- Partha Kar, consultant in diabetes and endocrinology
- drparthakar{at}gmail.com
Follow Partha on X/Twitter: @parthaskar
Have no doubt about it: the next generation of senior doctors, who we currently label as juniors, have found their voice. It’s one for debate whether the term “junior” itself is derogatory and the extent to which we forget that these are qualified adult clinicians with families and mortgages. Perhaps we should just call them doctors, while the rest are known as senior doctors. Either way, organisations have been caught flat footed by this group finding their voice—whether that be the Department of Health and Social Care, NHS England, the General Medical Council, medical royal colleges, or specialist medical societies.
In the past, a common tactic for quelling dissent in the medical profession has been to put forward a heavy handed response away from the public eye, whether it’s about training posts, patient safety, basic working conditions, or pay. In a monopoly health system such as the NHS, this leaves doctors with little option other than to back down. The rise of anonymous social media accounts is a sign of a system that tries to quell dissent (vigilantism doesn’t exist in isolation), and as abhorrent as some personal attacks from behind a laptop may be, one needs to dig deeper into what gives rise to these behaviours.
For the past few years, if not longer, medical education and training have been failing. Data have repeatedly shown widespread dissatisfaction among doctors in training. Bullying, racism, and sexism are all rife, with few signs of progress. Hospitals have spent years treating these individuals poorly: refusing their leave requests on a whim, not giving them their rotas on time, and basically refusing to treat them like the adults they are with lives outside work. We’ve finally come to the point where these doctors have had enough. We’ve collectively failed our Generation Next.
The resistance we see among much of the medical profession to the introduction of medical associate professions is not an isolated issue. It’s the culmination of years of pay stagnation, a lack of specialist jobs, and the erosion of training opportunities, all aided and abetted by organisations that are supposed to look after doctors. The desire to implement the NHS workforce plan is understandable, but delivering it will require productivity levels the NHS hasn’t achieved in 30 years.
Medical associate professionals can’t work in an atmosphere of constant animosity: they need support from doctors of all grades. Alienating a swathe of trainees by introducing these roles won’t give us the productivity boost required, and modern generations don’t flinch in the face of old school threats in the same way as their predecessors.
New year, new lessons
This new year is an opportunity to tackle the issues of 2023 differently, with lessons to be learnt by all organisations concerned. Going in hard against doctors won’t work, especially in a global health system. Labelling them as left wing to suit political rhetoric is wrong, as is dismissing them as a small faction of disgruntled elements. This isn’t just about money: it’s about their livelihoods, their future and, most importantly, respect.
The best thing for all involved, including the medical royal colleges, would be to take a pause and listen to these doctors. A desire to “stay in the tent” has given way to silence and the acceptance of misguided policies. A college’s role should be that of a critical friend to those implementing policy—not a willing accomplice to plans that may be counterproductive to the future of the NHS. The system has no hesitation in reminding us at every opportunity to “be kind to all”: it’s worth remembering that “all” includes these doctors.
This new generation of doctors, like any other, is bright, ready to help, and keen to make the NHS better—so work with them, try different tactics to engage, and use this as an opportunity to listen to these people who are hurting. Old school tactics of bullying any dissenters into submission, in a modern era of open and accessible information, is bound to backfire.
Footnotes
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Competing interests: See www.bmj.com/about-bmj/freelance-contributors. Partha Kar is national specialty adviser, diabetes with NHS England and is author of the MWRES Action Plan to tackle racism in the medical workforce.
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Provenance and peer review: Commissioned; not externally peer reviewed.