General practice registrar laments slow rate of change for junior doctors

Matt Woodley

10/09/2019 3:39:23 PM

More than two years after her open letter on the state of medical training in Australia went viral, Dr Sonia Henry says the same problems still exist.

Junior doctor hospital hallway
The medical training landscape in Australia still contains stories about toxic workplaces and ‘powerless, embarrassed and frustrated’ staff.

In her 2017 letter, originally published anonymously, Dr Sonia Henry exposes what she calls ‘the profession’s shameful and disgusting open secret’.
She was referring to suicide – and the working environment that contributes to it.
‘In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves,’ Dr Henry wrote.
‘In the cutthroat, often brutalising culture of medical or surgical training many doctors stay stoically mute in the face of daily, soul destroying adversity; at the worst case, their loudest gesture is deafeningly silent – death by their own hand.
‘When I think about all the things I have learned at the end of my residency, one stands out very clearly. There is something rotten inside the medical profession that has been festering for a long time with no realistic cure.’
Dr Henry specifically highlights the stoicism expected of trainees (‘weakness in medicine is a failing’), long hours, poor financial remuneration, discouragement to claim overtime, and extreme shortage of training places as factors that can have a tragically detrimental impact on the mental health of junior doctors.

However, despite increased awareness around the importance of mental health, and studies recognising burnout as a medical condition, the medical training sphere remains littered with stories about toxic workplaces and ‘powerless, embarrassed and frustrated’ staff.

‘In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves,’ Dr Sonia Henry wrote in a 2017 open letter.

Dr Henry, who initially trained in hospitals before transitioning into general practice, told newsGP that while positive interventions have been made in relation to doctors’ mental health, more needs to be done.
‘I’m not a politician, but I think we all recognise the need for more training spots, destigmatisation of doctors seeking help for their mental health, reduction in unpaid overtime, and a zero-tolerance policy towards bullying, harassment, and sexism,’ she said.
Yet, while she believes it will take a ‘total paradigm shift’ to enact cultural change within the profession, there are still many aspects of being a general practice registrar that Dr Henry loves.
‘The system needs positive change as a matter of urgency and I’m happy to advocate for this … [but] some of the best friends I’ve made [have been] throughout training and I will never forget the kindness I experienced from some of my senior doctors,’ she said.
‘There are good and bad things about working in hospitals, just as there are good and bad things about being a GP. What I enjoy about general practice is the greater autonomy and continuity of patient care. I also love the direct one-on-one patient contact.
‘I would love to be a GP who specialises in the wellbeing of my colleagues in medicine, as I think we all need a safe space to go and another clinician we can speak to who won’t judge us.’
Being a GP has also allowed Dr Henry the time to pursue other outside interests, such as writing her new book Going Under – a fictionalised account of life as a junior doctor.
‘Whilst my main character of Kitty, a junior doctor struggling through her internship is made up, I found it incredibly therapeutic to write down her thoughts and feelings, and appropriate to some of the experiences I was having into this fictional world and context,’ she said.
‘It’s very dark in parts, but there’s also light, and I think a sense of the importance of friendship in high stress environments, which was such a gift to sit down and reflect upon.’

junior doctor mental health registrar

newsGP weekly poll What is your chief concern with role substitution?

newsGP weekly poll What is your chief concern with role substitution?



Login to comment

Graeme Banks   11/09/2019 8:38:22 AM

The overweening bureaucracy has ensured that the future for medical careers is grim especially in general practice. Not too late for a career change to save your life from unhappiness beyond your control.

Cho Oo Maung   11/09/2019 9:08:42 AM

Diligent, Tolerant, Resilient, Patient ....were our motto ..when we trained to become a medical doctor. We do practice Meditation 30 min. everyday. We do practice Forgiving and Forget it as well. We see angry Boss or Bullying Boss as our psy. patients. They might pass through some kind of tough childhood life. So, I am still surviving as a doctor for 39 years.

Ayodele Ogunjobi   11/09/2019 10:20:14 AM

Hmmm........overweening bureaucracy.? I think that cuts across all speciality not just GP

Fred Smith   11/09/2019 11:28:53 AM

Doctors have no other choice or options than to vote with their proverbial feet. In general practice, applications for training are declining and there is an increase in registrars and GPs leaving full-time practice to become part-time, diversify, or leave entirely. Get ready for corporatised general practice, staffed by IMGs who can be controlled with policy and legislation...

Jennifer Brownless   11/09/2019 12:34:36 PM

Universities continue to select medical students for a career in medicine who ALREADY have significant mental health issues. Of course things need to change in the hospitals. We also need to find a way to discourage already fragile people from what is a difficult course and a challenging career.

Dr Peter Strickland   11/09/2019 12:47:45 PM

I am a creature of the early 1970s. We worked 90-120 hours/week during our residency ,and paid about $6,000 for the whole year. No resident of my era committed suicide, and because we expected to do this over-burdened work to receive our first medical registration. Three benefits we had were free meals, free parking and visits by spouses at any time, and that should be there today. Our pay was pitiful, but the senior registrar in surgery (three fellowships)was only paid about$10,000, and did an estimated $180,000 in surgery over the year. Toughness and professional integrity lead later to dedicated professionals in all areas of medicine, and my experiences helped me cope later in 1975 with some arduous medical times during and after Cyclone Tracy in Darwin.

Dr Karyn Matterson   11/09/2019 3:58:19 PM

Dr Strickland,
I find your "back in the day" position demeaning and a perfect example of the trivialisation of the big issues we face as Registrars in medicine today. Just because you & your colleagues "did it" doesn't mean that is was either right or good for you or their mental health. How do you know that no one committed suicide? I guess you don't as there was no internet then (only snail mail and the attitude that mental health issues should stay in the closet).
How dare you suggest that your experience of "tough love" provided you with a resilience that you infer that we, today's Registrars, don't have.
Congratulations Dr Sonia Henry.

Chris Hogan   11/09/2019 4:47:32 PM

I am also a creature of the 1970s but I distinctly remember the suicides & the single vehicle accidents that killed colleagues. I remember those who succumbed to alcohol & mental illness.
I remember the atrocious hours & the arrogant bullies who had me in tears- that was tough in times of "blokes".
But I also remember that the CEOs were medical superintendents who were doctors & who could be approached. I remember the enormous support I got from my medical, nursing & allied health colleagues. Of course , the midwives were initially a bit bolshie but after we worked together we realised that we needed each other. Also, midwives who were mothers themselves moved away from theory & dogma to hard nosed practicality.
I remember years later making direct & personal representations to the state health minister about the plight of our GP registrars who were overworked, under appreciated & not provided with either support or the education that hospitals were mandated & paid to provide

Chris D Hogan   11/09/2019 4:58:33 PM

There is no need for inter generational angst. Regardless of when we started we all now face a common enemy.
However, we need a clear headed analysis of our challenges & of their origins. I am an historian for RACGP & gather the stories of our colleagues.
There have always been problems for registrars but yes they are worse now.
I am as capable as anyone as to guessing what, why & how but we need hard facts & united action.

Dr Audrey Clarke   11/09/2019 5:35:40 PM

I am an older generation doctor trained in the 80s. Secondary school was not stressful, getting into medicine was straightforward. I had fees fully paid plus a highly generous grant and no debt at the end of uni. Some not so great junior doctor hours, but I could afford to buy a house and there was no exam for post grad training. Childcare was free/state funded for my young children. Sitting college exams - a few hundred. I compare all these gifts enjoyed by my generation with the enormous distress that I see in the tough,beautiful, caring, valuable junior doctors I now see as patients. I feel so angry at the way the system is crushing them. Female doctors or those who request reduced working hours for whatever reason are particularly oppressed. Our junior doctors deserve the same respect and treatment we would offer to any human being. We know beyond 40hwork a week physical and mental health deteriorates. Time to set legal limits.

Carole Rayner   12/09/2019 7:09:18 AM

One of my concerns is that the increasing hoops invented for general practices to jump through is just too burdensome for small group practices and individuals and increasingly favours corporate practices .. the latest being changes to PIP accompanied by the list of the compliance activities to be attended .. the role of corporates is important but a fulfilling career path to ownership by small groups needs to be encouraged and be provided as a viable option and would encourage GP numbers ... and still allow enough time for our core business of seeing patients .

Naseem Isaacs   12/09/2019 3:24:28 PM

I am a doctor that qualified in South Africa 1976 whilst apartheid was shredding the country to bits. I received a scholarship in 1973 by the Deen at the time. We grew up in very poor conditions without my dear father ( 50 yr -died of cancer of pancreas)My mother had 17children 5 boys and 11 girls. I am the youngest in the family. My husband and my two children moved to New Zealand in 1989 for a better life for my children( my son was 10, my daughter was three months old.We were the first of a large family that made this move. At end of 1994-1995 my colleague( with whom I set up practice with) was dismissed. Another colleague and I had to look after 8,000 patients and both of us decided to resign.( we were working for a trade union practice at the time) after two months of slog the first time I took work home was February 1995. I weighed 40kg and my neice who had been there a few years was going to be coming for Eid . That was when I became depressed. Since 2000 we moved over to Australia

Dr Claire Elizabeth Cupitt   12/09/2019 3:48:08 PM

Hi Sonia. I couldn't agree with you more - we need to be way more supportive of each other - and there are many who are - but, sadly, there are too many health professionals who are too quick to criticize and denigrate others - ? to make themselves feel better - but with awful consequences.

TR   14/09/2019 9:58:43 AM

I loved the post by Dr Maung - so inspirational. .. I don't agree that the challenges in training are worse now, but different in some ways. In fact female doctors have way more opportunities now in all fields of medicine. There does seem to be an increase in suicide amongst junior doctors, and failing to look at all possible causes will be doing junior doctors a disservice. Have to say that I am not encouraging my own Gen Z daughter to do medicine for other reasons.