Leaving foundation training to locum was not a decision I took lightly and yet it is one being made by an increasing number of my colleagues.
This year there have been 30 resignations from the foundation programme in Northern Ireland. Whether these doctors choose to locum or have left Northern Ireland to work in other countries, the reasons for doing so are broadly the same: poor training opportunities, poor workplace conditions and poor pay leaving many of us with no choice but to hand in our notice.
Lack of training opportunities
Rota constraints meant requesting and getting study leave was a massive challenge for me. I had to miss many courses that would have helped my applications for certain specialties due to staff pressures, or because it was deemed as not required for “foundation doctors educational needs”.
To add to this frustration, I would see advanced nurse practitioners and physician assistants getting better training opportunities and have closer contact with consultants than foundation doctors were. These staff members would get the chance to do patient reviews on the wards and then delegate tasks such as requesting scans, taking bloods and discharge letters to me and my junior doctor colleagues. And yet we were then expected to step up and deal with very sick patients during out of hour shifts when we could be the only doctor covering an entire ward.
By dropping out of training and working as a locum, I am at least able to dictate my own learning opportunities and give myself a better chance at career progression. I no longer must use my annual leave entitlement for study or exams instead of the much-needed rest it is meant for.
Poor levels of support
In medical school we were taught to raise concerns about treatment and care immediately via the appropriate channels. What medical school does not teach us is that this can sometimes backfire on juniors.
I have personally witnessed cases where my junior colleagues have raised concerns only to be ignored, gaslighted and then subsequently on the receiving end of negative feedback in ePortfolios for speaking out. Furthermore, when something goes wrong, everyone is quick to throw junior doctors ‘under the bus’ and blame us, so we often feel we do not have the support of our managers.
For me, this was an unpleasant, toxic work culture to be a trainee in. Now that I locum, I feel I can raise problems without fear of repercussions and have the freedom to leave if I experience poor workplace culture and treatment of trainee staff.
Poor workplace conditions
Rota gaps mean juniors are overstretched and burnout, which can create tension between colleagues at times. It also means requests for things like last minute annual leave may not be accommodated by rota coordinators, putting us in the difficult and awkward position of begging other exhausted colleagues for swaps.
To add to these levels of burnout and tension, there is a lack of designated spaces to take our allotted breaks. I once saw a notice stuck on the door of a break room stating that the space was ‘not for doctors’ but for other members of staff. This was despite doctors not having our own break room. Why would I choose to stay as an employee in a work environment that does not even provide me with my basic needs?
It is well-reported that junior doctors are not paid enough for the work we do.
Poor rates of pay offered at last minute to employed trainees for covering rota gaps – gaps that have been known about for weeks - mean they remain uncovered. Yet as a locum I am paid far more for covering these shifts and providing the same service. Time and time again it feels like those with the power are willing to leave rotas understaffed because they do not want to pay employed junior doctors a reasonable rate to work these extra shifts.
I want to take pride in being a doctor and be the best I can be by learning new things every day. That was hard to do as a foundation doctor when my job was pure service provision aimed at keeping an overstretched system afloat, with no time for real training or learning.
By being a locum, I have the time and freedom to further my knowledge in ways that I would like. I know that I can choose where to work. I know that I can leave a toxic environment if I need to. And most importantly, I know that I will be a happier doctor as a locum.
The author is a locum doctor in a Northern Ireland health trust