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‘I Wake Up Having Nightmares About Work’: Why Junior Doctors Could Strike

Taj Ali

Underpaid, overworked, and struggling to hold up a health service in collapse: junior doctors tell Tribune about the constant crises they face on the wards – and why the only answer is to vote for strike action.

It typically takes a junior doctor seven or eight years before they become a consultant in a hospital. (ER Productions Limited / Getty Images)

It’s 5:30AM and Tahmid, a junior doctor, has just woken up for a typical day at work. After his baby’s morning feed he’ll shower, get dressed, and maybe grab a cup of coffee if there’s time. Then there’s the 45-minute commute to the hospital. On the rare occasion that he gets in early, he’ll study for his exams; if not, he’ll start his ward round. Alongside another junior doctor and consultant, he’ll see around 60 patients.

This hasn’t always been the way it’s worked. Until recently, there would be four junior doctors on a ward round. That number has halved in recent years, and the workload has doubled for junior doctors like Tahmid.

‘The consultant has to go and do the surgeries as well,’ Tahmid says. He exhales loudly, and I can hear the exhaustion in his voice. ‘We’re meant to be getting training opportunities. Traditionally, we do the ward round and join the consultant at the surgery—but because we’re doing the job of two doctors, we’re not getting trained and we’re not going into surgery.’

Tahmid has a lot to do in a short space of time. ‘We’re dealing with complex medical issues like post-op complications. We’re also doing the really mundane tasks like writing up the discharge letters and the admin stuff to make sure patients are safe.’ When a patient gets home, he adds, it’s the junior doctors’ responsibility to ensure that they’re getting the right medication, so they’re contacting GPs and pharmacies for every single patient.

It’s this endless list of responsibilities that mean junior doctors find themselves working more than 50 hours a week—53 this week, for Tahmid, five of which are unpaid. ‘Even on my days off,’ he adds, ‘I’m still recovering from going without food for a whole shift and living off free coffee.’ During the week, he says, he barely gets any time to spend with his wife and child.

On basic pay, FY1s are contracted to work a 40-hour week for £29,384 per year, which means wages equivalent to approximately £14 per hour. But like Tahmid, Manish, a junior doctor in his first year of practice, often finds himself working 48 and above. ‘We have to do research, audits, maintain a portfolio and study for exams,’ he explains. ‘That additional work is necessary to advance my career and is done in my free time, which means I’m often working over 60 hours a week. You often don’t finish work on time either, so these are additional unpaid hours.’

None of this takes into account how long and expensive it is to become a doctor in the first place. ‘I have gone through six years of medical school and accrued significant debt, which has accrued insane amounts of interest,’ Manish tells Tribune. ‘I’m around £90,000 in debt for student loans which I will never be able to pay back.’

Mike, who now works as a trauma orthopaedic surgery registrar, was fortunate enough to avoid the £9,000 tuition fee, having started medical school in 2011—but he says many of his colleagues are now incurring debts of around £100,000. ‘Had I not got in that first year,’ he says, ‘I wouldn’t have been able to do medicine as I’m not from a particularly wealthy background.’

‘I had to use an overdraft and max out a credit card to fund my living expenses as the maintenance student loan is actually quite small,’ explains Manish. ‘You also have to pay for your General Medical Council fee, medical defence fee, exams, and courses which cost thousands each year.’ Manish intends to sit his Royal College exams, which he says will cost around £3,000 in the next two years alone.

Doctors are also expected to move to other parts of the country quite often as rotational trainees, in shifts that can be yearly or even every six months—an additional source of financial stress, anxiety and inconvenience. Junior doctors get placed in what’s known as a deanery, but the distance between various hospitals can be quite big; Mike, for example, is from the North West, and his deanery spreads from Barrow and Furness up in the Lake District all the way down to places like Macclesfield and Stockport.

‘Last year I was placed in Barrow and that was a one hour, 35 minute commute for me there about each day,’ he says. The commute can be expensive, too: ‘The NHS will give you 23p per mile once you get past 17 miles, but when I speak to friends in the private sector, that’s way below what they’re getting—and now with fuel prices and the cost of living rising, it doesn’t really cover it.’

It typically takes a junior doctor seven or eight years before they become a consultant in a hospital. The length of time varies depending on speciality, from five years to become a qualified GP to twelve years to become an orthopaedic surgeon. Tahmid has only been in the job for a few months—but he already feels exhausted and burnt out.

Drowning in Work

‘I didn’t go into medicine for the money,’ Tahmid says. A second generation British Bangladeshi, he grew up in Derby and studied a BA in international relations before becoming a doctor. ‘I actually had a pretty good job in marketing after my undergrad degree. But I’ve always wanted to be a doctor—I want to help people and make their lives a little bit easier.’

This urge to help others is now coming at the expense of his own wellbeing. He says every bone in his body aches, and his sleep is interrupted by reminiscences of life in an under-resourced and overstretched health service.

‘I wake up having nightmares about work, about what happened the day before. Recently I woke up from a nightmare thinking I’d turned up at work and one of the nurses told me I’d a mistake on a round before on a patient I couldn’t even remember,’ he says. ‘That’s the effect it’s having on me right now.’

This isn’t a fantastical nightmare; it’s a realistic one. ‘I recently dealt with the death of a patient who didn’t need to die. My signature was the last signature on their notes and I couldn’t even remember their name. That’s what really got me. I thought, “Oh my God, was it because of something I missed that they passed away?” When it came to me reporting to the coroner’s office, I couldn’t remember why they died or how they died, because in the meantime I’d already seen another 300 patients.’

Long days, nights and weekends have also taken their toll on Mike. When he isn’t on call, tending to patients on wards admitted from the emergency side, his days are spent assisting and training to become a surgeon in an operating theatre. He’s paid for work between 8AM and 8:30PM, or 8PM and 8:30AMif he works nights, but, Mike says, ‘in reality we pretty much always end up staying past those times to help vulnerable patients.’

Goodwill can only go so far, though, and the deteriorating standards of patient care are painful for doctors to see. ‘If someone fell over and broke their wrist tomorrow, there’s guidance out there that says that we should be trying to do an operation within a week. Now the pressures on the NHS are such that you’re likely to get it within three weeks,’ he says. ‘We’re seeing people who’ve broken their hip sat in A+E for 48 hours in agony because we can’t get them a bed.’

One story is particularly revealing: Mike says that during a night shift a few weeks ago, he went to the store cupboard to get what he needed to treat a patient with a broken ankle, and found another patient in there on a trolley. ‘I had to apologise to this poor patient for such a lack of dignity,’ he says. ‘We’ve got people who should be in a hospital bed literally in the cupboard.’

Tahmid also sees the impact of crumbling infrastructure and underinvestment across his work. CT scanners break and don’t get fixed for days; computer systems are so slow that a job that should take ten minutes takes half an hour. And while he’s working over 13 hours a day, his nursing colleagues are leaving even later than him. ‘I’m seeing one nurse covering the job of three nurses. How am I as a doctor supposed to make accurate decisions based on those observations?’

The Fightback

In response to calls for greater investment in both the health service and those who form its backbone, the government frequently retorts that throwing money won’t solve the issue. This kind of rhetoric is a source of frustration for junior doctors like Mike. ‘We’ve been shouting and screaming about underinvestment for years and we’ve been ignored. Every pound we spend on healthcare in this country means that we have a healthier population who are working more, and if you have more workers paying more tax, you grow your economy. It’s all well and good the government saying we’re going to double medical school places, but if a third of them go abroad because they get paid more overseas, we’re not solving the issue.’

In a British Medical Association survey published in December 2022, 79% of junior doctors said they often thought about leaving the NHS, while 40% said they were planning to leave as soon as they found another job. Respondents cited workforce supply shortages, increasing workloads, and lack of recognition as reasons—but pay was number one. ‘Next week I won’t eat anything at work because I can’t afford to,’ Tahmid tells Tribune.

According to the BMA, real pay has declined a massive 26% since 2008—meaning discontent has been brewing for a long time, and that the cost of living crisis was the final straw. With nearly half of junior doctors struggling with basic costs like rent, heating and commuting, and Health Secretary Steve Barclay making no indication that he’s willing to negotiate on pay, a 72-hour strike in March is on the cards for junior doctors in England, who are currently being balloted. Their colleagues in Scotland are expected to follow suit.

‘I’m tired of coming home every evening and being physically and emotionally drained,’ Tahmid adds. Without a decent pay rise this year, he’ll be forced to leave the profession in order to give his son a better future. And he won’t be the only one—many junior doctors are putting in applications for jobs in places like Dubai, Kuwait, and Qatar, where they can make £75,000 a year, more than triple what they receive in the UK.

Mike, too, has mulled over leaving many times. Three of his friends from medical school have moved to Australia, where he says the pay is better, the conditions are better, and doctors are able to provide a better standard of care. ‘It’s a shame,’ he says. ‘I love the job. I worked really hard to get where I am.’

The hurdles workers are required to jump over to strike are high—but Mike is confident that junior doctors will vote for action. ‘If you look at our last ballot in 2016, we absolutely smashed the threshold and I’m confident we’ll do it again,’ he says. ‘We’ve got more junior doctor members than we’ve ever had before since our ballot opened in January. People are angry. This is about the future of our health service.’