The first question I was asked at my medical school interview was 'how would you deal with stress?' It is no secret that medical schools actively seek potential students who have shown an ability to balance academic activities with non-academic pursuits outside medicine, coupled with a high degree of resilience. Speaking as someone 33 years down the line from my own medical school interview, there has rarely been a time that I have not needed to use this resilience to cope with stress and burnout.
From December 2018, the State Pension age for both men and women in the UK will start to increase and is expected to reach the dizzy heights of 66 by October 2020. This retirement age does not differentiate between individual professions. On the face of it, that shouldn't really worry me. After all, rates of unhealthy behaviours in doctors, such as smoking, have gone down over the years and the average age at death for doctors is not much different from the general population. But wait, that doesn't necessarily mean that doctors will suddenly be more able to maintain both their resilience and their general health for over 5 years more than their predecessors. In fact, we know that some groups of overseas doctors die 6 years earlier compared with doctors qualified in the UK. We also know that that certain specialties with high levels of stress and/or unpredictable working hours are sent to an early grave an average of 3 years earlier than the overall medical workforce. This is most striking for emergency medicine, psychiatry and anaesthetics. Although life expectancy for doctors qualifying outside Europe has increased over the past 10 years, there has been little change in the comparative life expectancy of doctors working in the above fields.
Are health problems always linked to the type of medical specialty practised? Well, that may be the case for early deaths, but there is now growing evidence for increasing rates of stress, burnout and depression across all specialties. A lack of autonomy over the job and long working hours also contribute to such health problems. With hours spent crouched over the operating table, it may be no surprise to find high rates of musculoskeletal problems among surgeons. You may do more than raise an eyebrow at the fact that one mental health service for doctors has witnessed a 400% increase in referrals over 10 years. This also includes GPs, who are faced with unrealistic targets and an older population with increasing health needs.
Let's now bring the message sharply into focus to the here and now. With financial austerity and an expectation for the NHS to deliver both routine and emergency services throughout the week, all eyes are on junior doctors. Although the new contract includes the overseeing of their working hours by a Guardian, that does not detract from the fact that the European Working Time Directive means frequently changing rotas and an unpredictable work-life balance. This may also eat into training opportunities to improve their knowledge and skills and add to the problems that they already face in financial pressures from a housing market that is out of reach and debt from tuition fees.
Faced with longer working lives and an uncertain future, an increasing number of doctors have 'portfolio careers', with more having career breaks, taking up part-time work and going into non-training posts, so that they do not get burnt out across a considerably longer vocation than those in the middle and end of their careers.
Doctors will continue to face an NHS that will inevitably metamorphose into several forms over the coming decades. There is sure to be no let-up in the hard slog through training, continuing into senior roles until what may even be a retirement age approaching 70 by the time 2040 is upon us. The fact is that we are not machines and will all succumb to the aging process that affects us all.
There could possibly some solutions to the problem, such as doctors taking on fewer clinical and more managerial responsibilities after the age of 60. But a forward thinking approach to the government's horizon scanning for answers to this vexed question is sorely lacking.
The junior doctors of today will be the ones to suffer the consequences of longer working lives. We owe it to them to secure a more positive future that will save them from an early retirement and allow them to have a work-life balance that seems to be continually beyond their grasp.