The journey of undertaking a medical specialist training programme, including making the choice of which one to do, is arduous not only for the doctor, but for their family, as this blog by a doctor’s wife details…
My experience so far with medical specialist training programmes and making the choice about which one to do, reminds me of the journey Frodo takes in the Lord of the Rings movie. It’s never ending with Frodo constantly holding on, dealing with relentless obstacles along the way. You know where you need to get to but the path is not straight, or even clear at times, and will certainly challenge your body and your entire being.
To get onto an Orthopaedics training programme in Australia now requires years of unaccredited work, where junior doctors are often expected to take on tasks (including some surgeries) without always being supervised or fully trained in the procedures and without receiving adequate remuneration. It’s like hiring an apprentice and not providing them with the complete apprenticeship training, expecting them to learn on the job mostly by themselves and we wonder why they commit suicide if they make a mistake. Crazy!
After proving yourself with unaccredited time, doctors can apply three times to an Orthopaedic training programme and if they are not accepted, they are no longer eligible to apply again. This may have once served to ensure the best (skilled) doctors complete the Orthopaedic training, however this is no longer necessarily the case, because there is now an oversaturated supply of medical graduates and there are so very few training positions available, making the competition fierce.
To get a look in for an Ophthalmology training programme, a potential candidate will complete a Master’s degree (in addition to the minimum 6 years of university already completed plus intense post-graduate training years in hospital) just to add a point on your resumé to get an interview. Not to mention that once on the programme (and it can take years to get such a position) the training requires doctors to move every three months around Australia from post to post for at least three years, as well as study for and sit exams every few months. For this reason, many ophthalmology registrars do not have partners or children, and if they do, the time they spend together can be very limited.
If doctors do not show their utmost dedication to getting on a programme and completing their training, they are easily replaced, and so they will do anything it takes to remain in the game. Burnout is common, not to mention suicide rates are devastating.
Presently, my husband and I are in the midst of deciding which trilogy length journey he will undertake in medicine. With a young family our options are much less, as many specialist training programmes require frequent moving around and in reality only one adult can sustain a fulltime career, unless you are willing to let someone else raise your children, as the doctor in training is needed in various locations and around the clock, for shift work and on call.
My husband commented with frustration that those who make it onto the programme are not necessarily ‘better’ doctors, but are able to or want to have a singular focus on their training with little time or space for life outside of work, including basic self-care. We have met many young doctors on specialist training programmes and I was surprised how few recommended the training, saying they did not have time to look after themselves, let alone have a relationship and start a family. Those with a partner had difficulties in their relationships due to the intense demands of the job. Other doctors have made the choice to cease training programmes part way in, because the intensity of the training was not offering them space to also be with their family.
The way medical training is set up, is as if it wants you to prove your dedication is to your job, even over and above your own life, let alone those of others. Doctors can have relationship and family breakdowns but still seen as succeeding professionally if they are getting on and completing a training programme. The thing is, this way of training is set up by doctors, and the prevailing dogma is: ‘If I had to do it, you have to do it too’. The doctors themselves perpetuate and glorify the system that brutalised them during their own training, thinking that this is what you have to do to prove yourself as a ‘good’ doctor.
We are asking doctors to be superhuman so they can save us when we need them and many doctors want to be seen as superheroes. How can this be possible when they are not able to be whole people and master life in its entirety?? How can they heal and support and even relate to patients when they are struggling with looking after themselves and have not had the opportunity to experience other aspects of life? This does not mean they all have to have partners and children and many hobbies, but they do need to be able to live full and rounded lives themselves, in which they care for their bodies and their beings. How can they offer the inspiration of true health and how to really live if they do not know it for themselves? If we do not include how to live and care for yourself as part of medical training, doctors can only offer us as patients band-aid solutions to our own health. Whilst modern medicine and surgery is terrific, and some of these band-aids are great, there is a whole other world of medicine (and life) that most doctors are not living in, because they do not know how to care for themselves.
Whilst making the decision of which specialist training to go for (as once you commit to one, it can be very difficult to change to another), we keep reminding ourselves and each other we can only choose something where we know we can care for ourselves and be true to us, and still offer everyone we meet, at work and away from work, a quality of how a person can live with true health. For it is all one life; the way we are at work and the way we are away from work is the same, for it is the same person in the same body living it.
What we ask of our trainee doctors is inhuman – expecting them to be superhuman when they are not. The commitment and sacrifice that is expected for them to achieve completion of their qualifications requires them to sideline their own health, personal life and relationships. This culminates in the production of doctors who are technically qualified, but burnt out, unable to live true health by example, or doctors focused on renumeration for the sacrifice they have made, rather than upholding the real reasons they started their journey.
We would not go to a financial advisor knowing they have great money troubles, and therefore we should seek doctors that really know health from their own lived experience. This does not mean that doctors cannot or should not get sick themselves, and in fact doctors who have had health issues themselves often end up being more caring, understanding and compassionate practitioners; but for them to be true practitioners, they need to care for themselves and understand that self-care is a vital element of health and wellbeing for their patients too.
I remember many interactions with attending doctors over the years and still know the feeling I had when interacting with each of them. I felt greatly supported and inspired at times and have also felt overlooked and talked at rather than heard, and many other experiences, some great and others not so great, all of which have left an impact on me.