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Our job can place a terrible burden upon us. As a profession, we have increased rates of suicide, substance misuse, alcoholism and divorce. So the small things can be a source of great relief.
What has this got to do with the DDRB?
One recommendation says pay should be based solely on grade. My colleagues have already made the point that for those carrying out life-saving research, those having babies or career breaks to care for family members will receive pay that falls behind that of their peers.
And what about those who simply change their mind about their specialty? This one almost makes me weep.
In medicine, we are expected to make decisions about not just what we do, but what we become, at a ridiculously early stage in our careers. Fourteen months after graduation, with only the most basic insight at F1 into medical or surgical options, I opted for general practice.
I chose it because I didn’t know what else to do. Many thousands of doctors have chosen it for the same reason and have gone on to lead happy and fulfilling careers.
But halfway through my GP training, I worked in psychiatry and loved it. It’s a big decision for any doctor to take but at least the practical elements were as smooth as they could be.
Crucially, I had pay protection, which recognised that while I was junior in terms of psychiatry, I had years of accumulated medical experience that would be of benefit to my patients. I may have been a new psychiatry trainee, but I had already started to grow as a doctor.
It meant that I could follow a different specialty, to which I felt far more suited, and still be able to pay my mortgage.
Had I stayed as a GP trainee I think I would have eventually burnt out. If the DDRB proposals go through, doctors would be left with an invidious choice. Either they stay in a specialty where their skills and enthusiasm will atrophy, or they move, and ruin any financial security they have at a time when they are still paying off student debt.
The workforce will become less flexible, and scarred with resentment and depression, and doctors may leave the profession altogether, rather than face the petty injustice of being given no credit for their past experience.
We must face the reality that this vocation can drive people to depression, suicide and worse. This must be ameliorated wherever possible.
Zead Said is an ST5 in general adult psychiatry in south Yorkshire
Visit the BMA website for more information and updates on junior and consultant contracts
Ziad I do understand where you are coming from. However seeing the argument from the side of the employer, one has to ask why are we paying someone at a more senior level when they can't do they job we want them to do because in that specialty they are a junior. Outside of medicine if you decide to change jobs you risk having to take a pay cut to retrain in a job you actually want and that is the price you have to pay but there may be some scope to have your transferrable skills recognised.
My feeling is that it needs to be one of our negotiating points - yes we will compromise on pay for at point of grade but only if NHS employers will hold your pay at the same level if you change specialties. that means if you hit ST4 and decide to change career then you will hold ST4 pay until you reach that level in your new specialty.
There is also the big impact of shape of training changes that we are not taking into account. If there is to be more broad based training it may be that the point at which you have to decide on specialties is moved further along so a) you arent choosing so early and b) if you do decide to retrain you may only be moved one or 2 points down the scale.
Finally i think we are also missing the bigger picture in that no matter how long you are a trainee, you will probably be a consultant for far longer than that. Perhaps we should look to making sure trainees have a decent living wage but also that they are have proper career advice early one, properly trained (not just apprenticed and left to learn on the job from our own mistakes) so that we can make training shorter and then put that money towards a decent consultant wage, so we are properly reimbursed for the privilege and responsibility our job entails.