I believed I had no future as a doctor
From Mmc
I believed I had no future as a doctor
Last Updated: 12:01am BST 02/07/2007
In the first of a new series assessing the impact of the junior doctor jobs debacle, Dr Sara McNally tells Bryony Gordon how the system has failed thousands
Patricia Hewitt's resignation as Health Secretary last week - she jumped before she was pushed - merited few headlines. It was, after all, the same day that Gordon Brown became Prime Minister.
But there were many people who had been eagerly anticipating her departure - 34,000 of them, to be precise. That is the number of junior doctors left to compete for 23,000 jobs, thanks to Hewitt's Modernising Medical Careers (MMC) initiative.
Hewitt not only cut the number of training posts available - her aim was to reduce the time spent training - but she also introduced an application system that had junior doctors of two years' experience competing for the same jobs as those who had begun their training up to four years previously.
The online recruitment system (the Medical Training Application System, or MTAS), launched in January, was a disaster from the start. It failed to take account of applicants' experience, qualifications and references, and left thousands of highly qualified doctors without an interview with no chance of a job and no way of progressing in their chosen speciality.
In addition, MTAS crashed frequently and allowed unauthorised personnel to access the confidential details of many applicants. Professor Alan Crockard, one of the architects of MTAS, resigned in March. In May, Hewitt abandoned the system for the remaining applicants but has never apologised, nor is there an alternative in place.
Now, with a month to go before the new training posts start on August 1, up to 11,000 doctors still do not know if they will have a job, while 4,000 posts have not been allocated, with a potentially dire impact on patient care. Of those who do have jobs, many have no idea where they will be working.
"You could call it a farce," one junior doctor says, "but a farce would imply that there was some comedy involved."
Indeed, there is precious little to laugh about. A recent study by the Royal College of Psychiatrists found that 90 per cent of junior doctors were suffering symptoms of depression as a result of the jobs fiasco.
Last month, Remedy UK, an organisation set up to protest against training reforms, took the Government to the High Court, where the judge ruled MTAS lawful but conceded that the system had "disastrous consequences" for applicants.
Today, in the first of a new series, the Telegraph assesses the impact on the personal and professional lives of Britain's next generation of doctors.
Dr Sara McNally, 34, is currently on a psychiatry rotation at a London hospital
I am one of the lucky ones. Two weeks ago, 50 minutes before MMC stopped handing out posts, I received an email telling me I had a job. Yet I don't feel lucky. Demoralised, upset and undermined by a process that, at times, has led me to believe I don't have a future as a doctor, yes. Lucky, no.
I start my job in psychiatry in August but I still haven't been told which hospital I will be working at. We had to apply to a specific Deanery [a region of the country], so I know broadly speaking where I might be in the London Deanery - Kent, Sussex, Surrey, Herts and Essex. Put simply, it covers the whole of South-East England.
This poses practical problems. How can I begin to plan a move when they won't tell me where I will be working? I own a flat in east London. How I am supposed to let it and find somewhere else to live in just four weeks? It has implications for my personal life, too. I am engaged, but my fiancé and I haven't been able to organise the wedding - we didn't know if I would have a job to pay for it.
The uncertainty has persisted over six long months. There have been times when I have considered leaving the UK or giving up medicine completely. MTAS has been a bit like UCAS: it's the kind of experience you expect to go through as an A-level student applying to university, but not as an adult who, having trained for 10 years and run up debts of £5,000, has already proved herself in a highly competitive environment. I wanted to be a doctor since I was a teenager. I was the first person in my family to go to university and graduating from Barts and the London School of Medicine was a very proud moment for my parents. They knew how difficult it was. Today I am angry that so many of my colleagues, who are highly qualified and committed to the NHS, but do not have jobs and face the prospect of their careers being over in their late twenties. At the hospital where I work, I do not know anyone, from consultants to nurses, who thinks MTAS is a good idea.
I spent two weeks in January filling out the online application form - yes, it was that complicated. That was two weeks annual leave that I had planned to use to study. You had to list all your qualifications and awards - I have a BSc and postgrad qualifications in several specialties, including medicine and anaesthetics - and there were questions on situations we had faced and how we had dealt with them. If there was any guidance on how to fill it out, it didn't filter down to us. But I put a huge amount of effort into it and was confident that I had done OK.
What I didn't know was that each part of the application form was separated out and marked by different selectors, so they had no overall picture of the candidate. The way scores were allocated was also questionable: you could get four points for writing 150 words about how you have dealt with difficult patients, but having a PhD gets you just one point. Three years' work for one point!
We were supposed to find out if we had got interviews on a Saturday in February. Then it was delayed to the Monday. I kept on checking the MTAS website, which said something like: "You have not been offered an interview yet." By Wednesday, my tutor had spoken to the Deanery and found out that all the interviews had been assigned and no more were being offered. Nobody at MTAS had bothered to update the website.
I was distraught - as far as I could tell, my career was over. I could get a job as a doctor, but it would be a non-training post, meaning I would not be able to progress any further towards a consultant's post in psychiatry. You can't help but take it personally.
There was a protest march organised in London and I wanted to vent my fury, but I was on call. I thought: "Why should I be committed to my duties when it seems I am not even wanted in this post?" You work hard, you work antisocial hours, and you expect more.
In March, after The Daily Telegraph highlighted the crisis facing junior doctors, the MMC told us that everybody who didn't get an interview would now get one. Another chance, just the one interview, to secure my future. I went but again they were vague about when we would find out the results. I rang numerous times.
Eventually I found out that the last posts would be handed out at midnight on June 13. By the middle of that Wednesday all my colleagues who had had interviews had heard. I was very concerned. I was at work, and all I could think was that my career was about to be over. I hid how devastated I felt, but the fact is I shouldn't even have been at work that day.
As the night went on my nerves were fraying. Every time the phone rang, I got more agitated. I checked my email inbox every two minutes. Then at 11.10pm, just as I had started consigning 10 years' training to the dustbin, I got an email telling me I had a one-year post in psychiatry. I felt huge relief.
Last week I heard that I had a run-through post, which means it will continue until I become a consultant in four years. Obviously that's great, but I don't feel much like celebrating when I know that a lot of my colleagues may soon be out of a job.
I worry about the short-term implications of the Government's training reforms for junior doctors and long-term implications for patient care. Doctors have always strived for excellence through amassing experience, but MMC runs on a competency-based system that seems to aim only for the minimum.
It means we will have done fewer hours with patients by the time we are consultants. I believe the Government is trying to deprofessionalise the NHS by putting targets above anything else. I do not think many doctors will vote for Labour next time.
I have several friends who are moving to Australia to continue with their careers. I've considered that, but it would involve too much upheaval and, having been through so much, all I want now is just to be settled.
