Northern Ireland’s hospital pressures are in the news regularly. Trusts are turning to social media with increasing frequency to warn the public of how busy our A&E departments are. Ambulances are queued outside them in convoy formation.
Our wards are bursting at the seams both with sick patients needing our care and patients unable to be discharged due to a lack of community and social care options. And through it all, junior doctors work ferociously to deliver the best level of care they can in a system under immense pressure.
As a junior doctor working in Northern Ireland for nearly 10 years, I have seen my workload rise year on year, rotation on rotation. With more and more patients to see, outliers outside of your base ward, rarely time for an actual break, and the ever-rising number of new admissions on acute takes, I regularly leave work exhausted both physically and mentally.
My day-to-day duties and responsibilities have been increasingly expanded but with little development in job plans to account for these, nor additional staff to help support them.
The ambulatory hub I work in was set up to try and streamline referrals, ensure patients warranting cardiac assessment are done in a timely fashion, facilitate early discharge and follow up, and pull appropriate cardiac patients from A&E to divert from admission. As the waiting lists have worsened, we are regularly overbooking this unit to try and make a dent in patient waiting times and are frequently pulling more patients from A&E than the unit can accommodate to try and ease ward pressures. Ultimately, this just moves the pressure elsewhere in the system.
Referrals from other specialties come thick and fast, all of which require our input, review or discussion with a consultant. On a good day, you have around 10 referrals. On a bad day, you’re talking 25 plus. And through all this, you’ve to make time to do your dictation and a backlog of paperwork, as well as teaching medical students.
As junior doctors, we also have training requirements to meet, portfolios to complete and exams to study for. The level of pressure on our day-to-day work makes it increasingly difficult to meet these objectives. Between rota gaps making it harder to get study leave, to just the sheer volume of patients to review and problems to address, our roles are becoming increasingly focused on service provision, which will invariably be to the detriment of our continued professional development.
While this is just my experience, I can see it echoed in that of other junior doctors across many specialties. It’s no wonder burnout is at an all-time high, something I myself have been actively trying to combat.
And when I talk of burnout, I don’t just mean workplace burnout. When you’ve nothing else left in the tank, you can barely engage with things outside of work. Most people look forward to the weekends to engage in recreational activities, spend time with loved ones and just have a bit of fun. As the years have gone on, my weekends are more about recovery than relaxation.
I’ve lost touch with friends, barely get to see my family and the times I do, I’m usually too exhausted to engage with them.
The mental taxation my job has had on my life over the years has been getting worse and worse, to the point I’ve seriously considered leaving the profession on two occasions.
For most people who become doctors, their initial drive to help people would be described by many as vocational in nature. To use their intellect and rational thinking to the benefit of others. When I reflect on those two moments where I thought of throwing in the towel, I try to think of what made me stay. And ultimately it was that vocational instinct in what I do that made me keep going.
But as time has gone on, with the impact my profession has had on my life, I feel that vocational call getting quieter, and I imagine I’m not the only one.
David Pelan is a cardiology specialty doctor in Northern Ireland, and a member of the BMA Northern Ireland junior doctors committee