For the first time since 1975, it looks like doctors are lining up to strike. Morale among juniors is lower than ever – over the last five years many of us have seen it dissipate before our eyes. I am sad to see colleagues and friends upset at this and know it will affect them and their families’ lives. I am frustrated that the government seem to be playing the profession off against itself and the public. I’m perhaps still surprised at the way so many doctors are expressing this so vociferously (across a largely supportive media including The Guardian, BBC, The Independent and The Telegraph) and I feel that surely the government must listen to those who care for the sickest and most vulnerable people. My instinct is also to stand in solidarity with my colleagues and friends and not be appear disloyal.
And so surely supporting strike action is a no-brainer?
Well I’m not so sure.
At least, I think we need to think this through carefully.
Let me be clear. I did seven years at medical school and have been a junior doctor for eight years. For two of those years I worked 70% then 50% less-than-full-time with no other income. I have a wife and three children and a house. I live in the (not so inexpensive) town of Canterbury. I am in paediatrics, one of the most on-call heavy specialities. I have been on rotas where five of nine slots are unfilled and where regulars like me were expected to fill in. I am faced with an effective 20% pay cut from my clinical pay and now I’m not in training I won’t automatically go up on the pay scale.
CMF considered this issue back in 1999 with respect to the proposed industrial action surrounding junior doctors’ working hours. This focused on the principles of compassion, justice and grace (also see here). In 2012 the industrial action was limited to cancelling routine clinics and operations, but doctors still dealt with emergency and urgent cases. Again CMF staff blogged on this, considering a biblical framework around industrial relations, motivation and our attitude to authority, looking at five questions loosely based on Augustine of Hippo’s ‘Just War’ theology.
I would urge you to read these articles and consider what is put forward there. But here I want to go a little further and suggest five areas I think we need to examine before we come to our own conclusion.
- Are we acting prematurely?
I don’t think Jesus would have been quick to jump into industrial action, and it may be that it is premature to act so dramatically so soon. We are yet to see the outcome of the face-to-face negotiations Jeremy Hunt is trying to run. In addition, it may be that there are other forms of industrial action short of a full strike that might be better to consider first.
Is it perhaps premature to throw our weight behind a strike when we are not sure of the exact details of what we are striking about? For example, what will the basis salary rise be? The government claims that a new system will be more transparent, abolishing the current variation in a trainee’s salary throughout the year which can be problematic.
It is also a challenge to us as Christian medics. Are we engaging in negotiations, attending roadshows, writing to our MPs – in other words using ‘peaceful’ channels – to engage in this, or are we jumping on a bandwagon at the last minute? We need to beware of the culture of cynicism that says that the government are ‘out to get us’; in this case it is possible that the government does not understand the realities ‘on the ground’. We can play a constructive role in ameliorating this, and need to beware a stand-off that could turn against us at the media’s whim.
- Is this about professional pride?
Many students and juniors have made a large personal investment into their education on the assumption that they would be paid sufficiently to repay loans etc. The proposals are understandably worrying on that front, and I have real empathy with this.
However, we need to be careful that we don’t allow a sense of pride to drive our motives. It can be easy to be sucked into believing that just because I’ve worked hard, I deserve to be rewarded. But there are people all over the world who have worked harder than me and yet are rewarded with little money and little or no respect for what they do. Why do I deserve a certain level of pay? In our society pay reflects the value society places on us. And we don’t like being devalued; it doesn’t feel good. It makes us feel unloved and unappreciated.
And yet how are we called to live as Christians? We follow one who was mocked, derided and devalued (Matthew 27:27–31) – and yet people should have bowed the knee and worshipped him. The Bible teaches that showing submission to authorities (1 Peter 2:13), being humble (1 Peter 5:6) and even being wronged (1 Peter 3:17) are ways to bear witness to Christ who is the one we ultimately serve (Colossians 3:17, 23). It’s striking that John the Baptist told those who followed him to give one of their two shirts to someone who had none and not to complain about their wages (Luke 3:11, 14).
If our professional pride is driving our actions then I would argue we have lost our sense of perspective and need to spend some more time in the real world. Just because New Zealand and Australia offer what they do (and in many people’s eyes, what we deserve – free lunches, masses of study leave, nine-to-five jobs etc) doesn’t mean it is what we deserve. Putting things into context can be helpful – if we are surrounded by other medics, or those who earn good money in the City for example, our pay and conditions can seem appalling. But if we are surrounded by those on benefits and in low-paid jobs, we might see our situation differently.
- Is this really about patient safety?
A common argument is that the new contract will result in patient safety concerns, that trusts will be able to pressurise doctors to work beyond the current European Working Time Directive limit of 48 hours and that a more overworked workforce will impact on patients. And yet staff working conditions have been deteriorating for years – seeing two nurses run a 32 patient respiratory ward with six patients on non-invasive ventilation is enough to make your eyes water.
Yet I have seen little outrage on social media about the need to protect patient safety – until it affects us. Perhaps this is again the straw that breaks the camel’s back, but it is worth considering how we advocate for our fellow staff.
- A privileged role
The secretaries in my unit are under immense pressure; this week their printers were removed; something seems to be happening on a weekly basis – but who will strike for them?
Many of us were privileged to go to medical school. My family made big sacrifices for me. The state paid possibly around £250,000 for my education, when in many parts of the world this just wouldn’t be possible. I am incredibly blessed to be working in medicine. My job is meaningful and fulfilling – I go to work and make a difference. Even after a 20% cut, I will still make several times more than my friend who works in a call centre. Yes I have trained for years, have bigger debts and pay more tax, but I have the opportunity to work in this incredible profession whereas she hasn’t. Do I deserve more pay? I’m not so sure. I am also far freer to locum and earn a good hourly amount in a flexible way which most of my friends in other jobs don’t have the opportunity to do when they need money.
Being a medic means I can also take my skills and get a job elsewhere, be it as a medic overseas or in other areas in the UK. Indeed I will likely be paid more if I do that. Junior doctors have opportunities that most people could only dream of; we should be wary of holding our employers to ransom because we feel our bargaining position is strong, when those with little or no power are repeatedly downtrodden.
- Is this selective justice?
I have a confession. It started at a young age – I am often silent on justice issues that affect the most vulnerable on our planet, but can be outraged and outspoken when something impacts on me. As an F1, when the nurse staffing number was cut on my ward I said nothing – but when I was owed £400 travel expenses I kicked up a huge fuss and even called a senior manager a liar, so indignant did I feel. Indeed it is other healthcare staff who are not as mobile, paid far less and perhaps less likely to stand up for themselves who are more vulnerable than doctors. Nurses are far more dependent on out of hours payment than doctors are for example.
What about our response to injustice in our world? I don’t see nearly as many junior doctors appalled that 21 children die each minute mainly from preventable causes, that 2.4 billion people lack access to sanitation, that 50 million children are killed every year by abortion – more than the total number of people who died in the entire Second World War. And so on. With rising prices, static pay and pensions, and collapsing social trust across the country, it is the poorest, the elderly and people with disabilities who are suffering most. Are we concerned with our own hardship or with those of our colleagues, patients, and above all, the most vulnerable members of our society? And where will we put our limited reserves of energy? Jesus spoke out strongly against injustice – God’s hates injustice, that’s for sure. And yet when the greatest injustice was being committed, Jesus willingly carried his cross, bore it graciously, and then beckoned his disciples to follow him (Matthew 16:24). Will injustice stop us serving God, our patients and the government which God has put in place to rule this land?
So what should we do?
Should Christian medics strike? I believe that we need to do all we can to persuade our employers (the government in our case) to see sense and be just. However, history tells us that employers can be unjust, and the Bible has a lot to say about injustice. But the Bible is not explicit about strike action and leaves it open for individuals to decide in good conscience where they stand, having considered the evidence and the potential pitfalls beforehand. Having said that, unlike the Tube drivers who seem to strike time and again, I believe there is a line at which we should stop ‘fighting’. Where that line is, be it before or after a strike, will depend on our conscience before God after much prayer and having considered all the relevant issues.
We need to respond compassionately to our colleagues who may well be in turmoil about their futures. We have a tremendous opportunity to speak of the security we have in Christ, that even when all is stripped away we can still be supremely satisfied in Jesus.
Medical students, you have an increased opportunity to trust God for your future in uncertain times, knowing that he is in control of your futures. Juniors, why not get together to pray for each other – you or a friend may well be really struggling with how to respond, and how to channel the anger and injustice you feel. Keep meeting together, praying that Christian doctors would stand at this difficult time and speak out for the vulnerable and the needy to preserve an NHS which can deliver high quality care to those who need it the most.
So what do you think? This is a controversial issue, so do leave a comment below.
To keep up to date with what is happening visit the BMA’s information page.