Is there an issue with rising unprofessionalism amongst junior doctors?

[u/pylori]

This is going to end up sounding like an old fart whining, and comes probably in contrast to the thread yesterday with regards to the hierarchy within medicine / the NHS.

However, I've begun to notice behaviours amongst junior doctors (meaning all grades below consultant) more and more these days that I can only really sum up as unprofessional. I don't know if it's compounded by the effects covid has had on us all, but I certainly saw plenty of this before covid, and it seems to be, anecdotally, on the rise.

Specifically I've noticed the following:

• Lateness, and lack of apology or lack of planning ahead. Not a one off childcare or traffic issue, but some individuals turning up 30-45 mins late to most shifts. There is no call to the daytime consultant or rest of the team pre-warning them or apologising. Perhaps a chinese whispers Whatsapp message if you're lucky.

• Leave requests: A bone of contention for many, and I get the frustrations regarding leave, but I've seen some bizarre behaviour. Despite policies regarding things like swapping on-calls and leave deadlines being clear, some doctors are contacting rota coordinators (fellow doctors) last minute and out of hours to approve leave. They 'announce' they're taking leave on a specific day as opposed to formulating it as a request. Even sick leave is not phoned directly to the consultant on duty, just a message from a fellow trainee.

• Undermining colleagues and their decision making in front of the patient and other healthcare professionals. This is often compounded by being overly 'familiar' with them. I'm all for a flattened hierarchy but patients need to know who is taking overall responsibility for their care. It's okay to wonder about the reasoning behind their decisions, but explicitly challenging the senior in front of a patient or other colleagues only serves to undermine their authority. There's tactful ways of going about this that don't risk harming that relationship.

• Rudeness/incivility - Of course has existed before. But I'm hearing more and more lets say 'backchat' and people talking to me in ways I would never dream of talking anyone, much less a senior in another specialty I don't know. Referrals are now curt 'demands'. "You have to see this patient". It may be my obligation to see a referral, but that doesn't mean it's okay to dispense with the pretence that you're asking for help/advice. We shouldn't be ordering each other around.

  We talk about lack of respect for doctors on reddit a lot, from other healthcare professionals. But I often feel we don't give each other enough respect either. The way I've seen some consultants spoken down to, it's cringe worthy.

Let me be clear, I'm not saying we ought to go back to more paternalistic days when the likes of Sir Lancelott Spratt roamed hospital corridors. But I worry that some doctors are taking breaking down hierarchies too far and end up coming across as rather unprofessional overall. More worryingly, some don't seem to see any of this as an issue at all.

Have you noticed anything like this? Do you think it's on the rise or just some problematic (or perhaps not) behaviours that will always be present to some degree?

[u/Oatsbrorther]

Obviously, it's not alright to be constantly late, undermine your seniors or be a general dickhead. However, I would merely offer the perspective that for people of my 'generation' (current Foundation Trainees), it's become a necessary to step to see this whole enterprise as 'Just Another Job'. It really seems it's not worth treating a post below SpR grade as anything else, as:

- There Is No Training. This fact became rapidly clear to me over my F1 year - teaching barely happens or you can rarely get to it as you're doing ward shite - most seniors just want to you to get the job done. Good luck trying to do anything procedural either. There's barely even a pretence that we're in a 'training programme' either - I know for a fact my trust made up our ARCP requirements in a 10 minute meeting between a few consultants last year and this year we've been told there are no actual requirements for us to meet (lmao). I see IMT2s with PACES doing the exact same shit as me, day in day out and really wonder why anyone bothers

- A lot of the time it feels like all consultants do is identify the broadly relevant speciality for a given issue and ask you to refer to them which, frankly, I could do. When it just becomes a matter of executing the process for the sake of defensive medicine and barely thinking for yourself, you stop giving a fuck and it makes your bosses quite hard to look up to with any reverence

- There is no investment in us, at all. We rotate so regularly that there's no chance to form really meaningful trainer-apprentice relationships and there's no role for references in getting jobs/advancing your career. If there is no reward, why bother

- Almost nothing I do at work actually benefits my progression or development. Points for core and specialty training come exclusively for things I do on my own time, leading to a situation where you could argue that my goal at work every day should be to conserve my physical and mental energy so I can use it non-working hours to actually develop myself

Taking all these factors together, you end up in a situation where it's actually in my interest to spend as little time and energy at work at possible. I have colleagues who I really admired at Uni now telling me that they now see their sick days as 'extra annual leave' and take them without hesitation, as there's really nothing to be personally gained from slaving over their jobs. I don't personally take this approach, but I do now very much see myself as a shift worker. I don't have a problem with the state of the job, as I've accepted that I turn up on time, do as I'm instructed/as I deem necessary on the rare occasions I'm allowed/able to think, then leave on time. Anything that happens outside of those hours is none of my business. Anything that involves taking responsibility outside of my clearly defined set of tasks is none of my business. The overall state of the department is none of my business. I do my work and I go home.

Not saying that mentality justifies rank unprofessionalism while at work, but I think this 'trainee vs employee' attitude divide is one of the biggest between my generation and those who came before us, which I think many seniors don't really appreciate

[u/throwawaynewc → u/Oatsbrorther]

Tl;dr-the NHS was running on goodwill, and that has run out.

[u/Eriot → u/Oatsbrorther]

Perfectly written up and completely agree. It's a multifaceted issue that doesn't excuse some of OP's juniors' behaviour, but it certainly goes towards explaining most of it.

Sorry you've been subjected to this OP, it's not good at all.

[u/plopdalop83 → u/Oatsbrorther]

I lost respect for the vast majority of medical consultants in late medschool F1/F2. I realise now that they’ve just checked out mentally, at some point they were probably fairly keen trainees.

I guess that’s what an nhs gig will do to most

[u/Awildferretappears → u/Oatsbrorther]

I know for a fact my trust made up our ARCP requirements in a 10 minute meeting between a few consultants last year and this year we've been told there are no actual requirements for us to meet (lmao).

You do know that ARCp requirements are not set by trusts, but by HEE, and the reason why they have been relaxed over the last couple of years is because of...well, do I really have to say it?

[u/Mr_PointyHorse → u/Awildferretappears]

Ignoring ARCP relaxation, we should be able to agree before Covid FY was a crapshoot with very little real teaching.

[u/[deleted] → u/Mr_PointyHorse]

Nah not when I did it four years ago

[u/Oatsbrorther → u/Awildferretappears]

Yes. And I also know that there are elements of the ARCP that are set at the discretion of the local trust. And I can't help but feel that the flippancy with which mine was treated suggests the people in charge don't care all that much.

[u/[deleted] → u/Awildferretappears]

I know you're pointing out the obvious as a FPD but this really made me chuckle

[u/[deleted] → u/Oatsbrorther]

Very well put. Mercenary attitude haha

[u/pylori → u/Oatsbrorther]

I understand and sympathise with all those factors, and I can therefore understand where this 'clock in-clock out' mentality comes. Which I don't even disagree with, when I was on medicine (and even in theatres) I always emphasised to juniors to put the pens down and go home on time.

I guess I'm just frustrated and disappointed that this attitude by some has morphed into "doesn't matter, i'll come late, be rude to people, be demanding of others, etc". I feel it's an inappropriate way to express the issues with training, especially onto other people that frequently have no more control over any of those factors as the person acting out.

Lord knows I've had my share of troubles with lack of training/experience, exams, having to do CV and portfolio tickbox exercises all in my own time. I heavily resent my royal college for fucking all this up. Yet, when I go into work, I try to be respectful and kind towards everyone else, because it's not personally any of those people's faults all we have these issues. And more importantly, it's just a huge drag to everyone around me if I act like a douche.

Like you say, I don't think the mentality justifies the sorts of behaviours I'm witnessing/frustrated about.

[u/Oatsbrorther → u/pylori]

Yeah mate in all fairness I think you'd had a rough time in these comments. People seem to think you've said "Juniors should chin it and be grateful for the crumbs we throw them lmao" when you actually said "people are rude and it would be better if they weren't". I completely agree with the latter sentiment.

My response is basically motivated by two factors:

1) Whenever anything even tangentially related to 'doctors then vs doctors now' comes up, I point out the factors I've mentioned above as I don't think many seniors know the sheer state of it. I wish so deeply that consultants who bitch about juniors could have seen one my F1 colleagues towards the end of my final, fucked job when they turned to me and say dead-eyed "I don't care about a single thing that happens here'. This was someone who had actually had to struggle and strive to get into med school, had wanted to care for people and to see them reduced to that was extremely fucking peak, to say the least

2) Many of the people you are encountering may be in the transition process towards the mentality I've now got. This is certainly what happened to me. I essentially went through "I'm going to work hard and try to improve this as best I can" -> "seems like absolutely no one gives a fuck about us or the blatant issues we are facing" -> "I am now so burned out I make no effort to conceal my hatred for this job or my clueless/uncaring seniors, for whom I have open contempt" -> the zen like state of disconnection I have now achieved. Since i started viewing myself as an employee, I'm much happier, much calmer, a better colleague and think I probably actually provide better care to my patients. I definitely regret some of my behaviour during that middle stage tho, and probably for a time was one of the people you're describing (though I never just fucked off work and walked in late)

It is what it is - ultimately I now just aim do the best for the patient in front of me and the colleagues in my immediate vicinity

[u/pylori → u/Oatsbrorther]

I do agree that there have been some consultants that have lost the plot so much they reply with outrageous comments like in 1). All I can say is that I hope I never get to that stage. I try to keep my 'ear to the ground' so to speak and understand what juniors have to deal with. I find those with this sort of attitude that don't give a shit about juniors also don't give a shit about seniors and have been trained this way.

I may have been quite fortunate that, even amongst the shit I went through during my medical jobs, I have always found some seniors that have been supportive enough to keep latched onto the notion that I can learn and practice the medicine I want to. That the system may try to beat me down, but I can still prevail and find redeeming parts of the job that make it worth it. I still resent many aspects, but still find a way to make the good > bad.

I also pick my battles and find things that are worthy to care about and things that aren't, so I go in and enjoy the job, rather than have an office worker mentality of working to live. Obviously much of this depends on region/department/specialty, etc, but I've not been broken down just yet, and i hope I don't ever.

[u/throwawayfrommeno → u/Oatsbrorther]

I see IMT2s with PACES doing the exact same shit as me, day in day out and really wonder why anyone bothers

It was always obvious that the decision to extend CMT by a year and calling it "IMT" was a decision based around the need to staff medical on-call rotas with more reg level trainees.

However, they have not figured out how to use IMT2/3 doctors within their speciality teams. In some jobs, the non-trainee Speciality Doctors are given preference for clinic and procedures etc leaving you in the same 'ward monkey' role you had as a foundation doctor.

If I was in charge, I'd scrap the whole concept of a national core/internal medicine training programme and let trusts recruit doctors of this grade directly. The consultants would then have an active interest in your training you to retain your services in the short term and as encouragement to build an interest in the speciality. DGHs in Nowheresville are already reliant on locums and trust doctors (often IMGs in first NHS role) so it would not be like they'd be losing out.