got the email. Bastards aren't they?

Medically Brunette said...

I second everything you said!

the little medic said...

murk - I wasn't going to take up F1 accommodation anyway so I was hoping we might all get a raise. Sadly not. Sucks.

anna - Yes it is rather frightening! There is so little morale among doctors at the moment its ridiculous!

Angry - Yeah, the consultants sure aint going to like it!

Anonymous said...

I share your concerns, even though it's a long way off and who knows what will happen by the time I start working.

Removal of accomodation for FY's is frankly ridiculous, for anyone who cannot drive in and commute they will have to rent near the hospital, no chance catching public transport for on calls right?

As for the training, it would be a real shame if we couldn't live up to the old school consultants of today because of the governments penny-pinching fuck ups.

Anonymous said...

In a way, shortening hours is not ideal. But on the other hand, it will be nice to have a life. I'm not sure that it should be up to us to work ridiculous hours in order to prop up a healthcare system. I think it's up to the DOH to provide quality healthcare without making people slaves to their jobs. They should be looking at ways to maximise our patient contact while we're at work, by getting rid of a lot of the nonsense jobs that we have to do (the types of jobs that don't require a doc).

Dr. Thunder

ditzydoctor said...

sounds awful. then again, dr thunder is right. do we really really need doctors to schedule patients for admission? to call the administration to beg for a bed/consult/social help? to sit there and wait for the patient to go for a scan?
i've seen my houseofficers/interns/F1s do those, and goodness knows how much sleep/other work/etc they could have done during that period. it's unnecessary and useless.

i really hope NHS rethinks for all our sakes!