What is it really like being a junior doctor today?
Special report: Long shifts, life and death decisions and often with little rest - and now as the Government proposes to change their working hours
A huge row has erupted over a potential change to junior doctors' working contract. English health secretary Jeremy Hunt and the British Medical Association are at loggerheads over the move to change normal working hours from 7am-7pm, Monday to Friday, to 7am-10pm, Monday to Saturday. Now, strike action has been threatened by medics.
Thousands of junior doctors joined a protest in London and hundreds in Belfast attended a rally earlier this month, claiming any changes to their terms and conditions will force them to work longer hours for less pay while putting patient safety at risk.
Scotland and Wales have rejected the changes. But Northern Ireland Health Minister Simon Hamilton has yet to decide whether to impose a new contract.
Here, five junior doctors from across Northern Ireland give an insight into their work and explain why they fear the proposed changes could damage an already stretched health service.
'You can feel so exhausted you fear you could kill someone'
Sabahat Hasnain (31) is a junior doctor at the Royal Victoria Hospital and works in neurosurgery. She trained at Imperial College in London in 2014 but last year moved to work in Northern Ireland. She now works part time but plans to leave medicine to retrain as a human rights barrister. She says.
My dad Khawar was diagnosed with cancer when I was two years old and I spent much of my life going in and out of hospitals. I saw the care that doctors and nurses gave to my dad and I thought that is what I wanted to do. I saw how my dad was treated and was given a good quality of life because of it for another 11 years before he passed away.
I started medical school in 2003, and qualified in 2009. I had been thinking of a change from medicine but the possible change to the contract was the final nail in the coffin, so I'm leaving to become a barrister. I'll have been a qualified junior doctor for four years when I leave.
A typical day would officially be 8am to 4pm but I've never left before 6.30pm, then you have your on calls, which also start at 8am and finish at 9pm at night.
I think the majority of doctors look at it and think 'unsocial hours, well that is normal'. None of us complain because it becomes part and parcel of the job.
In neurosurgery and neurology there are two wards - there are 27 beds in one ward and about 10 to 13 in the other side. There are four junior doctors at a particular level based there and a typical day would begin at 8am with a meeting involving the consultant, registrar and junior doctors. We discuss the new admissions, walk round the wards and then get down to work with scans, preparing for theatre and going to a pre-op assessment clinic.
There is always one junior doctor on nights as it is a 24-hour service. The night shift begins at 9pm and finishes at 9am and because of the 24-hour surgery there could be operations in the middle of the night. I would work on average about 40 hours a week.
I know four people who have left and gone to Australia permanently. My best friend has just retrained as a statistician and he is one of the smartest people I know.
As doctors we all know when we go into this job that you are going to have to work ridiculous hours. We are prepared for that and you do that because you care about your patients.
But if you are so exhausted you fear you could kill someone, maybe prescribe the wrong medication or go into theatre when you are literally about to fall asleep then, at that point you really do have to say 'I'm compromising my patient'.
I would love to be a doctor in the NHS, but I think we are being devalued and demoralised.
There is a lot of spin that this is about pay. Nobody wants a pay cut but this isn't about money, it is about doing the best for our patients."
'It's hard not to be affected by a patient's grief or pain'
Dr Gareth Patterson (26) is a trainee GP currently based in Daisy Hill Hospital, Newry. The former QUB medical student and Wallace pupil, originally from Annahilt, says:
I suppose I always had a desire to involve myself in community care. I think that being a GP allows you to build a relationship with a patient that some other areas of medicine doesn’t allow. I suppose it is that continuity and ongoing care element that appealed to me. I spent six weeks as part of my medical training at the Kapsowar Mission Hospital in Kenya and it was an eye-opening experience.
I worked in the medical, surgical, paediatric and maternity wards, but also got involved in some of the community outreach programmes including vaccination and antenatal clinics in the Rift Valley amongst the Pokot tribe.
My time at the hospital was a life-changing experience. Being able to build meaningful and lasting relationships with patients and their families, and to establish the level of trust that exists between a GP and their patient is a privilege.
I’m now in the paediatric ward in Daisy Hill hospital in Newry. There is no real typical daily routine. We work on rotas and at the moment I’m on the night shift. I start at 9pm and finish at 9.40am the next day. But I also do day shifts, on call.
As winter approaches we are seeing a lot of asthmatic children and ones with infections. We also deal with difficult cases every day. In medicine it becomes the norm to share bad news, watch a patient slip away and confirm death.
What doesn’t become normal is the emotional impact it continues to have on us as clinicians, and I often find myself becoming emotionally attached to my patients.
It is very hard not to be affected by a patient’s grief or pain.
I remember a difficult case I dealt with as a junior doctor working in A&E. A middle-aged man attended on a morning with a sudden mild headache.
From the history, I was suspicious that there could be something sinister and arranged for an urgent CT head scan to be done that day. Unfortunately, the scan revealed a large brain tumour. Having to sit with that man, who was normally fit and healthy, and break the news to him of his diagnosis was one of the most difficult experiences I've had yet working as a junior doctor.
On average, I work 50-60 hours per week, but in previous jobs I've done as a junior doctor, I've worked as many as 108 hours in a week. My basic salary is around £30,000 per year, which varies depending on the amount of unsociable hours I do.
I am worried about the potential to change the junior contract and the implication for patient safety. It would lead to the removal of the safeguards, so that doctors aren't overworked. Working in hospital is intense and stressful at times and that could impair our ability to make life and death decisions - possibly resulting in patient harm.
I would strongly implore Simon Hamilton to realise the potential risk the changes would bring.
I'm training to be a GP - one of the few - as in the next five years we are set to have a loss of a third of our GPs."
'My number one concern is the removal of safeguards'
Dr Michael Moran (35) from Belfast is based in Craigavon Area Hospital. An Ear, Nose and Throat (ENT) registrar, he graduated in 2004 from Queen's University and is due to finish junior doctor training in August 2018. He says:
My dad was a biology teacher, so I suppose I had an initial leaning towards sciences. When I was 14 my mum was brought into hospital for a time and was quite unwell.
I was in the Royal Victoria Hospital and just watched people do their day to day work and was intrigued by what went on. That is what inspired me to become a doctor.
My week now would entail every day having three sessions. For a surgeon that would mean you are in an outpatient clinic and in theatre and a combination of both. From Monday to Friday we would be very busy doing that and on a Wednesday I'm on a theatre list for 12 hours - that is the long day.
Every fifth weekend I am on call from Saturday through to Monday.
You have to look after your own inpatients during the weekend, then see referrals from other departments and be able to respond to emergencies.
Each week I would work between 44-48 hours, plus one week in five on call. My basic salary is £47,175.
Since starting work in ENT, which is a highly varied specialty, I developed a passion for the care of patients with cancers of the head and neck. Working predominantly in the regional ENT unit in RVH, I have been developing surgical skills in this area, and in 2011, I took time out to do research in this field.
I feel strongly that as a doctor, I have a duty of care to my patients beyond the bedside relationship. In research, there is a duty to focus on the needs of the patient.
The possible changes to the junior contract does raise serious concerns. My number one concern is the removal of safeguards.
I don't see it as a temporary measure and fear it will leave things so unstable the health system will eventually implode. You will have fewer people on the ground.
There is already a brain drain in junior doctors. We can help solve the problem but we need to be part of the negotiation to address the problems."
'The NHS institution should be protected at all costs'
Denise McKeegan (27) is from Glenariffe in Co Antrim. She says:
Currently, I am a third year junior doctor, but I'm only in my first year of speciality training which will hopefully lead to me becoming a consultant physician around the year 2023.
I work in intensive care. I am on a rota with seven other doctors, so all days, nights, evenings and weekends are covered by the seven of us.
I currently work one weekend in every three and a half weeks. The intensive care unit is populated by the most critically ill patients in the hospital.
My role as the CT1 doctor involves reviewing these patients every day, identifying issues and treating them.
It can be very mentally and emotionally challenging, but luckily there is always a consultant available for advice and support.
When I graduated from Queens University, Belfast, in July 2013, I stood up with my friends and in front of my parents and I swore an oath to make the care of my patients my priority. I mean that as much today as I did then. I love my job.
I work on average 48 hours a week, but this week I am working 53. And my pay is £30,000 a year.
There are ups and downs, but it is particularly during the downs that the NHS works so brilliantly.
I am inspired everyday by the work ethic of those whom I have the honour of working along side.
Everyone from managers to medics, porters to pharmacy technicians, nurses, domestic service workers, allied healthcare professionals and many more, all working together for the good of the people. It is an incredible organisation.
The NHS is an institution which should be protected at all costs.
That is why I am firmly against the new junior contract.
The terms of this contract would seek to further stretch an already thinly spread workforce, putting the patients at risk when they are at their most vulnerable, forcing dedicated professionals to seek work elsewhere and ultimately destabilising the NHS, leaving it open for privatisation.
The day when I have to ask my patient for their credit card details before I can help them, is the day when this eternal optimist will have lost all faith in humanity."
'This contract will bring us back to unmonitored hours'
Dr Chris Hoo (38), from Belfast, will be finishing his training as a junior doctor next year after qualifying in 2000. He is married to Jennifer and is dad to Elijah (11) and Valerie (10). He says:
Back in 2000, I qualified as a junior doctor, so I've been working for 16 years, but will finish training next year.
I am based in the Ulster Hospital in the plastic surgery unit and a lot of my work is reconstructive surgery. I also have to check on patients at the Royal Victoria and Belfast City hospitals.
When I first started working it was before the European Time Directives were introduced and I would have easily have worked in excess of 90 hours a week, sometimes 100. It was very tough, but then in 2004/05 the new contract was brought in and there was a gradual change in ethos about how junior doctors worked together.
There were more of them and the pressures decreased significantly, but over the last few years the gaps and cracks have begun to show.
I don't disagree that the current contract has outlived it's purpose and I agree that we need one that gives patients safe care and ensures that doctors get proper rest. But this new contract will bring us back to when hours aren't monitored.
If I'm on call over the weekend, which is all day Saturday and Sunday, which I do once every six to seven weeks and then work my normal week I would be on duty for almost 90 hours. I'm on the top of the junior doctor pay scale - which is about £47,000 per year."