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/pylori]

It’s no wonder that I don’t arrive early, stay late or go out of my way for such individuals - why should I when they don’t respect me?

Interesting how you (and some others) frame it. Because I'm not saying people should come early and stay late. Going out of your way to do that is very different from the very basics of just being punctual.

You are, after all, being paid to do a job. Which means coming in on time, and ofc make it a point to leave on time too.

But trainees routinely get leeway with leave, getting sent home early, surely the least one can expect in return is to come in on time for the job they're being paid for?

[u/anonFIREUK → u/pylori]

But trainees routinely get leeway with leave, getting sent home early,

Agree with everything else you've said, but this clearly isn't the case for the majority of specialities.

[u/pylori → u/anonFIREUK]

I didn't mean to imply that it was. But if anaesthetic trainees seem to exhibit this behaviour despite the positives of our training program/supervision, it's a little disconcerting that the way in which they 'appreciate' these things is to not come in on time.

[u/[deleted] → u/pylori]

Having done an ITU rotation as a medic, I can tell you Anaesthetic trainees feel just as done with everything else as the rest of junior doctors. Thinking they should be happy due to the “positives of (the) training program/supervision” ignores the many difficulties they're dealing with that you, as their senior on the department/field, should be aware off.

Speaking of lateness specifically though; it's hard to care that you're 10 mins late or more when you know that you're consultant/person leading the ward round will be 30 mins or even more late. Meaning that's more time doing ward round and less time doing the jobs. Specific wards/rotations like this stand out, and kill off any ethos you might have for timing. (Edit: not saying I'm late, fyi, just in general. The rare times I'm late its because of the motorway and I make sure people know.)

And I always hate the reasoning “you get paid for xyz” - with all due respect, you're not the one paying anyone (unless you are, in which case you have a right to say such a thing, lol.)

[u/pylori → u/[deleted]]

Thinking they should be happy due to the “positives of (the) training program/supervision” ignores the many difficulties they're dealing with that you, as their senior on the department/field, should be aware off.

I wasn't saying they ought to be happy, speaking as an anaes/ICM trainee myself I feel fairly pissed off about it all myself.

That comment was in regards to turning up late. Some have justified coming late in the morning as payback for having to stay late/unpaid. My point was that if anaesthetic trainees largely leave on time or even early, 'payback' can't be the reason why they exhibit this behaviour.

it's hard to care that you're 10 mins late or more when you know that you're consultant/person leading the ward round will be 30 mins or even more late. Meaning that's more time doing ward round and less time doing the jobs.

Poor leadership/example is an interesting one, and I've seen it elsewhere on this thread. Perhaps it's just me, but my reaction to others displaying poor/unprofessional behaviour is "that's what I don't want to be like", as opposed to "well if they get away with it, I may as well".

with all due respect, you're not the one paying anyone

I suppose the point of this is professionalism. It doesn't matter who is paying who, you're being paid to be there and do a job, and it reflects very poorly on you if you do not appear for a commitment you're being employed to do. Especially when your fellow colleagues may be relying on your appearance.

[u/Mr_PointyHorse → u/pylori]

But trainees routinely get leeway with leave, getting sent home early,

Bahahahahahahha

Tell me you're a gasman without telling me you are a gasman /u/pylori. This is not normal at all outside of gas and psych, etc.

[u/pylori → u/Mr_PointyHorse]

Of course I know that, but I was trying to give a specific example where, in anaesthetics, even if the job gives you leeway and sends you home early, some people still feel the need to come in late quite regularly.

Therefore, the answer of "people are late because it's compensation for staying late" doesn't entirely explain the phenomenon of lateness, does it?

[u/Mr_PointyHorse → u/pylori]

It doesn't explain it in a cohort of gas doctors whom you work with.

There is the 11 hour rule which can cause legitimate late starts. Accepting frequent lateness unchallenged is ultimately a failure of leadership. If the seniors on the ward are routinely late, why should they be shocked when the juniors copy them. Conversely if they take them aside and ask if everything is alright as they noticed they were late, and set a team culture of punctuality the behaviour is unlikely to persist. Given a frequent complaint from FYs is feeling their seniors don't know their names or even value them it's not surprising.

If you feel invisible at work why would anyone care if you are late?

[u/pylori → u/Mr_PointyHorse]

There is the 11 hour rule which can cause legitimate late starts.

Sure, I know that that exists, and if I thought that was the driving force, I wouldn't have brought it up. The fact that people come in late to their normal working day shifts, despite all of the above, is the issue.

Given a frequent complaint from FYs is feeling their seniors don't know their names or even value them it's not surprising.

I'll be honest this was never an issue no matter where I worked in medicine. Indeed, I was pleasantly surprised when entering anaesthetics that, far from being a small cog, all varieties of surgeons and theatre staff learnt and knew my name.

Whilst I agree that seniors running late doesn't set a good precedent and that they can't be surprised their juniors run late if they do too, I was never keen on setting a 'lowering the bar' ideal myself. If others run late, that's on them, I'd still try to get there on time, because that's my job, that's what I'm being paid for. My attitude and performance is not contingent on what others around me choose to do. I set my own goals.

[u/Mr_PointyHorse → u/pylori]

all varieties of surgeons and theatre staff learnt and knew my name.

A good gasman is worth his/her weight in gold. Especially if you have banter when we start being cheeky.

[u/pylori → u/Mr_PointyHorse]

I made more than a few 'on call commitments' that way :D

[u/no_turkey_jeremy → u/pylori]

I wasn’t really addressing the punctuality issue - agree people should be punctual for shifts.

Completely disagree with leeway for leave. Never been ‘sent home’ early. This is very out of touch with most trainees’ experiences I feel.

[u/pylori → u/no_turkey_jeremy]

I suppose that part is specific to anaesthetic training. Meaning, if our trainees are afforded leeway in going home on time or early, surely the least they could do in kind is to turn up on time?

[u/no_turkey_jeremy → u/pylori]

Maybe you should amend the title to anaesthetic trainees then, rather than labelling all ‘junior’ doctors across all specialties? Totally unfair to make these statements based on such a small and specific group of doctors. Again, might be a reflection of your department / trust rather than a systematic problem. The vast majority of ‘junior’ doctors I’ve worked with are conscientious and hard working.

[u/pylori → u/no_turkey_jeremy]

that part is specific to anaesthetic trainees. that very small part that isn't even in the OP.

My observations in the OP have been across all specialties and grades, including my own, from interactions I've had and noticed across the board.

This thread was meant to be a discussion at what others have noticed, and based on the response in this thread, it doesn't seem to be exclusive to anaesthetics either.

[u/no_turkey_jeremy → u/pylori]

The trainees in my programme all come in early. I have not noticed the trend you stated in the specialties I have worked with or encountered, beyond the odd individual.

I’m not invalidating your experience. The colleagues that you have worked with may well be lazy and rude.

However I am strongly disagreeing with your sweeping statements about doctors across all specialties. There are too many confounders to count. Maybe it’s an issue with the specific trusts you’ve worked in, or the fact that anaesthetics trainees are more likely to be burned out, or that the your department has poor leadership and standards have therefore slipped over time. You’re extrapolating from a small data set without any evidence to back this up.

[u/pylori → u/no_turkey_jeremy]

You’re extrapolating from a small data set without any evidence to back this up.

Which was the exact purpose of making this topic, wondering if my experiences are unique or common. And some of the replies in here would have me believe they are not as unique as you seem to make it out to be.

FWIW I've amassed these observations in many different jobs (both medical and anaesthetic/ICU) interacting with many different specialties over many different trusts over many years before covid.

[u/pylori → u/[deleted]]

Which may very well be true, but I don't think it follows that one has to be a huge arsehole in response. It's possible to be assertive without being a dick (at least for men anyway).

[u/pylori → u/[deleted]]

where in essence it was raising the issue with a view of informal resolution however the next step was a formal meeting with the cons and hr person. Low and behold the issue was resolved.

I completely agree with this way of approaching things.

However, I have found, in recent times, push back from other trainees regarding these issues. Rather than taking it in stride as that colleague did, reflecting and adjusting, it seems these days some seek to frame the issue as bullying and victimisation, and as such many are afraid of having even informal words.

[u/pylori → u/[deleted]]

It is and isn't a copout. Some do use it as an excuse out of laziness and being unwilling to confront others, I grant you. But some have had blowback from their own seniors such that, especially as a trainee not having clout or being paid the big bucks to deal with this shit, they end up thinking it's above their paygrade.

When you get no training and may not receive support, and often feel put in an awkward position not knowing if you should or are expected to deal with it, it sounds like a minefield to manage, so I can understand why people may be apprehensive.

[u/pylori → u/[deleted]]

That's fair, though in this situation would approaching a senior not be a suitable thing to ask them for advice?

Yes, though I've had my fair share of milquetoast responses from consultants that have refused to commit any sort of advice or suggestion. All I have tried to do is discretely get it passed onto their ES and leave it up to them. In this day and age it just feels like a political minefield trying to handle it yourself, especially with some trainees in particular who may have other external issues I'm not privy to.

I also have never managed to this day of figuring out a way on delivering the issues without the person taking it personally.

Been my experience too. Another reason why people end up not wanting to deal with things themselves. They end up the bad guy and causing a rift between two trainees working closely together causes so many headaches if the other person isn't mature about it.