I want to work in A&E, but as a junior doctor I know it would ruin my life

A&E departments are facing collapse because countless others like me are fleeing the specialism - and Jeremy Hunt's contract will only make things worse

Christopher James
Tuesday 10 November 2015 16:18
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Junior doctors are turning their backs on a life working in busy A&E departments.
Junior doctors are turning their backs on a life working in busy A&E departments.

I am a junior doctor and I have a confession to make: I love being a doctor. It gets worse: I love doing nights. Exams? Yes, I love those too.

Weekends don’t inspire quite the same emotions but I do my bit to staff the seven day NHS that, contrary to popular belief, already exists. Paying for extra courses out of my own pocket stings a bit, but they interest me and help me develop my skills. And hey, it’s a vocation after all.

I have another confession to make (and to my colleagues, I apologise in advance): I love A&E. In my three years as a doctor I have rotated through seven different departments in three different hospitals, and hands down A&E was my favourite. The camaraderie, the breadth of knowledge and procedural ability required - as well the diversity of people and circumstance you are hit with daily – is exciting. Yes, it’s a warzone. But in the same way soldiers talk of loving combat, acute specialty doctors love working in A&E. And I can confirm that is true because, at heart, I am an A&E doctor... who is becoming an anaesthetist.

I have pledged to stay and fight for the future of the NHS, and my involvement in a grassroots protest group helps me to sleep at night and fills me with hope. But giving my life to A&E was a step too far.

At the end of each patient encounter I take 30 seconds and I actively attack my impressions of a situation: I poke holes, I shake the foundations and see if I can knock it down. Working as an A&E doctor taught me to think that way. And do I think I have made the wrong decision to become an anaesthetist instead of an A&E doctor? Absolutely not.

Under the new contracts A&E is under threat of complete collapse. More than 350 A&E consultants have written a letter to the government highlighting the recruitment and retention crisis in A&E. I said no to A&E before the junior doctor contracts were drafted, but I can tell you of endless others who loved A&E, who feel it made them a much better doctor, yet on the day where they had to make a decision looked back ruefully and said, 'if only it wouldn’t ruin my life'. The government’s proposals are only going to make things worse.

I have no intention of venting my anger, nor will I tell you that the last minute “11 per cent pay rise” offer from government is a complete farce (even though it is). But the pay deal is still a pay cut. My “banding” makes up on third of my pay. What happens if you scrap this third but increase the “basic” two thirds by 11 per cent? I’m no maths whizz, but it’s a cut. There are loose promises of supplements to make up the difference, but after all the political manoeuvring and misinformation doctors now apparently have a “high index of suspicion” that whatever we are promised is far from what it seems. Once bitten, twice shy.

My concern for the future is simple. David Cameron, you are wrong - we do not have “all the resources” we need. And Jeremy Hunt, your contract is short sighted and damaging. If it is indeed your intention to bring down the NHS for privatisation then you should take a big deep breath, steel yourself and come out and say so. And stop claiming the BMA won’t come back to the negotiating table – they will if you stop imposing conditions. Stop hiding behind the media and engage with the staff you are supposed to be leading.

NHS staff are uniting. We are galvanised and we are ready for real change. Let’s start over. If you do that, I promise I will come home and become an A&E doctor and give you everything I have. But otherwise, I will see you on the picket line.

Christopher James is a junior doctor working in the UK

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