Bottom of a ladder I don't really want to be at the top of

Unfortuately you should have considered the downsides that come with being a doctor before embarking on a medical degree. A large proportion of young people just pick medicine because of the money without realising that it requires a lot of hard work.

I don't know if i'll hit "submit" at the end of writing this. It may well be therapeutic in itself just to write this and explore my thoughts. I don't know. I used TSR around A-levels, and am now an F1 doc after 6 gruelling years of med school, so it's been a while.

I'm not enjoying my job. Boo hoo, here comes sir complain-a-lot (hey, quite proud of that epithet, might click submit just to share it). I know I should feel grateful for being in the position I am in, having got into med school (why did I want to do it? Not sure I ever knew - I think this is a significant root of the problem), graduated successfully, working in my home town.

It comes down to being overworked to the point where I rarely take breaks in my ward job, feel incompetent during on-calls when I'm on my own for a large degree relying on my own instinct with often unhelpful seniors, and feel unsupported, as I don't work in a "team", but take care of a bunch of patients each with their own impossible-to-get-hold-of reg/consultant so I rely on my own judgement where a senior's thumbs up would be greatly reassuring. The fear and stress is real, especially in on-calls, and I usually go home exhausted and solemn.

The list of work grows ever longer during the day, without the hours, energy, support to achieve them. It's truly draining. I now understand what medics meant when they talked about the "responsibility" of the job, it really is burdensome. My colleagues are pulled away to do their own week's of on-calls and what not, which leaves me with weeks of massive workloads where again, there's no respite. All this means I rarely get much done productively in my free time, and have not been able to sustain my hobbies and interests and friendships and personal goals.

I don't actually enjoy very much about medicine at all, I've known this for a few years. I really can't think of anywhere worse than a hospital, in terms of its work environment, atmosphere, competitive and cover-your-back nature of colleagues, it's like nowhere else. The only part I do like is sitting with frail people or frightened relatives and being able to offer them some reassurance and comfort, lend a listening ear, address the worries they have, which are rarely the same as what's at the top of the medical problems' list. I think I'd make a good palliative care doctor, and might consider it, were it not for wanting to get out of hospitals and avoid core medical training with a passion.

2. Power through. Just get through F1. Then just get through F2... Then just get through GPST1...Then just get through GPST2 and GPST3. Sigh. I expect it gets worse before it gets better, but it's disappointing to me that I give up my 20's for the sake of a job I don't like.

Everything Democracy said. My gen med FY1 job was the most miserable 3 months of my career, and I think it's got worse since I did it (2009/10). You are not alone, and it is not your fault that things are crappy. Do the best you can, ***** about it with the other FY1s, and if things are really dangerous, escalate it via Datix/foundation school/GMC survey. It does get better once you find a specialty you fit in.

I must say, all of this could have been me writing about my first FY1 job in general medicine. Absolutely gruelling experience: leaving at 7 or 8 most nights, constant chaos, overworked, disinterested or actively hostile seniors, bureaucracy, mismanagement, no time for learning. Literally being the ward dogsbody. Why should you feel grateful for dealing with this shite? Anyone who says you should can piss off. The job needs to be done, and it's our resonsibility to do it well, but that doesn't mean we have to be eternally grateful for the rubbish that comes with it.

The most important thing to bear in mind is: it's not you who is the problem. Acute medical care in this country is just a complete mess at the moment (just watch the news). Not enough beds, not enough staff, not enough funding, social problems....all the while you and I have spent the past 4-6 years in medical school memorising Duke's staging and paediatric developmental milestones to get through finals. Important stuff for sure, but it doesn't prepare you for the combined onslaught of hospital bureaucracy, demanding bosses, finite resources, whilst trying to take care of extremely sick people, none of whom "act" like they "should" do in textbooks or question banks. I was someone who hardly ever skipped placement, turned up like a goody-two-shoes, did extra, and it still hit me like a freight train, so believe me, the problem is not with you.

General medicine wards are completely ****ed up - the combination of elderly patients with multiple co-morbidities, staff shortages, endless paperwork for the simplest tasks, and non-existent social care means that to get things done you have to be a doctor, social worker, secretary-on-speed, patient right's advocate, nurse, and porter. This is admirable, but cannot be done between the hours of 9-5 whilst also expecting to get decent sleep or maintain a social life. You will be miserable, and you will quite frankly hate it. I don't know any of my fellow FY1s in medicine who actually enjoyed the job.

Like you, I got into this job because I genuinely like being there for people, hearing about their lives, and doing my best for them. But frankly, the way that inpatient general medicine is structured means that the system is rigged against you and is more akin to a mass production line in a factory: nurses reduced to asking you if you're looking after "bed 11A" or "the DKA" (because remembering names and faces is a luxury when they're stressed over relatives and filling out falls pathways), everyone covering their backs, paperwork taking precedence over actual care, etc. It's terrible and it should be anathema to any right thinking doctor or healthcare professional.

So I don't have any answers as to how general medicine and inpatient care can be fixed: that requires political will and correctly directed public anger first and foremost. However, what I can tell you is that it is not you who is at fault here. Don't listen to morons who don't have a clue what it's like, you shouldn't feel guilty for legitimately being overworked and underappreciated.

Some doctors can detach and adapt themselves more readily from this sort of thing due to having an absolute passion for inpatient specialties and the ward environment. I am not one of those people, so naturally this sort of craziness is going to bother me a lot more. Since switching to a surgical ward, I have found things far more manageable (even the on calls) and I have begun to enjoy my job again. What was your first job like? What will you be doing next? As you say, there are specialties which, whilst not perfect, don't have to deal with this sort of insanity everyday. Anaesthetists generally seem happy, as do radiologists. GPland seems like a nice place with nice people. Paediatricians also seem to be reasonably happy. Doctors in these specialties have their own grievances too of course, but what I'm saying is, just because your first few jobs of FY1 aren't fun doesn't mean your entire career is destined to be like that.

I still firmly believe that being a doctor is a privilege and something I want to be doing, despite the crappiness of FY1. My personal strategy during those first four months was, as you said, basically just powering through, and vowing that I would never set foot on a general medical ward ever again. I think I was also fortunate in that, despite being on a crazy ward, the other junior doctors were all really nice and we all became close friends. I can promise you that you are not the only who feels like this - do you have anyone at work who you can talk to about how you're feeling?

Also, the good news is that when you hopefully do move onto a less stressful job, you will be quite well prepared because nothing will ever be as horrendous as what you're going through now

Disagree. From what I gather, most people find FY1 their worst year, sometimes by far. You may gain more responsibility as you get more senior, but you are more equipped to deal with it. May not seem like it now but you are. Mainly in terms of just learning to be decisive rather than actual knowledge but that still counts.

You don't have to sacrifice your 20s - FY3 year anyone? There aren't that many professional careers where its so easy to just take a year out safe in the knowledge that they will just take you back next August. And if you live frugally like you seem to imply then you can have enough money to not need to work at all - a years break to do what you want, within reason.

I work in clinical trials (not as a physician but still in the clinic). I have a good idea of what the Physicians do if you have any questions.

I really do have no idea - thank you for taking the time to offer your experience.

My questions fall under:

(1) what does/can the work involve, for someone who has a background in medicine?

(2) how much / what kind of experience is expected, e.g. is the MBBS degree enough to then learn on the job, or full GP training? And is active interest in research, clinical trials etc. a key part of it?

As brief or comprehensive as you like, much appreciated.

The main things that the medics do is: 1) Screen the volunteers to check that they are eligible to go onto a study.
2) Discuss study with volunteers and get informed consent.
3) If any subjects have adverse events you decide if it's related to the drug.
4) Cannulate subjects
5) Dose subjects
6) Have meetings with the sponsor.

In terms of qualifications you can technically work after F2 but you need to be quite confident working independently. You should have seniors and a PI to ask but it's a small team and you wouldnt necessarily have as much support as you would in a hospital.

Another thing to consider is that if you want to work as a PI in the future is that you'll have to do a pharmaceutical medicine qualification.

You are still on call but otherwise it's quite a good job for work life balance. It's pretty much Mon-Fri 9-5 and free weekends.

Sorry, abbreviation - PI? Not a private investigator I take it. Principal investigator? I'd really be keen to do a few months internship, any big names worth getting in touch with or leads?

PS. Very little support in my current job / as a GP so wouldn't be too afraid of that.

Had a bit of a dark week again, ending with my family rounding on me demanding to know why I'm not grateful for being in the position I'm in. Other people could only DREAM of being a doctor, and try so hard unsuccessfully. What would I rather be doing? Etc.

I ineloquently fumbled that it's not that I'm not grateful, even though - I agree - I might be putting out quite a "low" image and when asked often give a negative impression. And I don't think other people's dreaming for this means I have to feel a certain way...

Ah I really don't know. I have a little resentment that I was pushed into medicine by my family, and yet I do know I should be grateful that my parents educated me through childhood etc. and... Every job has its stresses. What would I rather be doing? I can't answer that one either. I don't think it's a fair question, but I can't think why.

Is it that I'm going through what everyone goes through, but I'm just not adjusting to it as well? Probably cos I'm so self-entitled? No I don't like to think that and disagree. Maybe wage-slave adjustment as you mentioned sir up there. I'd like to think that's all it is. Doctors in their 50s well into their careers seem to be doing well, why are you so miserable and pessimistic? Can't answer it. I just don't like to discuss it at all now, and will opt to suck it up and carry on I think. Gonna make the bloody most of F3 year.