“In a perfect meritocracy, tiaras would be doled out to the
deserving, but I have yet to see one floating around an office. Hard work and
results should be recognized by
others, but when they aren’t, advocating for oneself becomes necessary… The
most common way people give up their power is by thinking they don’t have any.
Do not wait for power to be offered. Like that tiara, it might never
materialize.”
Lean in, Sheryl Sandberg
Back in November… Way back when… I made the decision not to
apply to the SPR scheme. This was a personal decision that was in no way based
on the 24hour turn around on applications following notification on the
Membership exams. And while I could list the reasons why I chose not to go on
scheme, they really don’t matter to anyone else… Frankly, it’s no one’s business.
But I immediately received a large amount of feedback as to why I made the
wrong decision. Here is a sample of why I’d thrown my life away:
·
The SPR is the only way to get to consultant
·
You’re too good to waste time as a registrar
·
Only people who don’t know what they want stay
off the SPR
·
You’ve already done research, so just get on
with it
·
You have your exams, this is the next step
·
You’ll get your year of neonates out of the way
sooner
·
You can always turn it down
Again, while I appreciate feedback, none of these took into
account my rationale for not applying to the SPR, a rationale I had shared with
my seniors at the time. In fact, I felt that my opinion, my plan, my career
choices were dismissed as immature and I was fed guidance that I had no desire
for.
More recently, I made another decision. I have decided that
from the July hand-over, I will be acting as a locum rather than taking a 6
month job. I have many many good reasons for this, the least of which is that I
will actually be taking time off of work (completely) to study. Unfortunately,
the current system does not allow enough study time for my goals, and I’m sick
of it. Having made my decision, and slowly informing my seniors, I am, again,
receiving more feedback than I appreciate. Another small sample:
·
The HSE can’t afford locums anymore
·
No one respects the locums
·
There won’t be enough work
·
You won’t work enough hours to keep busy
·
It’s a terrible job
But far worse than the verbalized reasons as to why I’ve
made the wrong life decision, there is a current of subtext in many of the
conversations I’ve held that conveys the impression that my decision is a
betrayal. How can someone trained in Ireland, a product of the BST, not fill a
regular reg job? Don’t you feel a duty? A responsibility to pay back the system
that trained you? They don’t have enough regs to fill the posts, what are you
thinking not taking a normal job?! In other words… How dare you…
Let me fill you all in on a little secret. A dirty little
secret. I have never been treated as Irish trained doctor. Never.
Now, I will, hand on my heart, say that I’ve never been
treated with the same blatant racism that I see some of my colleagues subjected
to (It is noticed… And it is shameful). I have an Irish name, I’m white,
English is my first language, and I’ve even developed a brogue in the time I’ve
lived here. But while I would identify myself as Irish-American, I am not
treated as an Irish doctor. A few weeks before my graduation (and shortly after
the rank lists were due in the US), my class was informed that they’d be using
a central match for interns… We would be the test bunnies for that system, and
if you were non-EU, you’d have to wait until all the EU students had jobs
first. So that jackass next to you, the one that barely scraped by with a 50,
would have pick of jobs before you… Because you’re not from the EU… (and I’m
not going to address the tuition fees and education loans prior to that). And
for those of us from North America that wanted to stay here, we were told that
we’d been warned this was coming and we’d have to just wait and see. Told after
our only option to get back to the States had passed. Told callously. And boy
did my confidence going into my exams suffer. When I applied to the BST scheme
of my choice, I received a 1st round offer. Not my 1st
choice, but an offer. And you know what, I was one of the only North Americans
to be offered something 1st round. It was suggested later that it
was because people were afraid that we’d just leave before our training was
complete. I wonder where they got that idea?
Every 3 to 6 months, I change jobs, change hospitals, change
supervisors and colleagues, and every 3 to 6 months I face the same question:
What are you still doing here? As if I am in some way defective for remaining
in Ireland. As if I do not belong here. Well… Do I belong here? Now I actually
want to know. Because from the moment I decided to locum, I’ve been getting a
wave of, “now your true colours show…” That’s right, my true colours… I am
putting my career path in front of the desperate needs of the HSE.
When I tell people that I’m leaving Ireland (and it is
something I did not take lightly, I’ve lived here for a third of my life), I
get mixed reactions. My compatriots – Good for you. My seniors – Get out while
you can. My supervisors – You’re going to abandon your training? I want to give
my response here. And this is keeping in mind the reflection I previously
posted, the one on remembering…
1)
Any and all training I have received while here
is something I have fought for. You can easily advance in the Irish system (to
a certain extent) by keeping your head down and not killing anyone. Actually
training is something NCHDs have to want and seek out. Now I’m going to take
some time to train myself. Some of the most important exams are not Irish…
Let’s all accept that fact.
2)
I have a partner here in Ireland (who is also
American) and our families are in the US. This is going home. This is returning
to the system that for 20 years prepared me to work as a doctor. I don’t need a
lecture on loyalty. I miss my family. I feel guilty for not being close enough
to watch my nephew grow up, for not being with him often enough that he knows
me. I wish I had the money and time to see my friends get married on the
weekends. I hate that I don’t talk to my parents as much as I should.
3)
I have made a career defining decision, much
like the one I made to attend med-school in Ireland. And whether or not it fits
into the convenient box of HSE plans is not my problem. There is no career ladder
here. There is a pot of muck that you slop around in for ten years and
hopefully manage to find your way out of… and shower before becoming a
consultant. I will not seek forgiveness for wanting a clear-cut plan as to how
one advances in a career.
4)
It is a global market. Ireland/the HSE and
whatever system that takes over when the HSE is/might be dissolved in the
coming year need to recognize that people have become mobile. For me, I’m going
home. It’s an easy move. But for the Irish medics that are leaving in droves,
it’s not because they aren’t good enough to practice here. It’s a silent
strike. A slow brain-drain. And five years from now, the country is going to be
in big trouble.
5)
I have spent the past 3 years ticking the boxes,
filling the holes, and acting as a workhorse for every department I’ve found
myself in. I put my heart and soul into my work. But unfortunately, I have come
to expect something in return… be it financial, educational, career advancement,
a little bit of positive feedback. And I’m not really seeing that. I have seen
my responsibilities doubled, my workloads doubled, my time doubled, and my
paycheque halved. I find myself tempted to do the bare minimum and get by, as
long as I don’t get yelled at, it’s a success. I am too tired to keep this up.
There was a time when you could justify the sacrifices, because of compensation
and I’m just not seeing that anymore.
Perhaps my classmates graduating from their Residencies back
home is hitting me hard. But I can’t squander the next decade hoping there’ll
be a job at the end of it. More than anything, I will not be blackmailed.
Blackmail comes in many forms. There’s emotional blackmail –
the form used that has NCHDs cross-covering, picking up calls when someone is
sick, working late so a co-worker can leave for something important. There’s
moral blackmail – the form that leaves you holding an arrest bleep 2 or 3 hours
past your shift being done while you wait for the late coworker to get in; you
don’t claim all of the hours you work, because you possibly could have worked
harder/faster and the hospital is broke and you feel bad asking for the
overtime. Then there’s pure extortion – the form that has you ask your
consultant (the person who signs you off at the end of rotation, that writes
your recommendations, that decides if you advance in your career) to put their
name down on your overtime hours, where you take your research home to do it
there so you can’t be asked to do ward work even three hours after shift ended,
where you aren’t paid for the hours you claim… Actually, that’s not blackmail,
that’s actually just criminal. But I’m not going to let anyone suggest that my
taking time to make an international career move is damaging to my job. Jobs come and go. This is my career. This is who I am. This is my life. And I'm putting on my tiara.
“As I lie in bed each morning and ask
myself why I should put both my feet on the floor, there are precious few
reasons that I’ve ever come up with. The chance to escape Jordan’s morning
breath, sure. Scotch. It’s too early to drink it, yes, but it is never too
early to think about. And, of course, the ever-present possibility that I might
finally happen upon Hugh Jackman and give him the present I’ve been holding for
him. *Bam!* Still, the most persuasive argument I’ve ever been able to come up
with is that I get to come to this hospital every day and help keep people
alive.”
Scrubs, Dr. P. Cox
