A nice quiet retirement? Leading 300000 European Junior Doctors
“Sounds like quite a nice quiet ‘retirement’ job with lots of holidays”, one colleague remarked. To be honest, I understand why some of my colleagues were skeptical. A month after stepping down from two years as Co-chair of the Junior Doctors Committee (JDC) of the British Medical Association, I became UK Head of delegation for the European Junior Doctors Association (EJD) and was elected onto the EJD Board (or Executive committee).
Flash forward two years and I am now two months into my term as EJD President. I have responsibility for representing the views of 300000 junior doctors across Europe, and am the first UK doctor to hold this role for thirty years. Lots of travel? Yes. Lots of holidays? I wish. “Nice quiet retirement”? Don’t make me laugh!
Before I became involved in European medico-politics, I was advised that we operate a bit differently in the UK and I’d need to adapt accordingly in order to be effective in a pan-European arena. I remember rolling my eyes inwardly at the time but later realised how used I was to the UK way of undertaking professional activity.
The importance of being in the room… and staying there
Imagine you are in a high-level meeting. You really want to see the matter under discussion resolved quickly yet progress is slow. What do you do? Enter: “the big cheese”, the key decision-maker, to “wow” negotiating partners with their authority and to remove the impasse allowing effective discussion to resume. This “send the most important person to have a quick word” tactic is ingrained within the UK policy arena at all levels and is often a very effective strategy.
However, our European colleagues are generally far more relational than we are in the UK and respond to each other professionally by developing a relationship based on trust and close-working over time. There is a clear expectation that once you become a member of a particular group or forum you will stay. Even small changes in delegation or team members can be interpreted as waning interest and can set back discussions irrevocably. It is important to be in the room… and to stay there.
Dr Kitty Mohan chairing EJD committee session
More similar than we may have thought
It was in October 2016 that Jeremy Hunt, UK Secretary of State for Health (now Secretary of State for Health and Social Care) announced plans to introduce a mandatory four-year NHS service term for UK medical graduates. Hunt’s proposed “military-style restrictions” set out that newly qualified doctors would have to work a minimum four-year period in the NHS or pay back the cost of their medical education, which the UK Government estimated to be £220,000. The debate was reignited in January 2018 with calls for a “public debate” on whether sanctions should be used to tie graduate doctors to the health service.
A mandatory period of medical service for doctors is not only topical in the UK. At the EJD General Assembly in October 2017, three delegations present (Slovenia, Croatia and Latvia) described mandatory service measures currently used in their countries. For example, in Croatia on completion of residency, medical residents must remain in the same hospital/institution for the same length of time as their residency programme had lasted. If doctors break this contract, they are obliged to pay back the money invested during their training, which can range from 2000€ to 70000€.
A further five EJD delegations, including the UK, described on-going threats that similar measures may be introduced in their countries. This has also become an important issue in the much-publicised Polish junior doctor dispute with the Polish government announcing that junior doctors will receive a monthly salary increase equivalent to 143€ which will double if they commit to working in Poland for a minimum of two years.
Despite a range of languages, cultures and healthcare systems, we see the same issues raised by different delegations at EJD time and again. We have more similarities than we may think and must continue working together to identify pan-European solutions to the challenges we face.
EJD General Assembly in Malmo, Sweden
The future is uncertain… for all of us
Between 2015 and 2017, just over a quarter of all doctors migrating from EU countries (5235/19781), applied for and were granted recognition to practice in the UK. There are also approximately 750 EU medical students at UK medical schools who will not have finished their medical degree by March 2019 and who currently face uncertain futures about their ability to practice in their home countries on qualification.
The UK NHS and the lives of those who work in it and are treated by it are inextricably linked to those of our European colleagues – they are our work colleagues, our friends, our partners and our family members. This is why we must lobby and advocate to retain free movement of doctors and other health professionals between the UK and the rest of Europe: not just for our NHS which undoubtedly needs them to work, but for those we know and work with who have built their lives in the UK – our colleagues and friends too.