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How many working hours realistically are junior doctors having now?

Hello guys,

I'm about to graduate next year, and I have received mixed information that under the new contract our working hours are protected under EWTD, therefore the average working hours per work cannot exceed 48 hours.

However, some told me that because of staffing issues, hospitals simply will force us to work unpaid overtime, so realistically we will have to work over 70 hours per work.

Is this claim true?

On the other hand, I've heard cases where 2 junior doctors are assigned to look after 150 patients on a shift. I've even heard that some hospitals will ask doctors from a different rotation to cover the other department because they cannot find anyone to cover the rota gap.

This is extremely unsafe and radiculous. Is this claim true again?

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Reply 1
Avatar for daveliuhk88
daveliuhk88
OP
5
So would you say that the general working condition has improved under the new contract?

At the same time, I know it is the management who control my rota, but will my consultant also interfere with my schedule as well, such that they will ask me to work unpaid overtime in order to cover the gaps? I mean will there be any sort of pressure from them?
(edited 4 years ago)
Original post by daveliuhk88
Hello guys,

I'm about to graduate next year, and I have received mixed information that under the new contract our working hours are protected under EWTD, therefore the average working hours per work cannot exceed 48 hours.


Yes you are legally protected. And your rota will be compliant - if it isn't you report it.

However they find ways around it. For example, you are expected to do audits which can take a fair few hours, but they don't have to give you time for that. You are expected to do postgraduate exams which have really really low pass rates and are really expensive so you need to do lots of prep... but they don't have to give you any time off at all. And then if you stay like 30 mins later per day that's hardly worth reporting... so you can end up with say 55ish hours being reality when officially its not a minute over 48.

However, some told me that because of staffing issues, hospitals simply will force us to work unpaid overtime, so realistically we will have to work over 70 hours per work. Is this claim true?


Its possible but it'd be on the extreme end. That's 4 hours late every day assuming a 5 day working week. I have heard of that on the old contract once or twice, but not the new. And on the new you'd be exception reporting and so getting paid for those hours for sure.

A much more likely scenario is that you have to stay like an hour late maybe twice per week and very occasionally 2 hours late, and you exception report and you get paid and its annoying but that's how things are.

On the other hand, I've heard cases where 2 junior doctors are assigned to look after 150 patients on a shift.


Only 150?! :tongue:

On an on call its quite normal to have 250, 300 patients under the medical on call team. In my former hospital we'd be looking after 9 wards of 30, and between 8am-12 there'd be one FY2, then 12-8pm there'd be two. There was a reg too but they'd also be looking after the AMU and admissions so not really around unless an emergency. And that's far from the worst example I've heard.

I've even heard that some hospitals will ask doctors from a different rotation to cover the other department because they cannot find anyone to cover the rota gap.


Yes possible when you are an unspecialised junior. I don't think its too unreasonable either tbh, as long as you have the support of seniors. Its not like when you start as a surgical FY1 you get this amazing teaching that transforms you into the surgical FY1 - you just get thrown onto the ward and told to get on with it and call when you run into trouble :tongue: Doing the same when on call isn't really any different!

This is extremely unsafe and radiculous. Is this claim true again?



You will likely run into a number of query unsafe practices in your time. Sometimes its because people genuinely don't realise how service demands are changing, sometimes its because of unreasonable or money-grabbing seniors. Its up to you to raise the problem so it can be dealt with.
Original post by daveliuhk88
So would you say that the general working condition has improved under the new contract?

At the same time, I know it is the management who control my rota, but will my consultant also interfere with my schedule as well, such that they will ask me to work unpaid overtime in order to cover the gaps? I mean will there be any sort of pressure from them?

The rota is ultimately determined by consultants usually. There might be a secretary running things day to day though.

In my experience the new contract has somewhat improved things.
Working hours are undoubtedly more protected across the board since 2016. No more 7 nights in a row, 12 days in a row etc. This doesn't mean all rotas are nice or easy to work, however. And of course most jobs are generally more intense and heavier than 4 years ago especially acute specialties.

Whether these changes have positively impacted patient care, continuity of care or training, I think is debatable. Probably too much department variation to generalise
Reply 5
Avatar for Jckc123
Jckc123
13
I heard stories about how juniors are more protected in teaching, bigger hospitals so I can't say.

I'm based in a 800-1000 bed dgh whereby there's only 1 F1 covering medical and surgical each during oncalls. It's busy but you get used to it with helpful seniors. And with the new contract and exceptional reporting, I personally feel it's an improvement (did not work under the old contract so it's just basing on opinions)
Lol
I'm an F1 and I cover 8 wards on a night shift (the only F1 on) so in total I look after around 180 patients.
There is always at least an F2 and usually a CT on nights.

I also work 12 day shifts; depending on your current area it is 108 to 100 hours in total.
One week in 9 will be 40 hours.
Our week that has nights we work a total 64 hours then 3 days off.

I do manage to leave on time most days however and yes the 12 days are long but we're used to it now as we don't know any different tbh. It's a DGH & we have no rota gaps atm for us F1s. Busy but I feel we're learning a lot and used to dealing with sick patients on our own. For instance, DKAs/HHS are managed by us on the wards - I've started and stopped many protocols, especially during my nights.

As an F1 you just have to get on with it, someone has to do it and you just accept it and you don't know any different.
Nobody can “force you” to do anything. You’re a grown adult, not a naughty school child.

Junior doctors seem to have an indoctrinated state of learned helplessness straight from medical school.

You are contractually obliged to work your hours and no more. If a patient arrests as you’re walking out the door, you are ethically obliged to stay and help. Anything else should be handed over safely unless you choose to stay late.

Yes, there is pressure and manipulation to do so, but nobody is going to physically block the door.
Original post by Etomidate
Nobody can “force you” to do anything. You’re a grown adult, not a naughty school child.

Junior doctors seem to have an indoctrinated state of learned helplessness straight from medical school.

You are contractually obliged to work your hours and no more. If a patient arrests as you’re walking out the door, you are ethically obliged to stay and help. Anything else should be handed over safely unless you choose to stay late.

Yes, there is pressure and manipulation to do so, but nobody is going to physically block the door.

Said from the safety of not being an FY1/FY2 any longer...
Original post by Anonymous
Said from the safety of not being an FY1/FY2 any longer...

Why would that make any difference?
Original post by Etomidate
Nobody can “force you” to do anything. You’re a grown adult, not a naughty school child.

Junior doctors seem to have an indoctrinated state of learned helplessness straight from medical school.

You are contractually obliged to work your hours and no more. If a patient arrests as you’re walking out the door, you are ethically obliged to stay and help. Anything else should be handed over safely unless you choose to stay late.

Yes, there is pressure and manipulation to do so, but nobody is going to physically block the door.


I like this attitude, haha. I’ll do my best to follow this by the time I make it there. :tongue:
Original post by asif007
I like this attitude, haha. I’ll do my best to follow this by the time I make it there. :tongue:


Be the doctor you want to be, as long as you don't harm yourself, your patients or your colleagues.

The worst thing to come out of the junior doctor contract stuff is the pseudo activist *******s that somehow the people who work beyond their hours or go above and beyond are the problem. Like the swathes of health professionals, generation after generation, that have devoted their entire lives to the care of the communities they serve and worked for, are to blame for the mess we're in at the moment. This learned helplessness nonsense. You never heard this **** before 2016 on that god awful Facebook group.

Theres a balance to be had and everyone needs to find their own way of reaching that balance which fits their life.
Original post by fishfacesimpson
Be the doctor you want to be, as long as you don't harm yourself, your patients or your colleagues.

The worst thing to come out of the junior doctor contract stuff is the pseudo activist *******s that somehow the people who work beyond their hours or go above and beyond are the problem. Like the swathes of health professionals, generation after generation, that have devoted their entire lives to the care of the communities they serve and worked for, are to blame for the mess we're in at the moment. This learned helplessness nonsense. You never heard this **** before 2016 on that god awful Facebook group.

Theres a balance to be had and everyone needs to find their own way of reaching that balance which fits their life.


Who said anything about “learned helplessness”? Who said people who work over their hours are the problem? I support doctors who don’t take **** from management or whoever it might be. If you work over your hours, exception report the hell out of it and get the pay you are owed for the time you put in. Simple rules of being an employee.
Original post by asif007
Who said anything about “learned helplessness”? Who said people who work over their hours are the problem? I support doctors who don’t take **** from management or whoever it might be. If you work over your hours, exception report the hell out of it and get the pay you are owed for the time you put in. Simple rules of being an employee.



I recognise what fishfacesimpson is talking about both online and irl (not referring to anyone on TSR) and it bothers me. Some of the more militant advocates of exception reporting have come to adopt a rather bunker mentality way of approaching work as a junior doctor, and anyone who doesn't subscribe to their view of medicine now being an assembly line job complete with a time card is seen as a chump with a martyr complex.

This...is not a helpful way of viewing one's colleagues or even your own career imho.

For what it's worth, you can exception report as much as you like and spend all day whining to the guardian of safe working hours in pointless JDFs but management is still going to shaft you, whether you like it or not. If you think your exception report means you now don't "take ****" from management, I think you haven't yet realised just how broken medical training and representation in the UK is.

Be efficient, don't create unnecessary work for yourself or other doctors, enjoy your life outside of medicine, but also don't turn into a clock-watcher.

(This post isn't really directed at you in particular, I'm just speaking in general when I say "you")
I never sit there and watch the clock. I make sure at least all the really important/essential jobs are done, that everyone is safe, and things are handed over before I leave. I’ve worked with seniors who clock watch and who leave on the dot, which they are entirely entitled to do. The best seniors I’ve met are doctors who leave at the same time with everyone else in the team, who is never too senior to do simple ward jobs. My point is it really is dependent on the team. If the team works well together, I’ve found we generally all leave on time.
Original post by Democracy
I recognise what fishfacesimpson is talking about both online and irl (not referring to anyone on TSR) and it bothers me. Some of the more militant advocates of exception reporting have come to adopt a rather bunker mentality way of approaching work as a junior doctor, and anyone who doesn't subscribe to their view of medicine now being an assembly line job complete with a time card is seen as a chump with a martyr complex.

This...is not a helpful way of viewing one's colleagues or even your own career imho.

For what it's worth, you can exception report as much as you like and spend all day whining to the guardian of safe working hours in pointless JDFs but management is still going to shaft you, whether you like it or not. If you think your exception report means you now don't "take ****" from management, I think you haven't yet realised just how broken medical training and representation in the UK is.

Be efficient, don't create unnecessary work for yourself or other doctors, enjoy your life outside of medicine, but also don't turn into a clock-watcher.

(This post isn't really directed at you in particular, I'm just speaking in general when I say "you")


I get what you’re saying. Obviously I would never encourage anyone to do anything to the detriment of their colleagues. Medicine is a team effort wherever you go and whichever level you work at. My impression is that hours are probably worked over more often than can be reported to guardians of safe working, which makes it a lot more effort to keep chasing pay. Like you say, management still shaft you. But you give sound advice about being efficient and enjoying life outside Medicine: I like this approach.
Reply 16
Avatar for Hindudr
Hindudr
5
Average hours: about 48.

Original post by Etomidate
Nobody can “force you” to do anything. You’re a grown adult, not a naughty school child.

Junior doctors seem to have an indoctrinated state of learned helplessness straight from medical school.

You are contractually obliged to work your hours and no more. If a patient arrests as you’re walking out the door, you are ethically obliged to stay and help. Anything else should be handed over safely unless you choose to stay late.

Yes, there is pressure and manipulation to do so, but nobody is going to physically block the door.

Medicine is the UK is one of the few exeptions in the free world where you can be easily forced to do anything under a premise of "patient safety". In effect the NHS is a totalitarian system. Your senior can send you to work on another ward (albeit you are in a training programme and have things to do on the day). Your annual leave will be rejected because of the "staffing issues" (like if its your problem). You wont be able to take more than 5-9 days of annual leave in a row. They can make you come to work out of hours because of some "business continuity". The HR will arrange your average hours by half and hour a week so your pay will fall under a lower nodule/table (e.g. 47.5 hours a week vs 48, albeit you never leave on time) cutting your pay by several thousands a year. Your exeption reporting will be rejected. Your training will be made unnecessary long-again because "patient safety" and so on-e.g. IMT. The real reason for it is to keep you providing service on a lower salary for many years (the british medical training is some 5-10 years longer than in countries like France or Germany) but noone will tell you the truth. Tell your foreign colleagues about FY and "core training" that leaves you without any real specialty, they will laugh at it. A poor feedback from a nurse or a colleague can ruin your training portfolio and many years you spent building it. A nepotistic training programme director will be obstructive to your training progression, thus forcing you do something you dont want to do.

The only real "freedom" you have is to quit the NHS. And so do many people (and this is why the UK is "short" of doctors). A good employer will never be short of candidates.A good (or well paid job) will never be short of employes. The investment banking jobs are never short of applicants despite long hours.
(edited 4 years ago)
Original post by Hindudr
Average hours: about 48.


Medicine is the UK is one of the few exeptions in the free world where you can be easily forced to do anything under a premise of "patient safety". In effect the NHS is a totalitarian system. Your senior can send you to work on another ward (albeit you are in a training programme and have things to do on the day). Your annual leave will be rejected because of the "staffing issues" (like if its your problem). You wont be able to take more than 5-9 days of annual leave in a row. They can make you come to work out of hours because of some "business continuity". The HR will arrange your average hours by half and hour a week so your pay will fall under a lower nodule/table (e.g. 47.5 hours a week vs 48, albeit you never leave on time) cutting your pay by several thousands a year. Your exeption reporting will be rejected. Your training will be made unnecessary long-again because "patient safety" and so on. The real reason for it is to keep you providing service on a lower salary for many years (the british medical training is some 5-10 years longer than in countries like France or Germany) but noone will tell you the truth. A poor feedback from a nurse or a colleague can ruin your training portfolio and many years you spent building it. A nepotistic training programme director will be obstructive to your training progression, thus forcing you do something you dont want to do.

The only real "freedom" you have is to quit the NHS. And so do many people (and this is why the UK is "short" of doctors). A good employer will never be short of candidates.A good (or well paid job) will never be short of employes. The investment banking jobs are never short of applicants despite long hours.

Your comments are pretty accurate, in my opinion. (Although medical jobs in the UK are not really "short of applicants". Medical schools are vastly oversubscribed, most Registrar positions are fiercely competitive.)

So it always confuses me, why do junior doctors in the UK continue to insist that they love the NHS? Eg, the 2015 junior doctor strikes were apparently about "saving the NHS". If other countries have such better working conditions, then surely UK doctors should campaign for the NHS to be replaced with an Australian/European style healthcare system?
Reply 18
Avatar for Hindudr
Hindudr
5
Original post by Anonymous
Your comments are pretty accurate, in my opinion. (Although medical jobs in the UK are not really "short of applicants". Medical schools are vastly oversubscribed, most Registrar positions are fiercely competitive.)

So it always confuses me, why do junior doctors in the UK continue to insist that they love the NHS? Eg, the 2015 junior doctor strikes were apparently about "saving the NHS". If other countries have such better working conditions, then surely UK doctors should campaign for the NHS to be replaced with an Australian/European style healthcare system?

This confused me too. I think there is a degree of ideological brainwash in this. I can say for sure that in private conversations about half of junior doctors are extremely unhappy and looking for jobs elsewhere (abroad/other industries).

With regards to training posts being oversubsribed- well this is created intentionally. e.g. you will have 5 people per one training post but thn the trusts within the same deanery will be advertising trust grade vacancies for the same level of training. Go to nhs jobs and see how many trust grade jobs are availiable, its mad. And also, lets be honest-the most competitive specialties are those where you can either make money privately (cardio,ortho,plastics) or have a better work life balance (eg derm or public health),thus bringing us back to the same arguments as above
(edited 4 years ago)
Original post by Hindudr
Average hours: about 48.


Medicine is the UK is one of the few exeptions in the free world where you can be easily forced to do anything under a premise of "patient safety". In effect the NHS is a totalitarian system. Your senior can send you to work on another ward (albeit you are in a training programme and have things to do on the day). Your annual leave will be rejected because of the "staffing issues" (like if its your problem). You wont be able to take more than 5-9 days of annual leave in a row. They can make you come to work out of hours because of some "business continuity". The HR will arrange your average hours by half and hour a week so your pay will fall under a lower nodule/table (e.g. 47.5 hours a week vs 48, albeit you never leave on time) cutting your pay by several thousands a year. Your exeption reporting will be rejected. Your training will be made unnecessary long-again because "patient safety" and so on-e.g. IMT. The real reason for it is to keep you providing service on a lower salary for many years (the british medical training is some 5-10 years longer than in countries like France or Germany) but noone will tell you the truth. Tell your foreign colleagues about FY and "core training" that leaves you without any real specialty, they will laugh at it. A poor feedback from a nurse or a colleague can ruin your training portfolio and many years you spent building it. A nepotistic training programme director will be obstructive to your training progression, thus forcing you do something you dont want to do.

The only real "freedom" you have is to quit the NHS. And so do many people (and this is why the UK is "short" of doctors). A good employer will never be short of candidates.A good (or well paid job) will never be short of employes. The investment banking jobs are never short of applicants despite long hours.

That's quite the rant! :tongue:

Whilst putting all that together you probably can claim its unique to medicine, I'll point out for balance that a lot of that stuff very much isn't. For example, being told at short notice to work in another area and being limited in when you can take leave, definitely is possible in many other industries.

The NHS is very much a monopoly employer though, and it very much acts like it.
Original post by Anonymous
Your comments are pretty accurate, in my opinion. (Although medical jobs in the UK are not really "short of applicants". Medical schools are vastly oversubscribed, most Registrar positions are fiercely competitive.)

Hmm no they're not. In some areas (specialities and geographical areas), sure. In many, no. There are plenty of SpR rota gaps out there - especially GP, psych, acute med.

So it always confuses me, why do junior doctors in the UK continue to insist that they love the NHS? Eg, the 2015 junior doctor strikes were apparently about "saving the NHS". If other countries have such better working conditions, then surely UK doctors should campaign for the NHS to be replaced with an Australian/European style healthcare system?


You're definitely right about that. I think often their public opinion is different to their private, because being against the NHS is seen as being pro-privatisation in the manner the Tories (or even US pharma) envision, rather than some European style system that takes two hours to explain. Its just such a political hot potato that no one can even talk about it, which I think is counter-productive to both sides of the argument.

It is perhaps also of note that whilst Europeans have better working conditions (from what I can tell), and much shorter training times, their top wage as a consultant-equivalent is significantly less.
Original post by Hindudr
With regards to training posts being oversubsribed- well this is created intentionally. e.g. you will have 5 people per one training post but thn the trusts within the same deanery will be advertising trust grade vacancies for the same level of training. Go to nhs jobs and see how many trust grade jobs are availiable, its mad. And also, lets be honest-the most competitive specialties are those where you can either make money privately (cardio,ortho,plastics) or have a better work life balance (eg derm or public health),thus bringing us back to the same arguments as above

Its definitely the case that the people who determine training post numbers (HEE I think) do not want to fund the number of posts that is actually needed in some areas, meaning the local hospitals have to advertise their own posts. The RCR announced that we need 160+ new clinical oncologists per year in order to maintain current services, let alone improve them as the government has promised. HEE released... 30.

My theory is that they deliberately under-offer the competitive specialities, because they know that they can farm those out to candidates from abroad. And by rejecting people from say clinical oncology, they might go and take an A&E or psych post instead, something they'd never be able to fill otherwise!

But again to point out: there are unfilled SpR posts in the less competitive areas.

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