Chaining doctors to their jobs is no fix for the NHS

I was unsettled to read Tom Tugendhat MP’s recent article in the Telegraph. He suggests that we could resolve the doctor recruitment crisis in the UK by forcing doctors to work for NHS for a set amount of years after they qualify, to ‘pay back their debt to society’ instead of having the option of emigrating.

This is a very short-sighted solution, with multiple flaws. I don’t know how much exposure Mr Tugendhat has had to medical professionals, but if he’s had only a little he must surely be aware of the following:

The most obvious drawback to his plan is that it doesn’t do anything to solve the root problems which are making our doctors leave in droves. Surely remedying the pressurised workplaces, cuts to services and insulting contract prospects which are driving emigration in the first place would be a more logical (and kinder) step? Without these improvements doctors will continue to leave even if it has to be at the end of a period of enforced working.

Then there’s the fact that it would destroy what’s left of our morale. Doctors will stoically grind out hour after hour of work on the deck of the proverbial Titanic as long as patients benefit, but handcuffing us to a railing will only make us lose faith in the captain.

Furthermore, those of us that struggle with the inevitable strains of medical work, as so many of us do, will feel compelled to carry on, burning themselves out so badly that they won’t be able to work again for years.

And those that want to leave for Australia, or New Zealand, or wherever, but have been forced to stay, aren’t exactly going to be employee of the month, are they?

Another reason – patients will wonder if their doctor has been forced to stay. They won’t trust doctor’s motives as much, which is hugely important to us.

But it doesn’t stop there. Sixth formers won’t look at the prospect of a few years enforced labour for a flagging NHS at the end of their degree as an incentive to apply for medicine, especially those from lower income families who are watching student loans and the cost of living rise, but doctor’s wages falling. They’ll rightly think that leaving university with over £75,000 of debt entitles them to choose what they do with their degree.

There’s a philosophical point behind all this too. We don’t educate the young people of this country so they will give us something back. If we did, we’d be forcing teachers, scientists, lawyers and nurses to work for the state after graduation. But we don’t. We educate young people because education is a right, not one half of a deal.

Mr Tugendhat draws a comparison with the armed forces, who fund some medical students through university in exchange for a period of service after graduation. But this comparison is poor. The armed forces, essentially a third party, simply offers students lots of money in exchange for later work. The choice is about personal gain and is all theirs. Whereas NHS services that help train medical students already get paid for it by the state. Students pay loans to their universities for the privilege, have no choice but to train on NHS premises and their only gain is learning. Entirely different systems of motive. Maybe if the NHS started paying medical students tens of thousands of pounds in lump sums during their training, instead of them accruing massive debts, then we might be justified in forcing them to work for the NHS later on.

We should build a system in which young people study medicine and work for the NHS for their whole lives because it’s a great place to work, not chain our doctors to a sinking ship and think we’ve plugged the leaks.

Advertisements

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

One Response to Chaining doctors to their jobs is no fix for the NHS

  1. Judy says:

    otally agree. The NHS is already pretty much a monopoly employer. Working in finance if I don’t like my terms and conditions I can leave and work elsewhere… I don’t knwo why anyone would want to be a doctor in the UK at the moment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: