By Douglas Shepherd
Widespread poor conditions, low pay and excessive working hours.
That is the fate of many resident medical officers (RMOs), according to a shock report.
A survey of these doctors, providing services mostly in the independent health sector and most frequently recruited abroad as international medical graduates, describes pay deductions, bullying and multiple instances of racism.
The study, by the BMA and Doctors Association UK (DAUK), found:
Just over a third (34%) reported bullying and harassment;
47% complained of unfair treatment;
31% worked unregulated shifts;
89% reported working over 70-hour weeks, which as the survey organisers point out is in excess of legal limits and advertised contracts.
The BMA and DAUK said terms like ‘borderline slavery’ and ‘sh*ttiest employer anyone could ever have’ were representative of the mass of comments from survey respondents.
Patient safety concerns
Some 92% were recruited by agencies from African countries, which the survey organisers warn raise ‘significant questions about the treatment of international medical graduates by private medical recruiters and by the NHS trusts that employ their services’.
They added: ‘81% had trained in Nigeria, a country where active recruitment by UK firms is prohibited by the Department for Health and Social Care in order to stop the “brain drain” effect that depletes developing countries of their medical workforce.
‘Much of the concern expressed by RMOs in the survey is for patient safety, with fatigue, lack of support and poor mental health leading to worries that they aren’t able to give patients the care they need.
‘With doctors reporting working for 12-hour shifts for a full week, far beyond the safe limit of what can be expected for medical professionals, the agencies are seen as putting patients in danger with the way they treat their contractors.’
Many deductions from pay make an already low salary – barely above the living wage in many instances – worse, according to the BMA and DAUK.
‘Deductions from pay reported by RMOs include those for visas, appraisals, mandatory training courses and even deductions for being late. Lack of payment for annual leave and sick leave were also flagged by respondents,’ the association said.
BMA council deputy chairman Dr Emma Runswick called the treatment reported by these doctors ‘a disgrace to UK medicine’.
‘Our international colleagues have come a long way to the UK, have left behind families and friends, and deserve to be treated fairly as employees here.
‘What they have found instead are conditions so exploitative that it beggars belief,’ she said.
The BMA is calling for trade union recognition to apply to all medical staff in private settings and the NHS, regardless of who their direct employer is.
It can support international doctors new to the country via a contract-checking service and is asking those claiming exploitative behaviour to let it know anonymously through its support channels.
Dr Jenny Vaughan, of the Doctors’ Association UK, said: ‘Bullying, racism, unsafe hours, low pay and threats of withdrawal of visa sponsorship – it is just extraordinary that agencies have been getting away with this behaviour and it is an indictment of the authorities that they let this continue without redress.
‘For agencies to take advantage of British hostile environment policies to push unfavourable conditions on doctors is the very worst of international recruitment practice and brings the entire model into disrepute.
‘The lack of regulation in this area has meant that these practices have become the norm.
‘The reason these agencies think they can get away with this is because many of their doctors don’t have the local knowledge on their rights, so they are ripe for exploitation.
‘This includes foisting on them contracts that nobody would sign if they knew what the NHS standard was. Tired doctors being forced to carry on is in nobody’s interest and is unsafe for patients.’
Private healthcare sector reaction
David Hare, chief executive of the Independent Healthcare Providers Network (IHPN), told Independent Practitioner Today: ‘There are a number of different models in the independent healthcare sector of how RMOs are engaged, depending on the services organisations provide and the acuity of patients they treat.
‘Independent sector providers take their responsibilities in this area seriously and both independent providers and other employers must ensure that RMOs have a robust induction to their role, receive regular training and are able to communicate any concerns, including about their workload and health and well-being, with clear action taken if patient safety is put at risk.
‘IHPN have also recently been working with the Royal College of Surgeons of Edinburgh to develop educational resources to support RMOs in their role and ensure they can deliver the highest quality care for patients.’