A PGY6 doctor explains why temporarily hoping off the medical training conveyor belt helped them become a better doctor.

I spent the second half of 2019 agonizing over whether or not I should take a year away from clinical medicine. I did all the normal things to help me make a decision: a pros and cons list, asking family and friends, speaking to a psychologist and praying for a sign that would give me clarity. To be honest, the most helpful was seeing a psychologist. Speaking out loud about my reasons for wanting to stay or continue made me realise that I needed to get off the conveyor belt of medicine. 

The main reasons I wanted to continue through to another year at the hospital included:

• Getting the BPT exam done as quickly as possible
• Concerns about what my friends, colleagues and supervisors would think of me
• Genuinely conflicted about how I felt about clinical medicine
• Not wanting to ‘give up’ or admit defeat

The reasons to take a year off included:

• Sick of shift work after doing a whole year of shift work
• Feeling like I was missing out on life
• Perfect opportunity before I started studying for the BPT exam
• Wanting to spend more time with ageing parents and a partner I was only seeing once a fortnight
• Wanting to dedicate more time to developing hobbies e.g. social sports, baking
• Wanting to dedicate more time to having a healthy lifestyle
• Feeling like I was just a dispensable worker in a hospital going through the motions of hospital life and wanting to take control of my life

This last point acknowledged a feeling that I had been unable to describe all year. Through a culmination of issues, 2019 appeared to be the tipping point:

1. Stressed colleagues

There were so many (of what I considered to be) good doctors who failed their exams and were reaching their limits of attempts to retry. It didn’t appear to be a reflection of their clinical acumen - perhaps it was performance anxiety, burnout or just a bad day, but the consequences of that failed exam were numerous. People put their lives on hold for these exams and a delay in passing them can impact on every aspect of their lives (I can’t even imagine the despair that current exam candidates are feeling with the constant changes due to Covid-19). Yet they still turned up to work each day. Albeit tired and sad. 

I won’t know now but I think taking this year off before studying for my exam might help post-exam, regardless of the result. I have realised that there is more to life than just clinical medicine, and that I have skills that can be applied in many different areas. The burnout that I see so regularly is largely contributed to, I feel, the pressure and constricting feeling that there is no other avenue to an end goal. If there was a cultural shift and taking time off was more accepted and non-clinical jobs were encouraged and promoted, I think there would be much happier doctors at work.

2. Poor rostering

During one six month rotation, the day roster had one doctor allocated to each of the four different wards in the department with shifts ranging from 4-hours to 12-hours. There was no sick relief or on-call person, meaning that if someone was unable to come in that day, the other three doctors would have to cover these other wards as well as their own. This was particularly problematic when the 12-hour shift person did not turn up in the morning - there would be silence as the consultant would look around the room and each junior doctor considered if they would have to spend an extra four to eight hours on top of their allocated shift that day. I felt ‘safe’ to say no because I was already on the training program, but I felt for those yet to get on who were hoping to impress the bosses and get good referees for job applications that year. There just needed to be a better way - relying on a person’s good nature or guilt is not a safe or reliable rostering system.

3. Lack of support and appreciation

While I was a BPT1 trainee, I was on the registrar roster and was managing the emergency department at night by myself. Despite this, I was still being paid as a resident because I was in my first year of training. It seemed ridiculous to me that I was getting paid the same amount as the actual resident who I would be managing at night while making the more senior decisions about who would stay and who would be discharged at night. I was so frustrated by this that I spoke to both the director of emergency as well as the director of my training and both of them said the same thing: “This is the way it has always been”. This phrase has to be one of the worst responses, yet is so commonly said or assumed in the clinical setting.

- - -

It was a bad environment, surrounded by unhappy people in a system that was not set up to support its workers. I needed a break.

In practical terms, this was not hard. Once I had made the decision, I put in a form to interrupt my training and set out to find non-clinical jobs to fill my time in 2021. I didn’t ask for permission, I wrote ‘research and locuming’ as my reasons for leaving and that was that. I had expected more of a pushback and was surprised at how easily I got the time off. 

But doctors-in-training is a two tiered system divided between those on a training program and those trying to get onto a training program. The medical training bottleneck doesn’t help either. I have a friend who was trying to get onto a specialty program. She had done everything on her CV - research, presented at conferences and even her travel was somehow related to her specialty - but she didn't get on the first time she applied. She felt like she wasn’t progressing and needed a break. She applied to be a university tutor and needed to ask for six months off clinical work to do so. A lot of to-ing and fro-ing later, she ended up not with six months off, but with working the two jobs at the same time. The chance that you could upset your consultants and possibly jeopardise your career is just too big a risk to take. 

I think it was a lot easier for myself because I was between contracts and there were no roster adjustments to be made. I tried to give my allocated 2020 hospital enough notice so they would have plenty of time to find a replacement, and there would be no hard feelings if I did in fact return the following year. 

Now at the beginning of 2021, I feel rejuvenated and ready to start clinical medicine again. I wrote myself a list of all the things I wanted to achieve last year and slowly worked my way through it. I now eat better, I exercise more regularly, I am up-to-date with my dentist appointments, and I have even managed to do some research in my chosen specialty along the way.  

Not to minimise the tumultuous year 2020 has been for most people, but for me the timing could not have been more perfect. It has been a year of self-reflection and slowing down. I have loved this time away from clinical medicine but am well and truly ready to get back to work.

If there are others who want a break from the monotony and expectation of clinical medicine, I encourage you to take a year off. The biggest challenge I faced last year was the fear that I had no choice. No choice but to complete each year, until I passed the exam and became a specialist. What else was I going to do? There aren’t any other jobs that a doctor can do. Through the process of looking for jobs to do last year, and meeting and talking with people in non-clinical jobs, I realised that this medical degree that I have does not pose restrictions on what I can do in life. In fact, there are so many other paths that it can lead to and that makes me feel so much more comfortable now heading back into clinical medicine. 

There is always another option. There is always another way. The conventional path isn’t always going to be the right path for you.