What kind of doctor did you want to be? And what did you become?
Just over 10 years ago, the BMA contacted more than 400 recent medical school graduates. All were making the decisions that would eventually define their careers. Some knew exactly where they were going, some wondered why they were even there. All were likely to encounter at some point the trade-off between ideal and reality.
Each year, the doctors told the BMA about their working arrangements, morale and career intentions.
The results, which were published as the annual cohort study, provided a huge amount of insight to inform the BMA’s work.
But behind the statistics, what about the individual doctors who took part? Three of them recall what brought them into medicine, and the experiences that have helped to define them over the last 10 years.
Stuck on a ship. For months. Living, eating and socialising with your patients. It's not every aspiring doctor's idea of an ideal experience, something to aim for.
But the thought of being a ship doctor had always been at the back of Richard Mellor's mind, ever since he started as a medical student in Durham.
As a qualified GP, he got the chance to finally make it happen, on a ship bound for the Antarctic and a tour of its research bases. Some bases are in the dark 24/7 for much of the year. An easy environment it certainly is not.
‘I got to see a lot of incredible stuff,' Dr Mellor says. ‘But it was difficult, sometimes, living with your patients. Normally as a GP you wouldn't see your patient in an appointment then later in the day go for breakfast, lunch and dinner with them!’
Dr Mellor has been a ship doctor twice, for seven and then three-month tours respectively.
While tending to crews of 20 to 30 differs from working at a busy practice, doctoring on board has its own set of worries.
‘A lot of the time you are in the middle of nowhere. If there was a serious injury, it would really test the ships resources, and a medevac could potentially take days to get to you. But it was pretty amazing, living on a ship in the middle of the Antarctic.'
Being a doctor has helped him to work in Cambodia and New Zealand, to which he is planning another trip with his partner.
But medicine wasn't his first choice of career. 'I first did a degree in zoology,' he says. 'I had always liked biology and animals at school. You have to pick a degree at school and perhaps I was a bit naïve, with regards to what career it may lead to.'
Any anxiety he had about finding a job during his zoology degree soon dissipated after he got into medical school. 'I remember being excited to be studying medicine,' Dr Mellor says. 'I saw it as a chance for a rewarding career.’
After trainee jobs, including diabetes, neurosurgery and general practice, he opted for the latter as a specialty. ‘I thought it would enable me to have more of a work-life balance and it has allowed me to do a variety of different jobs.’
He now splits his time between locum GP work and out-of-hours work. ‘The days I do in GP work can be quite intense. The idea of doing five days solely in a practice, I think it would break me. I see it happening to my friends.’
Dr Mellor says he took part in the BMA's cohort study to help combat a pervasive 'negativity' about medicine, something he's combated all his career.
'Ever since I was a medical student, I've always felt there was an edge of negativity to everything,' he adds.
'We were told that some of us wouldn't get foundation jobs because there weren't enough of them. In the foundation years, when I wanted to go to New Zealand, that was frowned upon. You're still expected to decide early on in FY2 on which training programme they would like to do’
Junior doctors should be free to try a range of disciplines if they wish, before committing to a career path, he adds, and not be made to feel guilty when breaking with convention.
'If I had listened to the negativity, I would have missed out on a lot of amazing opportunities.’
‘I was always going to be a pilot,’ says Graham Johnson, an emergency and paediatric emergency medicine consultant at the Royal Derby Hospital. ‘But I was colour blind so I couldn’t.’
It was a chance encounter with a haematologist, at his brother’s fourth birthday party, that made him first think about medicine. ‘He arranged some work experience for me, some time in the lab, which I hated, and some time in the wards, which I loved.’
A ‘very rapid’ revision of his university entrance application followed. ‘I fell into medicine, rather than it being a lifelong ambition,' he adds.
Now, 10 years into his career, Dr Johnson sees medicine, in the emergency medicine department, as a good fit for his personality. ‘It’s the patients and the variety,’ he says. ‘Bouncing around from the critically ill to the sprained ankle and snotty kids, I really think I’ve enjoyed that variety more than anything.’
Over the decade, since graduation, he says he’s seen a significant increase in workload.
‘As an F2 in Birmingham, there was the odd night where the department would be empty at 3am. You could get it clear. That wasn’t the norm, but it would still happen. Now, we’re a 24-hour specialty. The idea of getting the department empty, wherever you work, I think, is a distant memory.’
He’s seen a ‘flattening’ in morale, over the decade. Friends and former colleagues have gone overseas and not returned. ‘Morale is the biggest problem at the moment in terms of day-to-day working, Dr Johnson says. ‘Then there’s the constant government stick to keep us hitting targets, while not increasing resources. That’s a big player as well.’
Emergency medicine is already a ‘stressful environment’, he adds. ‘We do see some tough stuff and are expected to do more with less.’ And the ultimate endgame for stress is burnout. It’s something, he says, which research from the United States, has found is ‘almost an inevitability’ for emergency medicine doctors.
‘This is certainly something that we’re becoming more mindful of as a profession,’ Dr Johnson says. ‘We’re recognising that, being less judgmental of it. Everyone should recognise that across the health service and that it can take its toll.’
‘There weren't enough healthcare workers. There weren't enough beds. It felt like we were sitting on a time bomb, waiting for it to go off.’
This is not the NHS. It’s Monrovia, Liberia, July 2014, the early days of an outbreak of Ebola, the deadly virus which claimed more than 11,000 lives.
And it’s where Nathalie MacDermott found herself working as clinical team leader in the capital’s only treatment centre, eight years out of medical school.
‘There were people rioting outside the gates because they were opposed to a bigger treatment facility being built,’ she says. ‘It was particularly bad in the summer of 2014 because the rest of the world hadn’t responded yet.’
Dr MacDermott had travelled to the west African country with the charity, Samaritan’s Purse, after securing two weeks’ unpaid leave from her post as a paediatrics speciality trainee in Wales.
Working in international aid had long been an ambition, the one which moved her into medicine.
‘I felt that being a doctor was one of the best ways to provide a sustainable form of help,’ she says.
Before Liberia, Dr MacDermott had already been to Haiti, in 2011 during the outbreak of cholera that killed thousands and two years later, to the Philippines, following Typhoon Haiyan.
But it is her experience in Liberia that appears to have influenced her career path the most.
Despite being evacuated from Monrovia, after two of her colleagues contracted Ebola, she was back within months after agreeing extra time off work.
‘Things were escalating even more,’ she says. ‘I returned as a programme manager, setting up and providing clinical oversight for small, rural treatment centres. We constructed three ourselves and ran three set up by Unicef. I also managed our rapid response model to rural cluster outbreaks.’
The situation in Liberia improved as the international community responded and more help arrived. But that didn’t make Dr MacDermott’s return to the UK any easier.
‘We were debriefed and there was support that I could access. But I didn’t like talking about it when I first came back. I saw people die horrific deaths and at the beginning it was a lot of people every day.’
On her return, Dr MacDermott went straight into a medical academic post, based at St Mary’s Hospital and Imperial College, London, to research genetic susceptibility to Ebola.
‘My experience put me in a good position to do this,’ she says. ‘I understand the impact of Ebola on the affected communities. But it has been hard, as I’ve had to go back to interview people in rural Sierra Leone, where the study is based. Many of the stories are harrowing.’
The Ebola outbreak and the aftermath, as awful as they are, has made the study of genetic susceptibility possible for the first time.
‘Genetic studies require a large sample size,’ Dr MacDermott says. ‘You need thousands of people in a cohort. There has never been that for Ebola until now.’
Dr MacDermott says she agreed to take part in the BMA’s cohort study back in 2006, for fear a new, more rigid training path for trainees might prevent them from gaining experience overseas. ‘There was quite a lot of upset from junior doctors about what was going to happen,’ she says.
As it turned out, it did nothing to halt her pursuit of a successful career in international aid. One for which she even received a specially designed medal to recognise the bravery of those who put their lives at risk.
Dr MacDermott was the exception that proved the rule among her female contemporaries who the study showed were less likely to consider to work or work overseas.
Find out more about the cohort study
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