How high?

When you work for the NHS as a junior doctor, you are not supposed to have a life outside the hospital. That is, at least what is looks like to me. You are not supposed to have serious relationships, settle down to buy a house or raise children. When the NHS says "jump", you reply "how high?" They don't care that you have commitments that might affect your decision to follow their bidding.

Kay has been busy since before Christmas, applying for the next stage of her career and it has been so stressful, you would not believe it. She is applying for Registrar training and selecting the specialty she will practice for the rest of her life to get her to consultant level. She has chosen two specialities which will dovetail with one another, each taking four years to qualify, so a total of at least eight years ahead of her to get to consultant.

Kay is 30 years old and newly engaged, so naturally wants to consider marriage, buying her first property and having a family in the next eight years, but all of that is in jeopardy because of her job. She has just undergone two very gruelling interviews with the two specialty authorities. On paper, she has a lot of experience  and glowing references from her bosses, but 80% of her success depends on the 20-minute interview alone. Not good if you are nervous. There is a three-week wait for the results of the interviews when you find out your ranking out of the total number of people interviewed. (Obviously there are more interviewed than there are jobs available. In Kay's case, because she was made to do an extra year, when the Royal College randomly changed the rules, there is now a bottleneck of two academic years competing for one year of jobs, which makes it even more competitive). Once you have been successful at interview, you can then place the jobs available in order of preference, obviously ranking your first choices as close to where you live or want to settle, not that THAT matters a jot to the selection panel.

Kay wants to live closer to me, so I can help with childcare in the future, plus her fiance has no choice but to be based in London, so a job in London is key. She has already been putting out feelers to house prices in the area and working out with lenders what sort of mortgage they could expect. This week loomed as the week she would know whether she had been offered a job from next August and where. The offer came in on Tuesday and was not in London. In fact it was not even close. It would involve a two-hour commute each way on motorways. She was so upset to think that she may not be able to live with her fiance/husband during the working week for the next eight years, or start a family, let alone buy a house together, if she were to accept that job.  All her dreams came crashing down. It is not made easier by the fact that she has to change hospitals every year to gain a wider experience of different procedures, so for example getting a job in a region that covers two or three counties could involve a commute of up to 100 miles a day,  if you were bold enough to put down roots somewhere. After a stressful day or nightshift that is unthinkable. She had the choice to accept the offer, decline it or hold it in case it could be upgraded for a better offer. A better offer came in, but still not close to London and in a region that covers three counties. If she moves every year to be a reasonable distance from the hospital she is allocated, then she can say goodbye to a relationship, to kids and buying a house. It is so unfair. We are praying she gets upgraded to London, although there is no guarantee. It just depends on whether people, who have been allocated London, decide they don't want it and it can be offered to someone else. 

No wonder our doctors are stressed or go abroad. The whole system needs overhauling.  This is no way to treat staff. If you want to get an idea of what it is like being a junior doctor in the NHS, look no further than the BBC series This is Going to Hurt. It says it just like it is.

UPDATE: After a week of stress and nightmares, Kay has now been upgraded to an area of her choice. Why couldn't they have offered it to her in the first place?!