Trusts want longer hours to fill gaps not train you

In the 15 months since the full implementation of the European Working Time Directive, doctors’ working hours have never been far from the headlines. In recent weeks the letters page of the nation’s broadsheets have been filled with missives decrying a clock watching generation of junior doctors. But if you take a step back from the superlatives and hyperbole you will see quite a different picture developing.

Take the recent publication of the GMC’s survey on trainees for example – it revealed over 5,000 junior doctors have now opted out of the EWTD. The survey also shows that 1 in 4 trainees do not feel their training needs are being met.

I think there can be little doubt that a significant motivation for opting out is a desire to get better training. But do high quality training and working hours go hand-in-hand? I am not so sure. Experience tells me that it is perfectly possible to get rubbish training in 56 hours.

Crucial to achieving high quality training within the new regulations are rotas which maximise training opportunities and ensure adequate trainee support. Unfortunately all too many departments have designed EWTD compliant rotas which leave quality training and supervision to chance.

Another telling statistic is the fact that 1 in 10 of those who opted out felt under duress to do so. Many employers want us to work longer hours, not to give us better training, but to fill the gaps in rotas. As juniors we have a right to proper training without having to ‘opt out’. It is not acceptable for employers to use educational opportunities as a carrot to tempt us into working longer hours, especially when there is no guarantee that opting out will give you better training.

If you are one of the 5,000 that have opted out, or it’s something you are considering, take a close look at the BMA website which contains information to guide you through the process and will help you to decide if opting out is right for you. Like so many things in life, it is important that you know exactly you are signing up to.

We all want good training but we should be able to get this within the 48 hour week. You should not be pressured to work longer hours and if you do work longer hours you should be paid for them.

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7 Responses to “Trusts want longer hours to fill gaps not train you”

  1. chrissa says:

    my words since the controversy about the ewtd began. the implimentation of the 48 hour AVERAGE over a more than 3 months period has been sabotaged by the trusts from day one. instead of a one in six rota with flexibly used days off in order to achieve compliance (perfectly possible, the max hours for any one given week is 91 hours), they deliberately created shift patterns that damage junior doctors´biorhythm as much as possible and deny them real training opportunities in order to coerce them juniors into “opting out” and “demanding” the long hours of old back.

  2. Malcolm Morrison says:

    The problem will never be conquered until ‘service’ is separated from ‘training’. The need for ’24hr emergency cover’ is a service need – so should be covered by ‘trained’ doctors (whatever one wants to call them). Of course there is a need for trainees to have some experience of the care of emergencies – but this should be part of a planned training programme.
    Proper training needs proper supervision and proper teaching (which is not, specifically, time based); but there is also a need for ‘experience’, particularly in practical procedures, and this does ‘take time’
    Retired Orthopod

  3. Dr Peter A Bamber says:

    The EWTR (formerly EWTD) needs amemding to deal more sensibly with people whose jobs require them to be at their place of work but who are often resting for long periods because their emergency work whilst essential is little. Until this (may) happen, I sympathise with anybody who feels (or, indeed, is) coerced into opting out. Also, both as a senior doctor (consultant anaesthetist of 20 year) and also as a potential user of the NHS, I take training seriously.

    Notwithstanding the above, I think that some junior doctors forget that they are WORKING in a JOB. This means that your employer reasonably expects and needs you to offer a significant service commitment. Some combinations of job and experience will need a very high proportion of training, especially at the outset (e.g., my own speciality), whilst others may need less. Whilst the comments from Chrissa and Malcolm Morrison are not examples of this, the headline ‘Trusts want longer hours to fill gaps not train you’ sounds as if intended to be perjorative. Whatever the editor’s intention, it shoud not be considered so. Of course Trusts want to fill gaps: nobody wants clinical services to have holes in them. There is, however, nothing in essence wrong with the idea that junior doctors might fill them, provided they still have enough time to be trained when necessary. Similarly, there’s nothing wrong with senior doctors filling those gaps, provided they in turn have enough time to take on the most demanding clinical work, to liaise with management, to mentor, to support professional bodies, to take part in appraisal, to contribute to professional regulation, etc. Oh … and to teach.

    I entreat both senior and junior doctors to consider that the only real difference between those ‘fully trained’ and those ‘in training’ is just that. We are one profession. We all must contribute a lot of service and do many other things besides. The seniors who don’t want to work out of hours should consider their position (as should GPs). Juniors who protest that hospitals want them to fill gaps should do likewise, unless they want a 12+ year medical course with student loans commensurate with that at the end.

  4. chrissa says:

    dear peter bamber,
    the editor only forgot to put one word: “trusts want longer hours to fill gaps CHEAPLY, not train you”. that is the message. they want ooh / anti-social hour / weekend / bank holiday cover for peanuts by calling it “training”. this bluff is now called. consultants who think working these hours for no surcharge is all right, are welcome to do so.
    kind regards

  5. Rob says:

    The 48h limit is a joke. We work 60h a week on average. We are not paid for the extra 12 hours. On an hour by hour basis F1 is not well paid 🙂

    And the training…what training? We are only there to cover the jobs of phlebotomists and nurses.

  6. Orthopod says:

    The BMA has persistently and consistently been singing ‘long hours bad, short hours good’ for the best part of two decades. Why can everyone not accept that different specialties have different training and different service requirements?

    I would not countenance the 1:2 or 1:3 rotas that characterised 2/3 of my post graduate career, but I do not think it unreasonable for surgical registrars/juniors to be on-call one night a week and one weekend a month. This allows adequate exposure to emergency admissions, yet allows the maintenance of surgical firms for teaching purposes, service commitment, mentoring and support. The provision of trauma and emergency lists means that night time operating is confined to the truly urgent cases, resulting in fewer broken nights.

    Medical, anaesthetic and other specialties may find that they have different requirements. One size does not fit all, and our juniors should not all have to follow exactly the same contract regardless of specialty.

    The chance of such flexibility being encouraged is unlikely because we live in a society which equates uniformity with equality, and common sense is now so unusual that it should be considered uncommon sense. Besides which the BMA has a vested interest in representing its own rather than its members interests.

  7. chrissa says:

    rob – the admirable people who fought and won our battles (simap and jaeger) can not carry every horse to the water. if you work 60 hours – it is your fault. you MUST stop after 48 hours. the managers are paid to keep the hospital working NOT YOU. if you do their job for them, free of charge even, you are guilty of propping up a broken system and allowing the managers to get away with it.

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