The junior physician contract dispute in the U.K. that has played out over the past two years will have a huge influence on an entire generation of physicians, according to a viewpoint written for JAMA by Andrew Goddard, MD.
At issue in the junior physician contract dispute are weekend staffing levels in U.K. hospitals. Though the U.K.'s supply of junior physicians, which are equivalent to residents, interns and fellows in the U.S., has increased from 39,000 in 1999 to 55,000 in 2016, working hours have declined. Additionally, more physicians are choosing to retire early or work part time, reducing the effect of the increased junior physician workforce. The U.K. has less physicians per population than the U.S. (2.8 physicians vs. 3.1 physicians per 1,000 people), according to the op-ed.
Meanwhile, hospital admissions have increased and bed numbers have decreased, so the National Health Service has worked to improve efficiency and reduce length of stay, according to Dr. Goddard. However, on weekends, low staffing levels have been shown to have a negative impact on delays and even quality of care, according to Dr. Goddard.
To help solve the problem, NHS sought to draw up a new contract that would increase staffing without significantly increasing costs. Initial negotiations between NHS and the Junior Doctors Committee failed, so the government called in an independent contractor. NHS drew up a new contract based on the independent review, which the junior physicians rejected. Jeremy Hunt, the health secretary, suggested imposing a contract on the junior physicians.
This did not go over well and led to a series of strikes and attempted negotiations. The issue was ultimately halted by Brexit, or the U.K.'s vote to leave the European Union, according to Dr. Goddard. Now it is unclear what will come next, but Dr. Goddard writes the process could have a lasting influence on physician morale.
"The damaging effects of these events on morale and the psychological contract between physicians and the state cannot be understated and will take a generation to repair," Dr. Goddard wrote.
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