New People, Old Systems – Changing the culture, changing working patterns
by Lucy-Jane Davis
What motivates you? For me, it tends to be injustice – something that just isn’t right – that fires me up and motivates me. I started medicine a bit later in my career, so I’d spent some time working in the “real world” observing and experiencing different working practices which have shaped some of my views as a representative. Having started later, I also found I had children earlier, relative to many of my peers in my junior doctor career. It’s mostly been a blessing, but sometimes also made life tricky. Children and caring responsibilities for others are often immovable things; I cannot simply drop my “life” bit of the “work/life balance”; it’s not a choice. If I don’t turn up to collect my children from childcare or school then it’d be social workers and questions about my fitness to be a parent.
You might think this was the genesis of my interest in less than full time working. But actually, it wasn’t. What sparked me was the idea that once you’re a junior doctor, your life somehow belongs to the NHS. We start our journey knowing that we are choosing a path of dedication and hard work. But I don’t think I had ever realised that there would be no choice when you were allocated shifts; no discussion of how we work as individuals. Medicine is like a sausage factory and I very quickly realised if you weren’t a standard sized banger, you’d be at high risk of being mushed by the system. I worked for two years as a junior doctor before I had children and quietly puzzled over why suddenly my life was organised by other people in distant offices I’d never even met.
I still find it amazing that many of our colleagues who work outside normal working hours agree between themselves how to cover their shifts, yet junior doctors are considered unable to make such decisions and opt-in to shifts, despite being proper grown-ups and everything. My frustration reached a peak when I realised that there was no provision for junior doctors to choose to work fewer hours without a reason which fell into the pre-decided categories. You had to either have caring/ health issues or possibly be something like an international athlete. Those doing a fine arts degree would be considered to have a valid reason, but someone running a small business, or wanting to write a book wouldn’t. None of it made sense. Why would we discriminate against someone who had a great deal to offer as a doctor, but found the punishing shifts of hospital rotations difficult to cope with? Why do doctors need to be superhuman and anything “Less” seen as substandard?
I’ve worked to change BMA (British Medical Association) policy on this; I have campaigned on it for over a decade. Getting the words in the policy book changed has meant we’ve pushed hard for change for juniors; there are now increasing Less Than Full Time (LTFT) programmes in almost all specialties. By making LTFT working normal, we reduce the issues of stigma and break down the concept that working LTFT somehow translates to being LTFT. Maybe most challenging, I’ve found that staying involved with BMA work means that when things are being discussed, the idea of a LTFT doctor isn’t an abstract – I am a physical presence in the room.
I try hard to make sure it’s never “just” about LTFT; being engaged in a variety of issues shows that I am not “Less” than; I just happen to work part-time. Being a single-issue person can tend towards tokenism and ultimately siloes people. This is a mistake, as people are seldom good at just the one thing. My question for you, though, is how do we change the narrative just by being the person in the room; and how do you ensure that this doesn’t become a single issue, siloed voice; either for you or for the doctors and leaders you work with?
Lucy-Jane attended medical school as a mature student and graduated from Peninsula in 2007. Following a few changes in specialty (from Academic O&G to Academic Public health) she is now half way through GP training. She has been an active BMA representative for many years, working on issues as diverse as campaigning against the introduction of MTAS/MMC, to being deputy chair of Junior Doctor Comittee (JDC) during the junior doctor strikes. She is now the first junior doctor to have chaired a Regional Council of the BMA, and is also co-chair of the Less than full-time forum of the JDC. She is passionate about fighting unfairness and improving the working lives of doctors in the UK. Follow Lucy-Jane Davies on twitter @Academic_owl