Leaving medicine
Dear Friend,
Congratulations to all of you who received your A-level results. I hope they were what you were aiming for.
It is amazing to see so many students posting on LinkedIn today that they have achieved the grades to go to medical school and become doctors. I remember that same ecstatic feeling when I opened my results letter 10 years ago.
Whilst it is amazing to see the enthusiasm and delight on so many faces, I can’t help but wonder how many of these students will still be in the system 10 years down the line.
A survey by the daily mail earlier this year showed that 65% of junior doctors had research leaving the NHS in the last year and 79% often think about the NHS. I can say that I am amongst this cohort – and my 3 night shifts this weekend don’t do anything to help that cause.
A survey of more than 10,400 people from the UK’s 44 medical schools found 32% intended to leave for countries including Australia, New Zealand, the US and Canada. Similarly, a BMA report said that 15,000 to 23,000 doctors were estimated to have left the NHS prematurely in England between September 2022 and September 2023, with a cost of replacing them and their expertise would be between £1.6bn and £2.4bn.
From personal experience, out of the 14 medics who started at my college, only 8 remain in the NHS today. Others have left to pursue consultancy, medicine abroad, academia. In my current hospital a lot of junior doctors are also facing intense competition ratios to enter speciality training after foundation training, with many having to spend additional years to gain experience to improve their portfolio or revise for exams to get an interview.
Obviously one of the biggest factors is pay – and we have been hearing about that for the past 18 months with respect to the junior doctor strikes. But those of you in medicine will also know that it goes far beyond just pay. Horrible rotas, changes to the foundation system to send us to random places all over the UK (of which now we have no control), poor working conditions in underfunded hospitals (where equipment often doesn’t work) and increasing patient demand…the list goes on.
By the time the students today who opened their results letter graduate, I hope that the retention rate of junior doctors has improved. If anyone has any recommendations how, then I would love to hear them. It seems like the issue no one has been able to crack just yet.
Hope you have a good week. And congrats to those of you going to medical school – I am sure you will love it. It’s the working years after that where it gets more tricky.
See you next week!
Drug of the week
Beriplex (Pro-thrombin complex)
Prothrombin complex concentrate (PCC) is a combination medication made up of blood clotting factors II, VII, IX, and X.
Prothrombin complex concentrate reverses the effects of warfarin and other vitamin K antagonist anti-coagulants and is used in cases of significant bleeding in people with a coagulopathy.
It is also used when such a person must undergo an emergency operation
Common side effects include allergic reactions, headache, vomiting, and sleepiness.
A Brain Teaser
A 32-year-old man is invited to participate in a clinical trial for a new treatment for cystic fibrosis. He does not have cystic fibrosis or any other significant medical history. He is not currently taking any medications. During the trial, he will be monitored for any potential side effects.
What phase of the clinical trial is he most likely being recruited for?
A: Phase 0
B: Phase 1
C: Phase 2
D: Phase 3
E: Phase 4
Answers
The answer is B – Phase 1
The correct answer is phase 1, which involves enrolling healthy volunteers to evaluate potential adverse effects of the investigational drug. This stage primarily focuses on safety assessment. As the individual in question has no known medical history, they would be classified as a ‘healthy volunteer’.
Phase 0 is incorrect. Phase 0 trials are designed to administer a very low dose of the drug to participants to study its pharmacodynamics and pharmacokinetics, which are critical for understanding how the drug acts within the body and whether it localises at the intended site of action. For instance, if evaluating a medication intended to reduce tumour size, researchers would verify whether the drug actually accumulates at tumour sites.
Phase 2 is incorrect because phase 2 trials involve patients who have been diagnosed with the condition that the new medication intends to treat, such as cystic fibrosis. As the person described does not have any past medical history indicating such a condition, they would not meet the criteria for participation in this phase.
Phase 3 is incorrect as these trials are more extensive, including hundreds or even thousands of participants. These studies aim to compare the efficacy of a new treatment with current standard therapies. The scenario does not indicate that the individual is receiving any medication currently, implying their unsuitability for this type of comparative study.
Phase 4 is incorrect as phase 4 encompasses post-marketing surveillance to assess long-term outcomes and side effects associated with the drug in patients who have been prescribed it for their condition. As such, an individual without the relevant disease would not be included in this final phase of clinical research.
