Listen to Episode 1
Episode 1 transcript
Intro
Joe: Hello and welcome to Here for Doctors, the RMBF podcast.
In case you don’t know us, the RMBF is the UK charity for doctors, medical students and their families. For doctors in financial hardship due to illness, injury, disability or bereavement, we provide financial support, money advice, well-being support, and more.
My name’s Joe Meredith, Senior Communications Officer for the RMBF. And in this podcast, I’ll be talking to some great guests who all share a common interest, supporting medics in need. I’ll also be sharing expert advice for doctors around mental health, wellbeing, working life, and more besides.
For our first episode, I sat down with Dr Rachel Liebmann, who’s a trustee of the RMBF and also chairs our Grants & Awards Committee. So I talked to Rachel about the pressures affecting the medical profession, about why doctors shouldn’t fear reaching out for help, and how she gets inspiration from a particular Paolo Nutini song.
Interview
Joe: I am here with Dr Rachel Liebmann, who is the head of the RMBF’s Grants & Awards Committee. And I’d like to talk a little bit more in depth about how that committee works, and what the process is for helping doctors. But welcome, Rachel. It’s very nice to sit down with you.
Rachel: Thank you. Thanks, Joe.
Joe: Would you be able to just introduce yourself in terms of a little maybe potted history of your career and what led you to getting involved with the RMBF?
Rachel: So I was really interested in the RMBF. I had been a donor. I’d seen the Christmas appeal that comes through with the BMJ for many years. And having had a background myself which involved some crisis moments, which meant that we had very little money, I knew as well that doctors who got really sick had major problems, in trying to keep all of the balls in the air and keep juggling, so that they could get through a crisis patch and get back to work.
So knowing the work that the RMBF did, whenever they advertised for a trustee position, I thought: “Actually, I think I might be able to do that”. In my career up until then I had been a trustee of both the Pathological Society and the Royal College of Pathologists. I am a pathologist, that’s my medical specialty. And I was delighted whenever I was appointed as a trustee for the RMBF, superb.
Joe: Obviously among our trustees there’s a lot of medical experience, so you know the majority of them are from a background in the profession. How important do you think that is in terms of what support the RMBF can provide?
Rachel: I think it’s important that the committee is made up of people who can picture what the person who’s applying is going through. That they’ve got that degree of empathy. And again, you do not know what it’s like to be a high-level medical student who’s coming towards the end of their training and then something in life hits you like a speeding train. You don’t know what that feels like unless you’ve been there. You don’t know what it is that they’re trying to achieve despite the issues that they’re going through.
And the same for medics. It’s a challenging job for people who aren’t going through any kind of health or other crisis. And so it’s doubly, quadruply difficult if you’ve got something going on that you can’t control, that is trying to get in the way of you actually achieving your goals as a medic.
So I think it’s really important that the people on the committee bring a variety of backgrounds. And some people will bring a background that is really helpful to other aspects of what the committee’s work is. But for that grant award decision-making, hugely important that they understand where the person is in their career.
Joe: Yeah, I’m always really struck by the fact that you can really get into the specifics of a doctor’s – like maybe where they are in their career, you’ll understand that this is a particularly critical point, for example, and that the support will actually go a long way. I always find that interesting.
Rachel: Absolutely. I think one of the most important things about the RMBF for me is the fact that we get so many doctors back into work. And when you talk about charity and charitable giving, it’s about that paying it forward.
Paying it forward and helping other people, hugely important, but it’s even more important with the RMBF because, when you do help somebody to get back to work as a doctor, you know you’re also helping all of the people that they can help because of their job as a doctor. And that’s fabulous. That’s really what keeps the motivation going.
Joe: From your own experience and also maybe from your experience of the people the RMBF are helping, what do you feel is the state of the profession right now, and how are doctors feeling? How are they coping?
Rachel: We certainly are going through a seismic shift in the way that medicine is viewed. The RMBF isn’t a political organisation, but nevertheless I think that the wellbeing and the career trajectories of doctors are shifting so far in the wrong direction that the RMBF has a role to play, not just in supporting individuals, but perhaps in raising the profile of the issues that doctors are facing and medical students as well.
The landscape has very much changed since I was a medical student, but I still remember it as being a really tough time. I remember working part-time to try to fund it, and I had nothing like the amount of debt that people leave medical school with now. So again, that understanding that this is not funded by the government. These people fund their own education, and if it goes off the rails at a very late stage, they can then be left with a huge amount of debt but no actual medical degree to allow them to practice.
And one of the things that I know is really concerning our young doctors at the moment is whether or not they’re going to have jobs. It is a very precarious job market with a lot of hurdles that they need to pass to even be considered for specialty training. And the specialty training numbers are too small for what the country needs, in my view, but also too small to allow us to have guaranteed employment for every doctor.
We always had some competition. We always had some jobs that were more popular than others. We always had rotations that were more popular than others. So there was still competition in the system. But people weren’t looking at being an unemployed doctor whenever I qualified. You knew you would get a job somewhere because people need doctors. Well, we still need doctors. There’s a demographic shift in the country where there’s even more people who need care and health care. But for some reason, we have unemployed doctors. And I think that really speaks for itself.
Joe: Is there a sense of what’s behind that difficulty? What’s behind these competition ratios for jobs? And what can doctors do if they really struggle to get into their specialty? What are the options?
Rachel: So we do know some of the factors behind it. So international applications are enormous. And with the dawn of AI, people can apply for jobs they haven’t even read. They set it up that their computer is applying for jobs for them. And so within minutes of launching a job, there will be hundreds of applications.
So that’s one of the things, that there’s an international marketplace for these positions. But the taxpayer has paid for medical students within the UK to get to the stage of being able to apply for them.
The other things obviously that are impacting on it is a tendency to appoint the Physician Associates into roles that previously would have had to have been done by doctors. Now I’m very much in favour of doctors having help and assistance, however I don’t think that should have been a policy to replace, and to replace on rotas. And we know that in some hospitals has happened. I don’t know how big an effect that’s had on the job market for doctors. I think it’s more the pressure on the specialty training numbers, really.
And the options for them seems to be to get into health tech companies, which is fine, but it doesn’t have the hands-on patient care element which most of us went into medicine to do. And it’s going to be precarious as well. If you join a start-up, not all start-ups go on to become Microsoft. So you really are taking a risk and it’s not a guaranteed career path in the way that the medical specialty training –it’s not guaranteed, obviously, there are dropout rates, but nevertheless, it’s guaranteed if you’re not going to come across something insurmountable during your training.
Joe: It feels like a real sea change as well. And it might seem strange to people because the expected path has always been you qualify as a doctor and then you kind of go into the NHS, which is very much a really valued national institution. And the idea that you’re now possibly going into the tech sector instead, while still being a doctor, and still practicing as it were.
Faced with this difficult landscape, what would you say to doctors who are worried about reaching out to the RMBF, perhaps? Because one of the reasons that keeps coming up time and time again is this stigma of reaching out for help. How would you persuade a doctor who’s feeling reluctant to reach out for help?
Rachel: So, first of all, I would say that the doctor can investigate by just looking at the website. There’s a lot of information that is available just on the website, so they don’t have to have made that step. But I would encourage them to make that step if they read it and think: “This does apply to me”.
Our Caseworkers are the kindest and most supportive people I have ever met. And if I were in a particular problem situation, if I were in crisis, I would be absolutely happy to reach out to them, and they will very definitely talk you through and help you to make an application. I couldn’t really do anything more than just say how supportive it is, as an organisation for people who are in need.
Joe: Yeah, I have to fully agree with that. I work with the Casework team every day and they truly are lovely people.
Rachel: Can I say as well that if they can’t help, if the person is not eligible for the criteria that the trustee board sets from time to time, if they aren’t eligible, they will signpost them to other organisations that exist, that you might not ever have heard of. So again, it’s a community of charitable support for the individuals that need it.
And again, the majority of the people we help go back to work. So this isn’t relying on charity, it isn’t a one-way ticket. This is a period of time that we can help you to get through until you get back on your feet and back to work, which is just great.
Joe: It’s a very common refrain of people saying: “I’m used to being the helper, and I didn’t think I would need help”. But I think hopefully we’re starting to see a bit of a shift in attitudes around that. Across society more, it’s more acceptable to reach out for help in difficult situations. And I do think it’s probably going the right way in the profession as well, though maybe still a little bit more work to do, possibly?
Rachel: I think it has become much more frequent that people who have senior positions, and are recognised in their fields in medicine, to share the problems that they had in the past. Whereas previously, you would not have talked about the problems, so anyone who was going through their own problems and issues would have looked ahead of them at leaders in the field and thought: “Oh, they’ve never had any problems”. Whereas that, of course, isn’t true.
But it’s just people feel much, much more comfortable about sharing. And that then helps lots of people that they may never have met, but will have read about their story and feel much more comfortable now about coming forward. But you’re absolutely right. Doctors tend to feel that if they can’t cure, that they’ve somehow failed, and that includes themselves.
Joe: Yes, very, very nicely put, I think.
Just worth mentioning, I think – we’re here at the RMBF AGM today, and we’ve heard some really interesting discussions from medical students around the problems they’re facing. And it was noticed that one of the barriers to seeking help is: if you go to somebody more senior who’s perhaps teaching you, then you may be a little bit worried about working with them in future or fitness to practice issues.
And I just think it’s worth underlining that if you’re approaching the RMBF for support, that it’s completely confidential, whether you’re a medical student or a doctor, there’s no reports to people who are teaching or supervising you, there’s no reports to your trust or your GP or anything like that, so I think that’s always worth mentioning in terms of encouraging people to reach out.
Rachel: Very definitely. In order to make sure that we fulfil the charity’s objectives in absolutely every way that we can, we do have to make sure that we know a lot about the applications, and the applicants have to share an awful lot with us. But we are very mindful of the responsibility that then gives us, to be confidential about what they’ve said to us and to make sure that it is, that data protection is really a high point for ourselves as Trustees, members of the committee, but also for the staff. It’s a very important issue for us, that confidentiality.
Joe: Yeah, and speaking of the Casework team again, I know it can feel very overwhelming if you’ve got to share a lot of information and evidence. But firstly, the Casework team can help you through that. And secondly, I also think it’s worth mentioning that the intention is not to catch anyone out, as it were. The reason that we want to know more about somebody’s situation is so that we can give the most appropriate type of help, because our help is very, very customised, isn’t it? You know, at a typical Grants & Awards Committee, you’re going to be helping different doctors in many different ways, aren’t we?
Rachel: Absolutely. And the help that we give is not just financial support, although obviously that’s a really important part of the Grants & Awards Committee. But also financial advice* because some people are overwhelmed when they find themselves in difficulties, and are making poor decisions which are costing them money, which are making the problem worse instead of making it better. And we have an excellent financial advisor* who will help people through and help them see that perhaps this might not be the most sensible thing for them to do at this time.
So for example, people may decide that: “Oh, I have to sell the house”. Well, but where are you going to live? And how much is rent going to cost? An awful lot of people will find it difficult to work through those decisions in a way that makes sense, especially if this is a period of time in which they aren’t able to work, but that they hope to return to work. It might be that they need that short-term support. They don’t need to make a life-changing decision like selling the house, for example.
Joe: A lot of people just not realising that they might be eligible for certain support, certain benefits. And I think that ties back into the idea of doctors as very high-flying people who aren’t maybe traditionally associated with claiming a benefit, for example. But it’s there for a reason. And if you really are in a tight financial situation, then it’s really important that you are pointed towards the things that you’re entitled to.
Rachel: Absolutely, absolutely. I’m a great supporter of the welfare state, and we all pay into it, and when the need arises we should all be able to draw from it as we need to. The NHS is the one that we all feel a huge affinity to as doctors, as healthcare workers, as medical students. But the rest of the welfare state exists as well, and that’s also for our benefit. We should be aware of it and not feel that there’s any stigma to using it.
Joe: Yeah, quite.
Is there anything else you’d like to say to our RMBF community?
Rachel: So I have had, again in my early childhood, a period of real crisis in the family. If I can just tell you that one of my favourite songs, is Paolo Nutini’s “Pencil Full of Lead”. And it makes me feel good. Any time I hear it, I have to dance a little bit. It’s very embarrassing at my age. But one of the lines in it is: “I’ve got money for the meter and a two-bar heater”. I can remember not having money for the metre and sitting in the dark. And it doesn’t matter whether that’s your story, and you can remember that kind of crisis or not.
We are in a world that is full of all sorts of horrific issues and problems and it’s easy to feel that – they call it compassion fatigue, where it’s: “There’s nothing I can do about this because I can’t solve everything”. But what you can do is put yourself in the position of somebody who’s in a really tight spot, and you can identify with them, you can empathise with them.
And we all know that as medical students, when you are learning about all of the new diseases, you start to feel all of the symptoms, especially the vague symptoms. “Oh, I have this, or I have that. Oh my goodness, maybe I’ve got this”. And your mind does play tricks. And you start to think: “What would happen if? What would happen if?”
And supporting the RMBF allows you to do something which is in your control, which you can picture. You can see how you can help. And whether it’s giving up time, or making a regular subscription, or just buying the Christmas cards from the RMBF to give to your loved ones. All of those things are ways in which you can make a small difference. And I think that’s just absolutely what I’d want to say to our RMBF community out there.
Joe: Yeah, in an age of, sort of, doomscrolling and being overwhelmed by the world, to be able to do something sort of very concrete, I think is always very helpful.
Really lovely to talk to you today, Rachel. Thank you so much. I hope you enjoy the rest of the day at the AGM, and I hope to catch up soon.
Rachel: Thank you very much, Joe. It’s been an absolute pleasure. And now I dare you to get that tune out of your head.
Joe: I actually don’t know it, but I will look it up!
Outro
Well, I did check out Pencil Full of Lead and can confirm it’s a great tune.
Thanks again to Rachel for taking the time to talk to me, and thank you for listening. Please subscribe on Spotify, YouTube or wherever you’re listening. You’ll get bite-sized episodes every month, an easy way to learn more about how to support doctors.
This episode’s music is Autumn Day by Kevin MacLeod, licensed under Creative Commons By Attribution 3.0.
If you’re a doctor or medical student facing financial hardship, you may be eligible for support. Just visit rmbf.org and click “Get Help” to find out more.
Finally, we can only help doctors in need thanks to our generous supporters. We receive no government funding. You can make a donation, or find out how else to support our work, at rmbf.org.
See you next time.
Notes
*The RMBF provides money advice, rather than financial advice, to beneficiaries. This is made clear during the application process.