The Mayfly effect

A solution to the turbulence caused by the NCHD annual changeover needs to be found

Like dead leaves in a gale, Irish trainee doctors will soon be whipped from one home to the next in our annual changeover. And like going to mass or enjoying the Eurovision, it only seems normal because we have always done it. It is a joyless irony of being a NCHD that one of the only constants in life is to be temporary.

The gusts of career progression arrive with clockwork consistency, but often little notice as to where we will go and no concern as to what stress this change will bring. We have all heard the ludicrous stories of people rostered to work on the Sunday of changeover and move cities to a different hospital for an 8am start the next day. Since 2013, I have worked in eight hospitals, four counties, and lived in seven homes; my experience is about average.

This periodic upheaval is more than an inconvenience. Professionally, we leave behind systems, colleagues, and institutions that we are familiar with to take on new ones, with all the risk that this newness brings. Socially, we leave behind partners, children, family, and friends repeatedly, and bring strain on relationships that can be taut at the best of times in medicine. Amid a housing crisis, we tear our hair out trying to find a short-term let when there are none. And as a workforce, we are among the weakest in the public service: We need roots and stability to organise ourselves and bring change. This is impossible when we are dragged asunder and land on unfamiliar turf every few months.
Why do we maintain this system?

Our intermittent flagellation by the emergency tax when moving hospitals (while still working for the same employer!) is the stuff of nightmares

You can argue that rotations bring a diversity of experience to NCHDs, which they would not otherwise receive; the most recent year I spent outside my home city was one I loved, meeting new people, visiting new places, and seeing life in a different shade. Others I know, though, had to travel hundreds of miles from home and move house for a six-month rotation that could have taken place much closer.

There are times, too, when we are glad to leave a rotation behind, whether due to difficult colleagues or disorganised hospitals, although I’m not sure this is a strong argument for rotations in itself. Finally, there are too many hospitals which would simply not attract any applicants if we were not mandated to work there. Shoddy technology, archaic work practices, (medical responsibility for administering first-dose medications springs to mind), overstretched rotas, and poor senior support, stamp some hospitals or departments with dismal reputations and NCHDs fear the thought of ever working there.

While it is true that hospitals outside cities will suffer some disadvantage compared to those in cities for reasons of commuting convenience, too often our mandatory rotations have absolved hospitals of any responsibility to improve the lot of their medical trainees and become attractive places to work. If you are guaranteed a steady supply of doctors come what may, why make any effort to provide sane rotas, affordable accommodation, or a reasonable allocation of tasks on the ward?

What could we do differently? As a bare minimum, trainees should be informed at the beginning of their schemes about where every training year will take place. Repeatedly leaving colleagues in the dark about whether they will need to move home and family until a few months in advance is not reasonable. Given our struggles with accommodation show no signs of subsiding, hospital groups should take a stronger role in co-ordinating accommodation for rotating doctors at reasonable cost. This is not impossible – multinationals in the private sector co-ordinate employee accommodation routinely.

Finally, inconsistency in IT systems, care standards, and NCHD roles are issues that ought to have been resolved by the creation of the HSE, but were not. Our intermittent flagellation by the emergency tax when moving hospitals (while still working for the same employer!) is the stuff of nightmares. Now is the time to insist that what we can expect of hospitals, and their expectations of us, are consistent and not subject to the vagaries of local tradition.

Training bodies should make clear that mediocre treatment of trainees will not be accepted and lay out the consequences for this. The turbulence of our rotation system has few parallels in any other workplace and make a stable adult life near impossible. It is past time that we reformed it and allowed NCHDs to lay roots that will protect us from the other squalls that modern life sends our way.