This article originally appeared on VICE UK.
England is on the brink of a doctors' strike, the sort of which hasn't been since the 1970s. By now, you'll no doubt be aware of the row surrounding the new junior doctors contract that Health Secretary Jeremy Hunt wants to bring in next August.
It's a contract that, in a bid to cut costs and make the National Health Service (NHS) into a "true" seven day operation (he doesn't think it is right now), could cause some junior doctors to lose up to 30 percent of their salaries and to work hours which were once classed as anti-social (and remunerated for accordingly) as part of their normal nine-to-five. For junior doctors, Saturday nights will be the new Tuesday lunchtimes.
Unsurprisingly, Hunt's proposals have resulted in three months of strained talks with the British Medical Association (BMA), and caused doctors to protest in unprecedented numbers. And now, it looks like they might lead to industrial action.
This week, Hunt attempted to sweet talk the BMA and some 45,000 pissed off junior doctors with a few eleventh hour concessions to his original proposals. Alongside a promise of an 11 percent pay increase, Hunt has curbed the anti-social hours he initially suggested doctors would be expected to work on Saturdays, and has said that there will be a limit on hours worked in a week. But it wasn't enough to reinstate talks, and yesterday the BMA decided to ballot its members over strike action—the first time a juniors-only ballot has ever been held.
"I think I might have ruined my life," Lucy*, a 29-year-old final year medical student tells me, only half-joking. "It's always a hard choice to do medicine—it's not easy, and there's huge debt involved. But now I'm in a situation where I'm set up for a career which will mean terrible hours, associated debt stress, and worse working conditions than I previously thought."
Even with the concessions, Lucy believes that the new contract will make life as a junior doctor extremely difficult. "There is a deep distrust of Hunt's policy," she says. "His complete failure to negotiate with the BMA and the anger felt by us means that whatever he brings to the table will be treated with a huge amount of skepticism."
As they're yet to be employed, medical students can't strike. But many of them are now staring at a far different future than the one they pictured when they started their training. Even with an 11 percent increase in basic pay, which would take the average salary for a first-year junior doctor from just under £23,000 [$34,000] to just over £25,000 [$37,000], the new contract would still leave many significantly out of pocket. But it's hard to tell what the true implications of the contract might be, given how opaque and complex it is. As BMA Chairman Dr. Johann Malawana said, "Junior doctors need facts, not piecemeal announcements" to understand what the reality will mean.
"I already work anti-social hours, so the new shift patterns won't make much difference to me," says Imogen, a 25-year-old junior doctor working in A&E (the UK equivalent of an emergency room) in London. "But last month half the money I took home was because of the out-of-hours work I did. If they're going to redact the pay for out-of-hours work, that's going to be a big financial hit for me, and it's unlikely I'll be able to stay living in London."
Junior doctors are already overworked and underpaid, and most are saddled with debts from years of medical training—£70,000 [$106,000] is at the lower end of what many will be repaying thanks to tuition fees and high living costs. But Hunt's contract has sent morale to a new low.
"It's actually really depressing," says Imogen. "A&E can be a really isolating speciality—I'm working a shift pattern at the moment which means I won't see my flatmates for three days—and when something like this happens it makes it worse. Money isn't the reason I went into medicine, but I wasn't expecting this to happen. I work incredibly hard and I'm not sure I deserve it."
This isn't just another story of a group of young employees being shafted by an unreasonable, tightfisted boss (or, in this case, the government). You might be thankful you're not a junior doctor right now, but the effects of these proposals will be potentially far reaching and will impact you—as a user of the NHS—as much as they will them.
A seven-day NHS might sound impressive, but it won't necessarily mean patients get better, or more efficient, care. Nor is it something that can be achieved solely with a new contract for junior doctors. "Doctors work as part of a team; we are not the be all and end all of medical care, and we need to be supported by other healthcare professionals that are just as important," says Imogen. "The contract won't improve the care the patients are receiving and I don't think it will shorten their hospital stay. It's not the solution to making a more efficient NHS."
Despite Hunt's own promise that junior doctors will not work beyond 75 hours a week, the contract does not, as the BMA's Dr. Malawana says, "deliver safeguards with real teeth to protect safe working patterns and, with it, patient and doctor safety." As such, many are concerned that a seven day operation will see them working upwards of 90 hours a week.
"Our senior colleagues used to work 100-hour weeks, but they successfully campaigned for that to be changed because that's when mistakes happened," Alastair, another junior doctor, tells me. "All the changes that have happened over the last 20 years have been to improve patient care and improve patient safety and make us a better, safer organization. I think this contract risks undoing a lot of that."
They're human beings, too. If they can't make a living they're going to leave. That's the tragedy of the whole thing.
Jeeves, a 27-year-old trainee GP, agrees. "They are taking out every safeguard. We're all used to working more hours, but not to the point that it is unsafe for people and has a detrimental impact on our own health."
Faced with extended working hours and no cash incentive to work them, it's no surprise that figures from the General Medical Council show that this year alone 7,727 doctors have applied for licenses to work abroad (that's an increase of 2,802 on last year). How many of these are genuine and how many have been made in protest is difficult to tell. However, if there were to be a mass exodus of junior doctors—whether they were planning to work abroad (Australia appears to be the current favorite destination) or to leave the profession altogether—that would present a desperately urgent problem for an already-stretched NHS.
"As a junior doctor, I love my job. I love treating patients, and 5 o'clock rolls around, and if things need doing there are very few days I don't stay behind to make sure that they're done," says Jeeves. "But this is already a profession which heavily depends on the goodwill of the people doing it, and if you demoralize and devastate them and destroy their lives and their health, then they're going to leave. "
"You've got a huge group of motivated, enthusiastic, and involved people who went into a career with a vocation, and to see people who absolutely love this job being completely prepared to leave—I feel the same," says Alistair.
But it's not just the juniors who are despondent about the future. David*, a leading cardiology consultant with almost 30 years of experience, tells me it's a "tragedy."
"They're human beings, too. If they can't make a living they're going to leave. That's the tragedy of the whole thing," he says. David won't be directly affected by the contract, but believes its impact will be devastating. "We're already short staffed, and we're going to have no one left. It's going to be chaos," he continues.
Student, junior doctor or consultant: it's clear that there's a unified front against Hunt's proposals. Many, too, seem to be of the belief that if Hunt imposes the contract it will spell the end of the NHS and a move towards privatization.
"Maybe not straight away, but it's the beginning of the end," says Imogen. "What will happen [if the proposals go through] is that we'll walk away and the government will be in a position to say the NHS is too costly, which is why we'll have to move towards privatization on the health insurance model," adds Alastair.
"The Tories have always wanted to privatize the NHS," says David. "I don't know if Jeremy Hunt is just a total idiot, or if this is a plan to destroy the NHS. But I'm pessimistic about it all. In two years I'm going to emigrate to Costa Rica and live in a beach house. I'm off. People don't know what they've got until they've lost it."
*Some names have been changed