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A newspaper article several days ago highlighted the claim that junior doctors in San Fernando General Hospital were being over-worked.

It was reported that the newly graduated doctors or interns were asked to work double shifts, particularly on weekends, while the lack of adequate facilities for any rest or respite further compounded this.

Junior doctor working hours have been a point of contention for as long as I can remember, and not just here in Trinidad and Tobago.

Many studies from international centres and hospitals have shown that more than half of junior doctors consider themselves under extreme stress due to long hours. In fact, even before the pandemic, burnout and dissatisfaction rates amongst doctors were at an all-time high.

Mental health amongst doctors is a growing area of concern and there is little doubt that the pressures of the job, in addition to little or no down-time between shifts is a major contributory factor.

The standard full-time working week is between 35 to 40 hours, however in reality junior doctors often work much more than 40 hours.

In the US, the junior staff or residents are expected to spend up to 80 hours a week in the hospital and endure single shifts that last up to 28 hours.

The UK eventually instituted Working Time Regulations, a directive that aimed to prevent the workforce from doing excessive hours because of health and safety issues. Although this directive imposes a 48-hour working week, many end up doing well over this.

These junior doctors are also trying to balance study and exams with the demands of continuous learning on the job often in a high-pressure situation. Furthermore, many often complain that their job consists of various menial tasks, while others feel that they do not have adequate senior supervision when dealing with clinical issues. Some say that they cannot admit to struggling to cope in fear of being chastised by their seniors which may affect their career progression.

The result of all of this is significant stress and fatigue, which potentially has profound effects on physical and mental health including sleep, exercise, nutrition and personal interactions with family and friends.

Some have even gone so far as to say that no other profession or at least very few professions would put up with such a gruelling system.

This is my point exactly. Medicine is not just any profession.

The path to becoming a doctor is known to be notoriously difficult and working long hours has been an accepted part of the culture of medical training for decades.

This does not mean there should be undue or excessive pressure on the young ones to “earn their stripes” and I rarely abide by the saying that because I went through it so should they all.

Medicine is ultimately all about training and experience. And this unfortunately does not happen only during “regular” working hours. How convenient it would be if all patients presented at 8 am on a weekday, leaving all nights and weekends free.

Training doctors to make crucial life-changing decisions cannot be done in a classroom or even online. Early on, senior consultants can identify those juniors who take a keen interest and those who are continuously looking at the clock.

The reality is that if you want to learn, you need to be around. Not all the time, but quite a lot of the time.

Even after institution of the European Working Time Directive years ago, junior doctors belatedly realised that less time at work meant less time for training opportunities.

In fact, some of the pressures that many go through are inherent to the nature of the profession. In what other job will a momentary lapse or error in judgement result in depriving someone of their hearing, brain functioning or even their life.

Of course, everyone is entitled to mistakes, but there is no doubt in my mind that sound training for those who are around more often mean that they learn more, gain experience quicker, become confident in their abilities earlier and therefore make less errors.

Grumbling and complaining by the old guard about the “quality of trainees these days” has less to do with wishing their rigorous past training on the junior staff but more to do with instilling a better work ethic in this new breed of doctors.

Not to mention the one small fact that we are currently in a pandemic, a staggering health crisis, the likes of which most of us in medicine have never encountered.

It is hard to complain about not getting weekends off or vacation leave when health systems are stretched so thinly already. Even maintaining everyday services requires more hands-on deck. Many countries are currently pleading for more doctors as coronavirus cases surge out of control.

In the end, I do feel for the new doctors and their excessive hours and conditions, but this requires more than just restricting their working time.

It is about mutual understanding of the stresses involved and the implementation of considerate rostering, better facilities, efficient work practices and ensuring adequate staffing.

Junior doctors may then feel that there is less of a mismatch between the commitment put it and the reward gained.