In March 2021, after a year working as a doctor in A&E on the COVID frontline, I burnt out. I was exhausted, despondent and irritable. I could barely get out of bed; my concentration at work was slipping to the point where I forgot basic details and tasks. I cancelled my upcoming run of shifts and restarted therapy. After three weeks off, I returned to work but reduced my hours and continued talking therapy.
I’m one of the lucky ones. I work as a locum doctor, which means I choose my own hours and was able to take this time off without it affecting my progression or contract. A lot of NHS workers aren’t in the same position.
In a survey by the British Medical Association (BMA) earlier this year, almost 60 percent of doctors said they were experiencing anxiety or depression, with 46 percent saying this had worsened since the start of the pandemic. In 2020, NHS workers took a total of 5.7 million sick days for mental health reasons, although this number is likely to be an underestimate due to workers’ reluctance to disclose mental health problems to their employer.
The added stress caused by the pandemic, combined with poor working conditions, long waiting lists and an ongoing exodus of EU workers post-Brexit, is causing many doctors – myself included – to consider taking a break or leaving the NHS all together. Almost half (47 percent) of doctors surveyed by the BMA in April said they are likely to work fewer hours in the future, with close to a third saying they were more likely to take early retirement and another quarter more likely to take a career break.
Junior doctors – a term that applies to any doctor who isn’t a fully qualified consultant – often bear the brunt of an increased workload and poor working conditions. After the strikes in 2016, junior doctors were forced into a new contract which in theory guaranteed a yearly 2 percent pay rise and as such have been excluded from the proposed 3 percent pay rise for NHS staff following the pandemic. This, coupled with the increase in National Insurance contributions and rising inflation, will feel like a real terms pay cut for many junior doctors. As the COVID-19 situation in hospitals continues to evolve and we move towards a “new normal”, many doctors are re-evaluating their career path and their role within the NHS.
Liz, 28, who was until recently a junior doctor in London, feels that her workload and lack of senior support during COVID led to her leaving medicine altogether. She requested anonymity as she is worried about blowback from her former employers. “The shit hit the fan and the support just wasn’t there,” she tells me. “It just felt like, on an institutional level, no one really cared.”
She says that there was pressure for staff not to self-isolate when they had symptoms, as the ward would be understaffed. Her team was stretched thin and working conditions felt unsafe. “We were told new patients were arriving, despite our matron saying we didn’t have the staff, nor the beds, nor the kit, and they arrived anyway, and we just had to deal with it.”
Like many NHS workers, Liz feels that her mental health suffered as a result of the pandemic and that she had to leave in order to safeguard her own wellbeing. She feels that mental health support for staff is insufficient. “It’s not something that is acceptable to be open about in the work culture of the NHS,” she says. “We are supposed to be a caring profession, but we cannot care for ourselves or each other.”
Dr Josie Jackson, 27, who also now works in Australia, had a similar experience. Through the first and second waves of COVID, she worked in a busy A&E department in the North West of England. “I hadn’t really suffered with my mental health before and I have a good support network, but now I feel that my mental health is dictated by work.”
She felt that she couldn’t be open at work about the stress and the extreme workload. “When I felt broken by the rota, it didn’t feel like it was acceptable, even though some weeks I would work 70 hours,” she says. “But you just do it because you have no other choice.” She agrees that there is an institutional problem within the NHS around taking time off. “When I actually had COVID, I was told to come into work because I didn’t have a cough.”
Josie was already planning on moving to Australia for a year before COVID hit but adds that it has changed her perspective on returning. “Now that I have left the NHS, I’m dreading going back,” she says.
Dr Rebecca Lockhart, a trainee GP in the South West of England, is currently on a three-month break from training. “I felt like I was going to burn out. I needed to take time to look after my wellbeing,” she says. “[Medical training] can feel like you’re on this big hamster wheel with no control over your life.”
When she returns to training, she plans to work reduced hours. She is concerned about the long-term impact that delays caused by COVID will have, particularly for GP practices. “The volume of the backlog is starting to take its toll – it’s relentless and GPs are bearing the brunt of it.”
Rebecca feels that the support system for junior doctors can feel superficial. “They have this front of being extremely supportive of your wellbeing, but I came up against a lot of barriers when I needed time out. I had to fight to be able to look after myself.”
Dr Rachael Ward, 27, is now based in Melbourne but worked in London and Leeds during the pandemic. “I wish I could say I was surprised,” she says regarding the BMA figures on depression and anxiety. “There’s only so much trauma that you can see at work and there are only so many times you can be asked to step up and absorb that responsibility and expect it not to affect you mentally.”
Like me, Rachael had to cancel some shifts last year to look after her mental health. “That was the only way that I could get through some of those weeks,” she says of the possible winter coronavirus peak. “My main priority was not to be working in the NHS over winter again.”
“If young doctors are already putting off going into training, already thinking about working part time or early retirement, that has a long-term impact,” she says, adding that there is no easy fix for the chronic underfunding and understaffing that has led to this point and says it is “short-sighted” of the NHS not to be tackling those issues now.
The NHS faces huge challenges in the coming months and years, with waiting lists, privatisation and the uncertain future of COVID-19. There is also a very real crisis among junior doctors that needs addressing. Problems that run as deep as these require radical structural change, bolstered by policy and proper funding. If we don’t face these challenges head on, there will be no one left to care for the country once a battered workforce reaches its breaking point.
I’m extremely fortunate to have been able to take the break I needed to protect my mental wellbeing, but the ongoing crisis in the NHS weighs heavy on me as I consider returning to training. I wonder how I’ll fit into a system that demands so much from its workers. If the cost of career progression is my sanity and empathy, I am – like many others in the NHS – not sure it is a price I am willing to pay.