Being abroad may be tough
I think it's in part being in a foreign country.
Both of those who described ‘low’ morale levels (of 3 and 5) were experiencing career delays; one had had difficulty in completing training and the other was working on past the usual retirement age. (Powerlessness and lack of control have been described as pervasively negative influences on morale.)
I ve got a horrible feeling come August I won't have a job.
I think I should have come home (from overseas) a lot earlier.
At the time of the interviews (April to July 2004) there was general optimism about increased new contract funding, promised to benefit income and pensions, and GPs were no longer responsible for out-of-hours work:
The out-of-hours changing, that's taken me up from a 6, probably a 5 or 6 at times, to an 8 or 9, it's made such a fantastic difference … the junior partner was on every Friday night.
Despite national concerns about the morale of the NHS workforce, and the common stereotype of stressed-out or burnt-out GPs, this group, though faced with the launch of an elaborate new contract and the oft-mentioned increasing expectations from patients and society, largely described high current morale.
Huby et al1 found that the complex relationships between workload, personal style, and partnership arrangements were the most important factors influencing GPs' morale; the dynamics between these factors were critical.
In Counting the Smiles, the Kings Fund Review2 suggested that four factors affect morale; the working environment, feeling valued, job satisfaction, and resources and pay.
In this group, mostly comprising a mix of salaried and principal GPs, partnership problems and job insecurity were mainly identified as causes of lowered morale. No-one mentioned finance as a negative or positive factor.
How typical were they? This group had all chosen to train in the inner city, often having experienced unusually challenging incidents and situations before and during their GP training year. Does their high morale reflect unusual individual hardiness and adaptability, and was this resourcefulness even enhanced by having survived such experiences while training? Perhaps Darwin has the last word:
It is not the fastest or the strongest who survive, it is the most adaptable.
