LIKE MOST JUNIOR doctors, Rachel McNamara is no stranger to the exhaustion of ultra-long shifts.

She’s worked through more nights than she can remember, but the hardest ones are still seared in her memory.

There was the 64-hour shift, for example, that ran from 4pm on a Friday until 8am on a Monday. She managed to get home for a few hours’ sleep during the daytime, but she knew the phone could ring at any point with a question or update requiring her to get back on site.

Then there are the nights with no let-up at all. On one of her first 24-hour shifts, calls and admissions poured in until around 4.45am. She walked through the wards that night feeling “pretty much comatose”, as if her body had shut down.

“I eventually got into bed but then the phone went off again after about 15 minutes – another sick patient. It was painful having to get up, but there was no one else to call.”

McNamara says the tiredness felt by doctors working in these conditions is hard to explain. “You work through the day and the adrenaline will take you through until eight or nine in the evening, but then you just have to keep going and going. If you’re needed on the wards, you can’t really stop.

“By the time it gets to the early hours of the morning, you’re operating on a much lower level. You’re not thinking as clearly as you should be, and you start to doubt yourself.”

She tells The Journal of the guilt felt by doctors stretched beyond their limits. “People can be upset or distressed right in front of you, and you don’t have the energy to properly empathise or give them the care they deserve.

“You end up not being able to derive any sort of satisfaction from the job because you’re so chronically fatigued. It’s not something you can do to yourself long term.”

The Limerick woman knows several colleagues who’ve recently left the profession. “These were great doctors, but there comes a time when you see it’s taking too much from you.”

She herself has considered choosing another specialty. “There are weeks where you might work 12 days in a row, and you can see the impact it has on your relationships. You can’t keep up with family and friends, and your house is a mess. Whatever time you have away from work, you’re sleeping.”

Problems across the system 

McNamara’s frustrations are shared by many in hospitals across the country. In a recent survey by the Irish Medical Organisation (IMO), 78% of junior doctors said they were at high risk of burnout.

The research identified widespread breaches of the European working time directive, under which non-consultant hospital doctors (NCHDs) are supposed to work no more than 48 hours a week, or 24 consecutive hours. Doctors are also “routinely not paid for all hours worked”, according to the IMO.

NCHDs are now being balloted on industrial action, with junior doctor representatives warning that a nationwide strike will be considered if these issues continue. A result will be announced after balloting closes on 9 June. 

It’s been nine years since the last junior doctor strike, when 51 hospitals were hit by a one-day walkout over working hours.

Aidan Coffey, who’s on the IMO NCHD committee, says no junior doctor would take the decision lightly.

“I hate the idea of not going into work, but I also hate the idea of being ten years down the line and seeing that nothing has changed. I don’t want to be working as a consultant in the future and wondering why NCHDs are still facing these conditions – and wondering whether we could have done more to improve things.”

Coffey worries about the future of the health service given the growing number of junior doctors moving abroad. He himself had a stint in New Zealand before returning home at the start of the pandemic. The differences between the two healthcare systems are stark, he says.

“In New Zealand, you were given a roster, and that roster was respected. If a change needed to be made, it was up to the hospital to find cover, whereas here so much of that responsibility is put on the doctor.

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“There was more flexibility and more of an understanding of the need for a work-life balance, which just doesn’t seem to exist at all in Irish hospitals.”

Expectations 

Like McNamara, Coffey has seen friends and colleagues leave hospital work because of the impact it’s had on their mental health and wellbeing. The Cork man counts himself lucky to have “a somewhat tolerable” roster, with 50 to 60 hours a week being the average.

Pressures are being felt across the system, though. He and others point to the increase in patient numbers and complexities due to our ageing population, as well as the workload caused by new interventions and guidelines.

NCHD advocates say that while contractual breaches have to be addressed, a cultural change is needed as well.

“There’s often been this expectation that the doctor goes home when the work is done,” says McNamara. “I think there’s a greater appreciation now with Covid that life is short.

“The belief that being a doctor is a vocation and that all else must be sacrificed in order to carry out the role … I think that mentality is waning. People are asking why we can’t do this job but also maintain some of ourselves in the process.”

This work is also co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.