Starting house jobs on the right footing

New doctors are vulnerable in a way that many people cannot understand. Ian Urmston gives those about to start their house jobs some advice, to avoid being exploited by their new employers

In July, anticipating the latest cohort of brand new doctors, newspaper columnists and medical journalists will be dusting down their “try to avoid being ill in August” stories. Expect to read better jokes, but remember those broadsheet readers are probably not the only ones who are worried. No matter how well prepared for life as a house officer, many medics in the class of 2002 will be anxious about becoming a doctor.

Preregistration house officers have much to concentrate on: consultants to impress, references to collect, and, most importantly, patients. As someone who will never have to face a first day at work as a doctor, I can relax. The stresses and strains of trying to remember all I have learnt over five or six years, and dealing with patients only months after being a student, is a challenge I will not be facing.

The peculiar trials of working life as a junior doctor can be compounded by the absence of what have been called “hygiene factors.”¹ These include suitable safe accommodation, food, and, in particular, rest.³ Junior doctors pay is determined by the number of hours worked, and the system will be unfamiliar to most UK graduates. Understanding how a trust should treat a preregistration house officer may not be a high priority to a new doctor: there are more pressing things to learn. But, if the preregistration year is to be as productive as it might be, getting the employment basics right is important.

An intimate knowledge of the terms and conditions of service of hospital medical and dental staff (TCS) and the General Whitley Council (GWC) conditions of service might be as useful as being able to reproduce the Krebs cycle on demand; knowing just a little about the TCS, however, is worthwhile. The fact that the junior doctor contract is national and applies across the NHS is a good starting point. All preregistration house officer posts are subject to the same rules and agreements covering pay, hours, rest periods, leave, accommodation, etc, wherever they are in the United Kingdom.⁴

Many trusts try hard to treat their juniors according to national standards, and some achieve very good standards. Abuses, however, do occur and they include

• Imposition of new shift patterns without consultation
• Non-provision of locum cover
• Non-issue of contracts or issue of non-standard contracts
• Pay band reductions without a reduction in working hours
• Restricted canteen opening hours
• Inadequate facilities—for example, no showers—in residential accommodation
• Pressure to under-report working hours
• Rent abatement rules being ignored.

The factors listed in the box provide juniors with a “double whammy.” They encourage trusts to breach agreements and can dissuade doctors from insisting on their rights. The incentive for a trust is to save money. The provision of decent rooms, proper mess facilities, and clean linen each time an on-call room is used costs more than keeping doctors in decrepit flats, closing the canteen early, and not changing the sheets. Many doctors do not get the agreed periods of rest at nights and weekends; the cost of employing extra senior nurses to filter bleep calls or more phlebotomists is a disincentive to making sure doctors get some undisturbed sleep.

The disincentive to a doctor is that they do not want to “to rock the boat” or get poor references. The sheer hassle and effort of taking a stand can also be discouraging. If you find yourself in a post where some of these or other abuses occur, the alternative to standing against the mistreatment is to accept the status quo and let it erode your goodwill, your good nature, and your enthusiasm for medicine. The preregistration house officer year is difficult anyway, and many doctors are taken to breaking point. Sadly, some go beyond this. Working long hours unpaid, or living in a flat with no shower or heating, can increase the stress.

The message is that you can do something about it, and there are people to help. The BMA is the doctors trade union. Its Junior Doctors Committee represents all juniors to the government, and BMA staff can advise and represent individual members facing employment difficulties. To highlight its role in promoting better conditions for juniors the committee launched a “fair treatment for all junior doctors” campaign earlier this year. The campaign is supported by the Department of Health and encourages doctors to report trusts that treat doctors unfairly.

If you are a finalist, do take the time—when pressure of revision, exams, and then post-exam parties allows—to find out a little about the nuts and bolts of working as a doctor. BMA members can have their contract checked before signing.

And if the pundits are right, stay out of hospital in August! Good luck.

Information and guidance about work as a junior doctor (including the complete text of the Junior Doctors Handbook 2001) is available in the member only sections of the BMA website (www.bma.org.uk) and at studentbmj.com⁴

1. Herzberg F, Mausner B, Snyderman BB. The motivation to work, 2nd ed. New York: Wiley, 1959.
2. Maslow AH. Motivation and personality, 2nd ed. New York: Harper and Row, 1970.
3. Urmston I. Problem postcards. studentBMJ 2001;9:331.
4. Urmston I. Are you about to start as a preregistration house officer? studentBMJ 2001;9:194-6. studentbmj.com/back_issues/0601/careers/194.html