I am currently reaching the end of my F1 year in a large teaching hospital in a rural county in England. I think my experience is broadly similar to any other F1’s, although I’ve heard that London juniors are more ‘protected’ than us due to staffing issues in this part of the UK (more on that later). This means that our shifts are scarier than theirs, but on the other hand we get more exposure and greater experience.
I’ve tried to think of all the questions that I had before I started working and have answered them below, but if you’re reading this and have a question I haven’t answered, put it in the comments section and I’ll try to answer it!
How long are your shifts? This totally depends on which department you’re in and what type of shift you’re doing. The shortest shift I’ve done is 8 hours (few and far between!) and the longest is 13, with the average being around 9 or 10 hours. This of course isn’t taking into account the fact that you will frequently end up staying late (I’ll get onto that in a bit)…
How many hours a week do you work? The rota coordinators can’t make us work more than 8 shifts (days or nights) in a row (I believe this is part of the ‘new contract’ that came in not so long ago). Within these 8 days, you can’t be made to work more than 72 hours in a 7 day stretch. My shortest week is 40 hours (infrequent but they do exist!), and my longest week is 8 days of a total of 79 hours (Hell on Earth). Generally speaking, I would think my average week is somewhere in between that, but again, remember that you won’t always leave on time.
Do you have to do night shifts? At my hospital we do, however I know that some hospitals (especially some in London) do not rota F1s on nights. The ‘new contract’ states that we can only work a maximum of 4 nights in a row.
What’s your working day actually like? This is really an entire post in itself I should probably get around to writing one day, but essentially you tend to oscillate between mundane drudgery and blind terror.
- The ‘normal working day’ shifts are like being a very busy PA to the Consultant or Registrar. I spend my life running around prescribing things, booking scans, writing discharge summaries and chasing results. If you are doing a ‘Take Shift’ where you are working in the Admissions Unit, your job also involves clerking new patients and presenting them to the Consultant.
- Weekends and Bank Holidays are the above on steroids because some genius in the NHS seems to think that people don’t get sick on these days, therefore they can cut the number of staff. You basically end up doing the same amount of work that three F1s would do on a weekday.
- Night shifts are utterly exhausting and terrifying as the staffing levels are cut to the bare minimum. If you’re on a surgical job, the Surgical Registrar and SHO will go to theatre for emergencies and you will be left on your own looking after all the surgical patients. A weekend night is the stuff of nightmares; there have been too few staff during the day to look after all the patients properly, so you run around all night on your own putting out fires before they become raging infernos and someone dies.
- ‘Cover Shifts’ are where you run around doing jobs for a number of wards (generally 3-4 wards). They are very busy and sometimes quite difficult as you don’t know most of the patients but yet still have to make important medical decisions.
- Some hospitals (like mine) make you carry the ‘crash bleep’ on certain shifts. This is where you are one of a number of doctors and nurses (of varying seniority) on call for emergencies. The emergency can range from someone falling over in the canteen to someone having a cardiac arrest. I find this a bit scary but some people love it.
- The lack of adequate staff and senior supervision can be a huge issue in some departments and it hits F1s quite hard as we’re still very junior but often expected to take charge. Generally seniors are quite understanding but unable to do anything about it as there are simply too few doctors for the number of patients. This can make things incredibly stressful and positively dangerous at times. One F1 friend of mine did a shift where she was the only doctor looking after 90 patients (a not uncommon situation). Three patients died and one ended up in ITU.
How much do you get paid? You have a ‘basic salary’ (£26,614 per annum), and then you get extra for working ‘antisocial hours’ (as decided by Jeremy Hunt). From what I’ve figured out from my paycheck, this basically means we get paid £13 an hour, and a little more if we’re working between 10pm and 7am. Factoring in things like student loan payments, tax, NI, NHS pension etc, I actually take home approximately £2,000 a month (although it has been as low as £1,741 and as high as £2,100). If you are working in London you get very slightly more to prevent you having to sleep in a shop doorway because the rents are so high.
Can you do locum work? Yes you can pick up extra shifts if you really want to, and you will be paid slightly more for them as they are locum shifts. However as an F1, you can only locum in the hospital that you are currently working in. Personally I’ve never done locum shifts as I value my days off too much, but plenty of people do.
How often do you have to stay late? I have to stay late fairly frequently but it depends a little bit on the type of shift and staffing levels that day so its difficult to quantify.
Do you get paid for overtime? ‘Exception Reporting’ extra hours worked is a relatively new thing (I think it’s something that the new contract put in place). Essentially you can report online that you have worked overtime and then your supervisor can approve it and you get paid for it or get time off in lieu. It also means that the Trust can more easily identify staffing gaps as they know that there is too much work for the number of F1s to do during their working hours.
This all sounds perfectly reasonable in practice, however the reality is very different. Few people actually Exception Report because they feel embarrassed to, feel staying late is ‘part of the job’, or don’t want to appear to be ‘taking money from the NHS’ (yes, an actual direct quote from an F1 I heard recently). This then leaves the minority of us who do Exception Report looking like there’s something wrong with us. I once had to fight to get a supervisor to sign off my Exception Reports because he tried to argue that there was clearly something wrong with my time management skills. I won the battle in the end but it was really annoying and dispiriting, especially as I only exception report when my overtime creeps over 45 minutes rather than from the moment my shift should finish.
How much holiday do you have? We are allowed to have 9 days of annual leave every placement (so every four months). However you can only take those days on certain types of shifts (so for instance, you can’t take annual leave on a night shift). You have to take those days within the placement; if you don’t take all 9, you lose them and they can’t be transferred over to your next placement. If you work on a Bank Holiday, you get an extra day of annual leave as compensation.
What are your breaks like? Breaks per se don’t exist for doctors so you’re just expected to snatch time to eat or pee whenever you can. Expect to be constantly interrupted by your bleep going off.
Do you get free food at the hospital? No you don’t, although some hospitals have an arrangement where you can get a small employee discount at the canteen/shops.
Do you get free parking at the hospital? No and not all hospitals have car parks or allow their staff to use them. I am allowed to park at my current hospital because I live sufficiently far away and the hospital has a number of car parks. I pay £2.50 a day for parking.
Do you get free accommodation at the hospital? No those days are long gone, but there tends to be accommodation available if you want to pay for it (although frankly, I can’t think of anything worse than living at your place of work). Some hospitals have very decent staff accommodation (Margate for instance), but in other hospitals it’s dire. I’ve even heard of one with a rodent infestation…