MEDICS

Published: 04/08/2005, Volume II5, No. 5967 Page 33

Efforts to boost conditions and morale among hospital doctors and GPs are falling short, writes Stuart Shepherd

The tenth and final British Medical Association cohort study of 1,995 medical graduates shows a high level of concern about work-life balance, dissatisfaction with the European working-time directive and a desire for a more comprehensive medical training and supervision.

Recommendations in the report - compiled through a combination of postal questionnaires and focus groups - are framed within entitlements outlined in the Improving Working Lives standard.

Better preparation for a career in modern medicine and a mentoring scheme to support doctors during their entire professional lives are among the proposals. There is a clear need for a round-the-clock childcare service that is both reliable and flexible, and more women should be encouraged to enter specialties such as surgery and radiology.

Working hours One-third of the cohort plan to take up an overseas appointment to 'increase experience' and 'improve standards of living'. Reducing working hours is another option for many.

'I would have rated my satisfaction at less than one if I could, ' said one of nearly 25 per cent of respondents who found their work-life balance unsatisfactory.

Heavy workloads and long hours were the principal culprits.

Even the introduction of workingtime directive last year has had relatively little success in improving work-life balance.

While 25 per cent of cohort doctors work in a post that is working-time directive non-compliant, 50 per cent of those in compliant trusts do not believe the changes have been effective.

Their concerns include 'training loss' and 'de-skilling', a disregard for appropriate work patterns and a negative impact on continuity of care. There was also a view that 'the blanket application of hours limitation does not allow the job to be done safely or adequately'.

Reassurance for the future of the profession comes in the finding that three out of four cohort doctors have a 'very strong' or 'strong' desire to practise medicine.

Key reasons for their enthusiasm include career progression, a stimulating and supportive working environment and a good relationship with colleagues.

For others the challenge of caring is its own reward.

'I have obtained... a job as a consultant; suddenly the last nine years all make sense, ' says one.

Another says: 'My desire to practise medicine is directly linked to the satisfaction and interest I derive from my contact with patients and colleagues.' But these experiences are not universal. As many as one in five of the cohort says their desire to practise medicine is 'lukewarm'; for 3 per cent it is 'weak'.

Complaints of mounting bureaucracy are widespread.

One respondent is clear about the reason for their lack of motivation: 'Having to deal with appalling, lying, cheating NHS management whose only interest is to meet their targets by whatever underhand means are available rather than trying to improve patient care and working conditions for hospital staff.' Unsurprisingly perhaps, 60 per cent report that their expectations at graduation nine years ago have not been met. But the experience exceeds what some once hoped for: flexibility allows them to combine work and family life with success.

Many, however, find the quality of life poor, the hours too long and the pressure of government targets too great: 'I underestimated how stressful the job would be and how much politics feature in daily decisions, ' says one.

General practice The satisfaction gained from a career in general practice - 'a much more family-friendly option', one respondent says - leads several to recommend that it is given greater emphasis at medical school.

One-third of the study group have worked as GPs in the past year, a proportion that continues to grow.

Flexibility is the attraction of locum-working to 20 per cent of the cohort GPs, while 75 per cent are working - or would like to work - part time in the future.

'For the first time since I became a doctor I feel that I have some kind of work-life balance and as a result I am regaining my love of the job, ' said one doctor who is now working part time.

But the evidence suggests that problems in accessing childcare have forced many doctors into part-time work.

A new NHS model for childcare is needed, with further investment to 'impact positively on morale and motivation, improve staff availability and potentially result in a net return to the workforce pool', says the report.

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