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I'm a radiologist and writing helps me make sense of the world.

"My method is to take the utmost trouble to find the right thing to say, and then to say it with the utmost levity" -George Bernard Shaw

Tuesday 7 May 2024

The Juniors are Revolting

The UK’s Society of Radiologists in Training (SRT) has just published the highlights of it’s 2024 training survey. It landed on social media as an infographic and made quite the splash. Although it only featured the preliminary results, it makes for ugly reading.

Many are withholding official comment until the full data is released. Plus the results should be viewed with caution as the 202 radiologists in training that were surveyed represent just ~15% of the UK’s total. Notably, 1/3rd of these trainees were from the North of England and a further 1/3rd were from London and the South East. I’m not saying the radiology training in those locations is considerably worse but, well, it might be.

It isn’t all doom and gloom. 64% were satisfied or very satisfied with their training, which, for a bunch of Gen Z-ers, is a win. Plus the majority felt that they’d be taken seriously if their raised concerns about their training. And this is on a background of radiology being one of the most popular specialities, with an 11:1 competition ratio for applicants: radiology training places. So they arrive fairly motivated, you would expect.

There is also a societal context: Brits like nothing more than complaining. It is a national pastime. Being quick to judge, quick to anger and slow to understand are, sadly, widespread traits in these Isles. Plus it has always been that the young to judge their seniors negatively and vice versa. The old see the young as feckless and lazy; the young see the old as repressive dinosaurs. It’s a tradition, an old charter or something.

But the general tone of these results is very depressing. Recent changes to the Royal College of Radiologist’s training curriculum were viewed negatively by the majority. 61% felt pessimistic about the future of radiology training in the UK. Even increases in training places was seen negatively by 44%. Which is paradoxical but perhaps understandable.

The major beef, as presented, is that non-radiologists are increasingly being trained to do what would typically be considered radiologist’s work, specifically the training of Physician Associates (PAs) and Reporting Radiographers (RRs). Although only 10% had worked with PAs, there was unanimous condemnation that they had a negative impact on their training. A slim majority also felt that RRs already had a negative impact on training in plain radiograph reporting and the vast majority felt the RRs reporting cross sectional imaging has a negative impact on their training and that further expansion should be resisted.

Despite the potential for bias, these results cannot be ignored. And, together with similar results from recent training surveys by the British Medical Association (BMA), Association of Surgeons in Training and Doctors Association of the UK, a consistent picture emerges of young doctors across the UK. The picture is one of vanishing training opportunities and marked disgruntlement.

This dissatisfaction is so pronounced that 78% of respondents to the SRT survey stated they were more likely to leave given the current expansion and extended practice of non-Radiologist roles. When nearly 8 in 10 of your trainees want to leave, the prospect is horrifying. Eerily it is almost identical to what 3819 junior doctors said in the BMA survey from December 2023: 79% said that they often think about leaving the National Health Service.

Understanding why the UK’s junior doctors are in revolt isn’t complex. Pay has been massively eroded over the last 14 years, resulting in ten rounds of industrial action thus far. Sadly there is no end to this industrial action in sight with government paymasters holding steadfast. Debt amongst medical graduates has never been higher and the UK’s cost of living crisis grinds on. Plus working conditions in the NHS have never been more demanding, with widespread staff shortages and spiraling demand.

This isn’t to say that the plight of radiologists in training is irredeemable and intrinsically linked to the woes of the NHS. But it is difficult to envisage and easy solution when looking at the existing body of consultant radiologists. There is a much-publicised and long-standing consultant radiologist shortfall. And, as ever, when time is short and work-lists are long, training is the first to suffer. In our local patch at least, individual consultant trainers are doing their best with what little time they have.

Obviously an increase in pay for trainees would help. Life is easier if you aren’t both poor and miserable. It might seem self-evident but exploiting each and every training opportunity is vital. Plus radiology trainers should very visibly prioritise the learning of radiology trainees over other staff groups. The next generation of radiologists will suffer if the current generation pulls the ladder up behind them. Without these measures, we will be in a deeper hole than ever before.

But whilst the government and higher echelons of the NHS are wailing that, “There is no money for training or pay increases", you can’t help feeling a rising level of despair and it is no wonder that our current trainees are eyeing up Australasia and North America for their tertiary careers. If I was in their shoes, I’d be doing exactly the same.