And who is looking after you?

‘The first step toward success is taken when you refuse to be a captive of the environment in which you first find yourself.’

Mark Caine

On the 7th April 2008, The New Zealand Resident Doctors Association (NZRDA) gave notice of a nationwide 48-hour strike after several months of negotiations with the District Health Boards (DHBs) of the country collapsed. This wasn't the first time New Zealand had faced a strike from its healthcare workers, as in recent memory it has faced a strike or potential strike from nurses and consultants respectively.

The NZRDA was founded in 1985 and is the only organization in New Zealand to specifically represent junior doctors. It is to this day run by junior doctors for junior doctors and is a common voice to present their views and protect their working conditions.

According to the NZRDA, the motives behind the most recent action are pay, conditions and ongoing issues of retention. They point out discrepancy of pay and conditions between New Zealand and Australia, where New Zealanders are free to live and work without restriction. Many Kiwi doctors and nurses – from new graduates to long-standing consultants and nurses – are beginning to flock there in their masses. This is beginning to create a noticeable vacuum that is burdening the system, staff and most importantly patients. The NZRDA are also fighting to maintain their Multi-Employer Collective Agreement (MECA), which provides consistent conditions of work for a doctor regardless of which DHB they work for.

To critics it would seem that the NZRDA are being over-zealous in using one of the most extreme forms of acceptable protest, especially when compared with the UK, for instance, working conditions are arguably favourable. To the NZRDA, their actions are perfectly acceptable as they are simply protecting the long-term interests of their members towards whom they have a duty care of care, just as doctors have towards their patients.

It is possible that the reason why conditions are more favourable is because of their history of tackling issues as soon as they arise to avoid any long-term problems as a result. Organizing strike action is hardly a norm of their daily work. The NZRDA's typical role ranges from contract negotiation to support of individual doctors in specific cases.

The organization which represents doctors in the UK is the British Medical Association (BMA). Founded in 1832, it is the registered trade union and professional association for all UK doctors. It is a monolithic organization, but within its infrastructure has committees that represent doctors in different branches of practice, including a Junior Doctors Committee.

Junior doctors in the UK have faced a disproportionate number of problems in recent years, which is beginning to make the career unappealing enough for some to leave the National Health Service (NHS), or even the country. Key phrases need only be brought up to a junior doctor in the UK for them to immediately experience a pang of displeasure: ‘MTAS’ (Medical Training Application System); ‘loss of House Officer accommodation’; ‘pay increase below inflation’; ‘shortage of training jobs’; ‘continually rising GMC (General Medical Council) and exam fees’ are just a few examples.

Just like their junior doctor counterparts in the antipodes, UK doctors have depended on those representing them to anticipate such issues and defend their interests. It wouldn't be too contentious to say that the average junior doctor in the UK feels that the BMA haven't exactly earned their subscription charges of late. The general perception of those on the hospital shop floor is that their representatives are grossly out of touch.

Part of the problem is the size of the organization. This causes difficulty due to the number of differing and conflicting interests that are simultaneously trying to be appeased. Despite delegating separate committees to represent different groups of doctors, it is still under the umbrella of one organization. An organization like the BMA suffers from political involvement, which mirrors the political influence it also has. The NHS is often a major voting determinant. It is unsurprising that such an organization can face pressure from the political world that would influence its decisions to benefit those in power.

It is an unfortunate reality, but unlike their Kiwi equivalents the Junior Doctors Committee has been slow in anticipating issues relevant to junior doctors. It has eventually acted, although this is often after doctors have first taken it upon themselves to sufficiently bring these issues to the forefront. One need only look at the number of doctors who marched in protest over MTAS before it was deemed significant enough to be on the national news. Foundation Year 1 hospital accommodation has disappeared with minimal warning and no compensation, essentially equating to a 20% pay cut. Although relevant bodies, including the BMA's Medical Student Committee, say they are addressing this issue, it would be realistic rather than pessimistic to assume that this is likely to go without sufficient challenge to invoke any change unless doctors and medical students take it upon themselves to ensure this issue is adequately addressed.

Despite the many things that have been said about the NZRDA and those at the helm, one thing it certainly isn't is passive. It is a highly proactive organization that continually anticipates whatever is likely to arise and it is for this reason that they have a high level of appreciation from their members for constantly fighting their corner. Consequently this may explain why the morale of doctors in New Zealand is palpably higher than that of doctors in the UK.

It seems the case that whilst it is normal that doctors in the UK are often fighting for the wellbeing of their patients in increasingly busy hospital wards, much more needs to be done to protect their wellbeing. This needs to be without delay – before doctors leave for greener pastures and the profession in the UK becomes moribund. Problems are there to be addressed in good time, not swept under the carpet until sufficient time passes for it to become the norm. It is beyond time to start taking a leaf from the Kiwi, before the NHS goes the way of the Dodo.

‘If you don't love yourself, you cannot love others. You will not be able to love others. If you have no compassion for yourself then you are not able of developing compassion for others.’

Dalai Lama

Footnotes

DECLARATIONS —

Competing interests DT is a UK-trained doctor currently working in New Zealand and a member of the NZRDA

Funding None

Ethical approval Not applicable

Guarantor DT

Contributorship DT is the sole contributor