I have too many jobs!
Amongst other tasks I manage the foundation program for junior docs at my large university teaching hospital. I’m effectively responsible for getting them through the two years of their career with the hope that they will get signed off by the GMC and go on to greater things. I have great trainees, many are high achievers who will go far in whichever career they choose.
I’ve run the program for a few years now and unsurprisingly one of the things I have made everyone do is emergency medicine. All docs do at least 4 months of EM in my hospital. I think it’s good for them, it exposes them to a wide range of clinical problems and tests them to stand by their own decision about diagnosis, treatment and discharge.
So what’s this got to do with recruitment you might ask? Well, at the end of the two years I ask all the trainees which jobs they enjoyed, and as you would expect there are a variety of answers, but it’s perhaps surprising that about a third rate EM as their most interesting and rewarding placement.
So would they consider it is a career I ask?
The responses are consistent and worrying for those of us who are seeking to nurture the next generation of EPs in the UK. Despite their interest in the clinical work, hardly any trainee considers EM as a career choice, and it’s not because of the clinical practice. They love the team working, the unpredictability, the frequent and rapid patient contact. It’s the working conditions, the lifestyle and the career prospects that’s putting them off.
Why they ask should I do EM as opposed to something like medicine or general practice? Fewer weekends, fewer evenings, easier exams……, same pay.
Pay does seem to be a major motivator for todays young medics, but not in the way I originally thought. It’s not so much the amount but the fact that there are no differential pay recognition for those who work the hardest, and at the most socially disruptive times of the week. Why would you do our job for the same pay as your friend who only works every 10th weekend (whilst you do every 2nd). It’s not the absolute amount, rather its the fact that it does not matter which speciality you train in, and indeed practice as a consultant in, the pay and financial reward is the same. So how we find a way of valuing the extra effort and disruption that a trainee embarking on a career in EM takes on? I’m not sure that I can think of many that are not financially orientated. Perhaps time off? More holidays so that we can retain some of our excellent oversees trainees who struggle to find time on busy rotas to travel home to see their families? Ideas please.
But is this not the case with many there specialities? Are there others where personal sacrifice is required as a junior in order to get to the top? Of courses there are. Plastic surgery is a good example where competition is fierce and additional effort is expected with a long and challenging training program…but the rewards at the end are potentially enormous. Not so much for plastic surgery Chicago clinics, there is little or no private practice to rival that of the plastic surgeons nor the prospect of leisurely on calls as a consultant as increasingly EM consultants are moving towards the very same 24-hour rotas that is putting off the juniors.
We are already in a staffing crisis in EM. Consultant posts remain unfilled, Middle grade rotas have been decimated in many departments and trainees in our early training programs are leaving EM for the less onerous and disruptive specialities such as anaesthetics.
What then can we do? A starting point would be to recognise the additional disruption that training in EM causes to the individual and their family. The UK Government is consulting on the idea of differential pay depending on where you work. Perhaps the time is now for us to give additional reward to the hard working trainees in emergency medicine. Perhaps that might convert some of my enthusiastic and brilliant trainees to stay in a speciality where they love to work, and one in which they feel rewarded for doing so.