As a pre-registration house officer, I can fully understand why some doctors consider leaving the NHS ('Quick march', page

26-28, 3 December).

A number of my colleagues, after only four months at work, are beginning to reconsider their career choices.

For many junior doctors the NHS continues to provide a hostile working environment. One-fifth of trusts still fail to comply with the New Deal. This means there are a considerable number of PRHOs working excessive hours with limited rest periods. Not surprisingly, chronically sleep-deprived doctors soon begin to lose their enthusiasm for medicine.

Trust managers should take more of an interest in the working conditions of their most junior clinical staff, not leave it to clinicians and assume that no news is good news. For some junior doctors, complaining about working conditions to future referees is simply not an option.

The European working-time directive, with its wide-ranging implications, should provide a further incentive to investigate current working practices. The PRHO year is a training year, the transition from student to doctor. It should not be a year which pushes an individual's instinct for self- survival to the limit.

Kate Adams

National junior doctors committee

British Medical Association