'How can you not know if you’re coming to the wedding? It’s in two weeks.'
'Are you coming home for Christmas?'
'How can you not know if you’re off this weekend?'
These are common questions I hear from friends and family, and it is the reality of a workplace rota for a junior doctor in Northern Ireland.
Planning events or holidays months in advance is nearly impossible. If you’re brave enough to book a holiday without knowing your rota, you’ll likely have to arrange a series of shift swaps to get the time off. Swapping shifts has become increasingly difficult in recent years due to worsening rota gaps and increased frequency of shifts, resulting in limited options to swap with colleagues.
I once turned up to my first day of a rotation at a new hospital without having received my rota, or indeed even knowing what time I would finish that day. This is the same story for juniors every four to six months, with each rotation coming with the same problems. Officially we should receive at least six weeks’ notice of our upcoming work pattern, but this often isn’t the case.
Each time it’s a similar story: ‘We don’t know how many doctors we’re getting;’ ‘we don’t have the doctors’ names’; and, worryingly and more recently; ‘some of the doctors have already resigned’.
Any sickness at all significantly impacts rotas and can lead to stressful situations. We’ve all heard stories or personally experienced scenarios when junior doctors working a dayshift have been gathered in a room and instructed not to leave until someone volunteers to go home and come back in a few hours to cover the nightshift.
I’ve experienced these circumstances arise over vacant night shifts that have been known of for weeks previously by those in charge, with little action taken to arrange cover or seek a locum doctor. Rota monitoring exists with the aim of identifying rotas that are contractually noncompliant, but faith in these short monitoring exercises has long been lost amongst junior doctors.
My family find it hard to comprehend that emergency departments filled to capacity – often with patients in corridors, on the floors and, increasingly, waiting outside in ambulances or police vehicles – are staffed by only four junior doctors at night. It’s a similar tale across the rest of the hospital with often only three or four junior doctors assigned to cover the entire hospital’s medical wards at night.
It’s important to understand that junior doctors are not all fresh out of medical school. They range from newly qualified doctors on their first day of work to senior medics on their last day before becoming consultants.
The doctors seeing you in the emergency department at 2am, removing your appendix in theatres, and forming part of the cardiac arrest team 24 hours-a-day are junior doctors. My colleagues arriving from England, Scotland, and Wales for foundation training are often shocked when they start working in our Northern Ireland hospitals and discover the low staffing levels. They often feel like just a number on a rota, rather than a medical professional.
Recent media coverage reflects the current junior doctors' reality of feeling overworked, underpaid, and generally underappreciated. It’s hard to blame those seeking better working conditions and a better work-life balance in sunnier climates.
This mass exodus of junior doctors following completion of the first two years of training has only fueled rota gaps and those left behind are under increasing pressure to cover gaps and shortages. I can’t blame those who choose to leave the NHS, having often reflected on pursuing this path myself. For years now worsening conditions and rota gaps have made working conditions exhausting, stressful and at times patient safety has been impacted.
In the rest of the UK junior doctors are either in pay negotiations or in the middle of industrial action. The media there may focus on pay, but a combination of poor working conditions, high levels of burn out and concern for patient safety are also key reasons for junior doctors there feeling they have little choice but to take action.
In Northern Ireland the situation is much bleaker as the results of the most recent GMC national training survey show. Almost half of all junior doctor respondents from Northern Ireland (49%) reported working above their rostered hours – higher than the UK average of 42%.
Significantly more juniors in Northern Ireland (38%) reported that rota gaps were not being sufficiently dealt with than in the UK as a whole (29%), and that this was impacting on education, training and morale.
Little wonder then that morale and resilience amongst junior doctors here is at an all-time low.
Paul Mogey is a member of NIJDC (Northern Ireland junior doctors committee)