Until now, it has not been clear to most people what the junior doctors’ strikes are all about. It began about a total pay cut masquerading as a ‘basic pay rise’. Then it became about protecting doctors’ family and social lives at weekends. Most recently, there have been accusations of sexism. Somewhere in the middle, the more marketable concern about patient safety was introduced, and has risen to the forefront of the junior doctors’ campaign.
Last time I wrote, I considered the plausibility of these claims. I suggested that the strikes are primarily about doctors’ quality of life. This is no cause for shame: everyone has the right to campaign and work for a better quality of life. The predictable onslaught of abuse, threats and power plays came from the more fanatical wings of the campaign. A sizeable minority of doctors confided in me their agreement. A noble middle ground disagreed vehemently, but with admirable clarity and grace.
I have no interest in pandering. On one side is a ‘Conservative’ government who discharge any and all principles of genuine conservatism as wantonly as they commit to the flames their obligations to the vulnerable. Real conservatives have no interest in defending a Cabinet who are committed to nothing but a poisonous cocktail of austerity, partisanship and vote-chasing wherever the ideological wind blows them.
On the other side is a profession for which I have no profound affection, and whose constituents I am unlikely to win over. There are too many charred bridges between doctors for me to gain anything from defending them, and I am unlikely to stay in full-time clinical work long enough to profit from better working conditions.
This leaves honesty as my most reliable – and my most important – companion. And the chilling truth is this: whether their own fault or Jeremy Hunt’s, doctors are ready to quit. And this is a public health crisis.
At the beginning of the campaign, I had already seen hundreds of doctors throw away their social lives and their youth for the sake of Medicine. The commitment of so many of my peers to Medicine over and above so many important things in life has always baffled me, and I was convinced that the changes offered by Jeremy Hunt would not be enough to change it. It is not that doctors have good hours. They have long, inflexible and inconvenient hours compounded by extra hours at home researching and indulging portfolio bureaucrats. But I thought that their relentless obsession with Medicine would be enough to keep them. Doctors love Medicine, and they enjoy it so much that they would give up almost everything else for it. They would be happy and proud to do so.
I was wrong. Doctors love Medicine. They love their job, for the most part, and they love the prestige that comes with it. But they love their families more. So take it from me: they are ready to quit. It matters not whether you think they are being selfish. It matters not whether people in other professions have it worse. It matters not whether they should give up more and more family time for their vocation. What matters is that they are highly skilled, inordinately committed people with an abundance of career prospects. And they are all we have. Once they go, our health goes with it. And they are standing by the door.
All-out strikes will not kill anyone. Today and tomorrow, I will be replaced by a consultant who can do anything I can five times as quickly and competently. My suspicion is that emergency patients will get considerably better care today and tomorrow than they normally would. To insist that patients will be put at risk is propagandist poison.
What will kill patients is an exodus of doctors who want family and social lives and who – frankly – can do better than what a career in Medicine now offers. This is not a threat: it is reality. At this stage, the criticism I have made of both sides is fading into irrelevance. The blame game is a sideshow. Whether the contract is intrinsically unsafe is immaterial. The rhetorical tit-for-tats mean nothing. Political victory over doctors is the most Pyrrhic of all victories. When further A&Es close and patients die because doctors can find better lives elsewhere, the crown on Hunt’s head will bring no glory. Whether he endures that wretched coronation is now his choice.
Calum Miller is a junior doctor in Greater Manchester.