Do people really want to join an industry in crisis? In the second of a series of articles on heatlhcare, Dorset medical student Molly Harriman talks to Fergus Byrne about what it’s like to train to be a doctor.
Reading a memoir of a country doctor recently I came across a story the author related about how one of his new patients wanted to go private. “I don’t take private patients,” he told her. She had insisted she wanted the best treatment possible, but he explained that he didn’t do private visits because he felt that would put pressure on him to ensure that every time he saw her it was financially in her best interests. He felt that if he wasn’t worrying about whether it was in her financial interest he would see her more often and therefore take better care of her. Reading this, the two things that struck me were how nice it would be if all businesses could use the same logic, but more importantly, what a pity the medical industry seems to be leaning toward the American model of paid-for health care. To put this into context, however, the doctor was working in a small practice in Hawick in Scotland and it was at a time when there were no computers in the industry. So yes, quite some time ago—the joy of viewing the past through rose-tinted glasses.
We are undoubtedly incredibly lucky in this country to have the NHS. However, as is well documented and confirmed in my interview last month with Dr Lisa Naylor, it is in crisis. And the coming months will likely see more turmoil. We will have to get through that but the question that keeps coming up is what is the future of medical care in this country and do we have a strong foundation for training future physicians? According to a recent annual report from the General Medical Council (GMC), the majority of new doctors in the UK have trained overseas. The report revealed that only 39% were UK graduates, down from 53% in 2017. That may not necessarily be a problem, unless you have an aversion to being treated by someone trained overseas. However, Charlie Massey, chief executive of the GMC suggests that the reliance on International Medical Graduates (IMGs) puts healthcare in a ‘precarious position’. Mainly because the IMGs leave the UK workforce at a higher rate, either to return home or to practice in other environments. The likelihood is that a high percentage of homegrown healthcare workers will stay or at least return to the UK.
So what is happening to medical training in the UK? Those of us in declining years are more likely to worry about who will look after our children and grandchildren than ourselves, as they are the ones that will need secure medical care long after we are gone. Molly Harriman from near Dorchester is studying medicine in Glasgow. It’s a minimum five-year course with the option to go into General practice or specialise. However specialising requires up to nine years of training. I asked Molly whether the training was worth the effort. ‘I think it would be fair to say medicine is a very challenging degree’ she said. ‘Unlike other students, you are expected to study year-round alongside 9-5 clinical placement days.’ This makes it a very different student experience. When everyone else is unwinding, making new friends, and enjoying the student experience, medical students are more likely to be grabbing much-needed rest. ‘The exams are hard and every year we have students fail who have worked very hard’ said Molly. ‘If you put in the hours it is manageable, but there are no shortage of papers discussing how stressful medicine is and how much pressure it puts on students. Fortunately, I have always managed and enjoyed the challenge but I have peers who certainly wouldn’t agree.’
However, it’s not all doom and gloom. Despite the effort, Molly recognises that the long-term goal is being able to make a difference, and most people who go into medical care have a natural instinct to want to help people and learn how to make the world a better place. She also describes the process as ‘super fun’ with opportunities to work abroad as well. Strong bonding within the medical student fraternity also helps.
But does the uncertain future for the NHS make it less attractive? ‘There is no doubt that the NHS is in an incredibly challenging period’ said Molly. ‘Funding is short, waiting lists are the longest they have probably ever been after Covid and then there’s Emergency Department (ED) waiting times.’ She says that morale in hospitals is not as high as it was during Covid when there was a real team spirit and a lot of public support. ‘I think many clinicians are tired and feeling the strain. However, most people still love the NHS and most will continue to work in an NHS system. Some consultants I have spoken to are taking up more private work and moving away from the NHS because they don’t feel very looked after. Equally, some are canceling private work to try and catch up with NHS lists. So it is very person dependent.’
When I spoke to Dr. Naylor last month she highlighted her concern that General Practise was not attracting enough doctors. She, like many in the profession, suffers from the backlash from frustrated patients. ‘There is a shift in General Practise (GP) work’ said Molly ‘and certainly during Covid, not being able to have face-to-face appointments has damaged the all-important doctor/patient relationship. I think it depends on where you are. In Scotland, there are lots of rural GPs and they still have that local family GP charm. In the city, it is harder to maintain that.’
Molly points out that GPs work incredibly hard and that the patient volume is huge. The administration and paperwork have to be done alongside clinical work. However, she thinks that the pressure will eventually resolve. ‘At the moment it can seem a less attractive job to apply for but I think once the Covid backlog settles and everything becomes more face-to-face again, it will improve. The public opinion of GPs is a little harsh. They are working and struggling and the negative press they get is upsetting for the clinicians who are trying their absolute best.’
About a year before the Covid pandemic I spoke to a doctor friend who told me he would never recommend his children go into healthcare. He has since retired and I don’t know whether any of them have. But Molly is more sanguine. ‘I have spoken to some consultants who wouldn’t want their children to do medicine’ she said. ‘I have also noticed a lot more doctors seeming fed up and unhappy with work at the moment. I think despite this they are probably all glad they are doctors. To do medicine you give a huge amount up—timewise, during training, etc. But the job satisfaction is huge and “helping people” makes it feel worth it.’