If we are to get the most out of employees, we need to treat them well.

Continuing my argument that if we are to get the most out of employees, we need to treat them well – starting with perhaps the group that are treated the worst, junior doctors.

I am sure no junior doctor will thank me for not talking about pay, but I’m not going to. Instead, I want to talk about most of the other aspects of junior doctors’ experience of work and training.

But to start with the place of this group in our society.  I took my A levels in 1966 – and about that time competition for medical school places was so fierce that you needed the best set of A level results of almost any significant number of university entrants to get into medical school.

I didn’t think then that there was much of a relationship between people’s level of intelligence and the A level grades they received (and I think a bit less of that correlation now [1]) but as a society – then and now – we use A levels as the benchmark for university entry and our nation’s senior professions.

Since 1966 the number of medical places has grown, but so has the number of people successfully taking A levels.

And because nearly every year since you have needed the very best A level results to get into medical school, we are organising ourselves as a society (according to the way in which we choose to measure it), for the brightest 18-year-olds to choose to train to be doctors.

Whilst this is a set of individual decisions, the fact that it has happened for over 50 years and that over that period many thousands have made that decision, makes the whole issue a significant societal fact.

However we decide to judge our brightest at 18, they could decide to do all sorts of things. They could decide to be civil servants, run tech businesses, play soccer (I know of someone with a first that plays for Millwall) – but they don’t. Year after year they chose to become doctors. And the same is true today, though their gender and ethnic makeup has changed since 1966, they choose to enter medical training.

And how do we treat them as they go through the very long rite of passage that takes place between being an 18-year-old and finally leaving training?

Sticking to the theme I started a few posts ago, more young people seem to feel able to move out of labour market relationships which seemed, the past, to provide tight behavioural guidelines. As they go through training an increasing number don’t really like it as much as previous generations.  This is a problem.

Nowadays domestic trainees are taking ‘time out’ from training in larger numbers and for longer periods. In 2012, 68% of doctors (UK national, UK Primary Medical Qualification) went directly from F2 (Foundation Year 2) in England into further training posts. In 2022 the figure was just 22%. In a decade nearly 50% more F2s decided that rather than go straight on with the next step they would take a break from what previous generations had done.

As I have said previously about young, qualified professionals opting for a portfolio work experience, we could tut-tut about young people today not doing as previous generations did.

Or we can try and understand the relationship between this generation’s career aspirations and the way in which they are experiencing medical training at this stage. And then factor that understanding into how we change that experience.

What do they make of their experience of learning?  NETS (The National Education and Training Survey) respondents who would not recommend their training post most frequently cited inadequate standards of education (60%) and a lack of learning opportunities (59%). In the NHS Staff Survey, Doctors in Training (which includes dental trainees) reported an average score of 5.33/ 10 against the ‘We are always learning’ theme, with poor appraisal (average score of 3.84/ 10) being a major contributory factor.

Of course, these doctors in training are carrying out real care of real patients, but they are also at the stage in their career where they are meant to be learning from that care – and from being appraised as they learn.

There’s more.

23% of respondents to the GMC Training Survey  reported that they were at risk of burnout, an increase on the previous year (19%). There is wide variation between specialties (emergency medicine – 34%; Pathology – 7%). In the 2023 NETS survey, among those who would not recommend their training post, rota/staffing issues were cited by 56% and 49% said their workload was too high. Doctors in Training responding to the NHS Staff Survey reported an overall decline, year on year, in measures of staff engagement and morale.

Why does all this matter?

Well, back to my earlier points. Society, and the individuals concerned, channel those with the best A levels into this profession. Over the last few years, for an increasing number, the experience of training and caring that they go through seems to detract them from their original motivation.

And whilst all disputes about pay are essentially about pay, they are also often about the overall experience of work (and in this case learning).

We can’t ignore this.   And I think we will need a radical approach to changing junior doctors’ experience of their work education and training.

Regular readers will know that I am frequently critical of how NHSE has been stewarding the NHS, but a brief word of congratulation.

In page 7 of this year’s planning guidance, they say.

“We will also shortly be setting out changes to be made locally and nationally to improve the working lives of our staff, including junior doctors, by addressing some of the most widely felt frustrations that adversely impact their experience working in the NHS”. 

The good news is that NHSE have recognised this as a problem. Let’s hope they are talking to the junior doctors involved and acting on their experience.

Well return to this issue when they publish their reforms.


[1] In a few weeks’ time I will explore this more fully. Since the Long-Term plan is committed to increasing the number of apprenticeships in nursing in the next few years, we have the opportunity to train a large number of NHS professionals without depending on A levels.