Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
Recognising achievement is important. A Fellowship ceremony at a Royal College marks the beginning of a career in a chosen specialty but it also bookends a difficult period of intense study, commitment, and sacrifice. It was a privilege to witness this milestone as a new wave of young doctors shared their pride and pleasure with friends and families. They are the future of medicine.
The academic procession of almost exclusively older men, predominantly grey haired and in elaborate academic robes, added gravitas to the occasion. But, I also wondered to myself what they might think of the changes in a profession undergoing a radical transformation.
Young doctors think differently. They expect a professional life with a work life balance. Work is not the only thing - an approach endorsed by working time directives and official guidance on duty and responsibility. Young doctors do not buy into the historical model of a male dominated competitive and career focused process of education and training. Expecting people to fit into an old style training programme is no longer realistic. The long and arduous rotas of previous generations are no longer acceptable and this means fewer hours.
Many senior doctors feel there is now insufficient exposure to patients- and they may have a point. If we simply reduce the hours without revising the educational model, this is unavoidable. It is simply impossible to squeeze traditional teaching into the time available so there will, inevitably, be less patient exposure, less experiential learning and, almost inevitably, inadequately trained doctors. We need to think differently. Education must adapt. We can no longer think of training towards an endpoint, but looking at training itself as a long term process.
The gender balance in medicine has also changed. Pregnancy is a reality. Yet, I am not sure that our medical leadership has fully accepted the principles of equality that must allow young women to integrate career and family, not to mention fathers. There is no equality without paternity leave. It is not sufficient to support the rhetoric of healthy pregnancy, shared family responsibilities and professional equality if we do not see it put into practice. Rather than see pregnancy as an inconvenience in medical training or an awkward gap where service needs are compromised, we need to accept it as the norm. It is unfair and unrealistic to expect half the profession to sublimate nature and delay pregnancy simply to fit with an archaic training model. We need to change the way we think and we need to change what we do
To create a caring empathetic and nurturing profession, we need to care, nurture and appreciate the needs and expectations of our colleagues. We need to be creative, and redesign, not just careers and curricula, but our mind set.
Uncomfortable as it may be, it is important that the profession has a radical rethink. True leadership means fostering change. It’s not just the attitudes of young doctors. Medicine has also changed; it is more technical, more ‘high intensity’, constantly monitored and increasingly less tolerant of uncertainty. On-call is difficult, work is tough, doctors’ quarters are long gone as are the comforts of the doctors’ mess. It’s the day job, except that it is at night.
Let’s recognise that doctors’ life aspirations have changed, the gender balance has changed, and the job has changed. We, the older members of the profession, need to change too.