Improving working lives for doctors - part one
Q: Doctors these days seem more unhappy with their working lives than ever before. Could we start by looking at some of the reasons which have been suggested for this and see what you think of them.
For instance, one suggestion is that the psychological contract has changed for doctors. That's the mutual expectations of doctors and hospitals that aren't always in the written contract of employment but can still be real and powerful.
A: Yes. The pay wasn't great but what you used to get once you became a GP or consultant was a lot of control, autonomy and respect in society and the long hours were quite important in creating a relationship with patients and mutual loyalty. It helped ensure GPs in particular were seen as part of the community.
More government money has gone into both primary care and hospitals but with strings attached and these strings and the lure of higher salaries have sometimes taken doctors away from continuity of patient care and probably led to some decisions based on what is quick to do and meets government targets rather than purely clinical factors.
Doctors like to be valued by patients but the ways things have gone doctors have tended to end up breaking that loyalty/commitment to individual patients and the community and this is probably a major source of stress for them
For example I used to know my GPs well and they knew me. These days I often end up seeing locums. The relationship isn't the same as it was before.
Q: So what can GPs do about this?
A: GP Practices have become more of a business but not yet the professional businesses you would get in, say, the USA. Years ago, if I went to see my GP in Los Angeles he would arrange his own blood tests, X-rays or whatever, tell me to go for lunch and then come back for the results. I know this was private practice and I'm a great believer in the NHS but if GP Practices are going to run more like businesses they could take on board some of the better practices from business and end up with more satisfied patients and more job satisfaction for the doctors.
Q: Another suggestion for doctors being unhappy is that they have usually been trained to work with individual patients in a professional/craft tradition and find themselves relatively unprepared for the sometimes different demands of working in the larger, more complex, more 'political ' and target driven, resource hungry organisations modern hospitals and GP practices have become. How accurate does this assessment seem to you?
A: Yes, this is a major problem. Sitting in meetings. Being a cog in a bigger wheel. Not being valued for your clinical expertise. These are all a turn off for many doctors but can seem to be a consequence of the way the NHS has developed.
This may not be as big an issue for the next generation of doctors as for today's 35 to 60 year olds. They will have come into medicine knowing a bit more about the way the modern NHS works and there may be less a clash of expectations.
Q: Work/life balance is often cited as an issue. How do you see things developing here for doctors?
A: In principle, for junior doctors and GPs in particular, new working arrangements offer the prospect of a better Work Life balance - something doctors have been saying they want to achieve for years. In practice it may not be quite that simple. For instance GPs may have less out of hours patient contact but more paperwork. One of the downsides of the government putting more money into the NHS is that they expect greater accountability and that can end up meaning more bureaucracy.
Having said that doctors, like other people, may sometimes be complicit in the long hours culture. There's probably been an Americanisation of the UK - with people here (including doctors) looking to earn as much as they can to achieve an affluent lifestyle, rather than a quality of life. Some doctors may have the option of working shorter hours (eg by doing fewer clinics), resulting in a lower income but more time with their family and for personal interests. The recent changes in working hours and arrangements are still sufficiently new that some doctors may not have had time to appreciate the full implications.
The other side of the work/life balance is job satisfaction. If you're not happy in your work you're going to take that home with you at night and this won't help.
Professor Cary Cooper CBE, professor of organizational psychology and health and pro vice chancellor (external relations), Lancaster University