Anuj Sean Chathley is a UK-based GP with an extended role in medical and surgical dermatology.
I completed my basic medical training in India, and I remember it as a time of camaraderie, pressure, and pride. As interns, we competed—not for awards or publications—but for the honour of doing the longest calls, seeing the most patients, or standing through marathon surgeries with the consultants. A 36-hour on-call shift wasn’t gruelling; it was a rite of passage. Working a 100-hour week didn’t feel oppressive—it felt like we were becoming doctors.
When I moved to the UK in 2006, I began to appreciate the value placed on structured training and time for personal development. But I struggled with the concept of “work-life balance” in medicine. To me, medicine was a lifestyle, not a job. I grew up in an environment where senior surgeons were perpetually on call, and their dedication—though sometimes excessive—defined professionalism.
Working a 100-hour week didn’t feel oppressive—it felt like we were becoming doctors.
Fast forward to now. I’m a GP trainer, and I find myself increasingly unsettled. Today’s trainees—whether medical students, junior doctors, or GP registrars—often cite “work-life balance” as a primary reason for choosing general practice. Their training is meticulously structured, with protected time for self-study, tutorials, and portfolio development. But what’s left is a surprisingly small slice of time dedicated to seeing real patients and grappling with the realities of general practice.
How did we get here? When did the pendulum swing so far from vocation to accommodation? Am I alone in feeling that something important has been lost?
There’s no doubt that modern training is more humane. Burnout is real, and we have rightly prioritised wellbeing and safety over heroic endurance. The European Working Time Directive, structured supervision, and competency-based curricula were born out of hard lessons. But with every safeguard, have we also diluted the clinical exposure, resilience, and professional identity that once defined medical training?
The GP trainees I work with are intelligent, thoughtful, and committed—but many have been shielded from the intensity that once prepared us for the unpredictability of clinical practice. There is a growing mismatch between the structured, protected world of training and the reality of modern general practice, where decisions must be swift, pressures are high, and ambiguity is the norm.
There is a growing mismatch between the structured, protected world of training and the reality of modern general practice, where decisions must be swift, pressures are high, and ambiguity is the norm.
I worry that we’re producing doctors who are well-informed but under-exposed. Who know the guidelines but lack the instincts. Who have portfolio-ready reflections but insufficient lived experience.
Perhaps I’m nostalgic. Perhaps I’m simply from another time. But I don’t think I’m alone.
This isn’t about glorifying overwork or dismissing progress. It’s about asking whether we’ve struck the right balance. Maybe the goal is not to return to 100-hour weeks, but to recover some of the immersion, responsibility, and grit that made those weeks so formative.
A quote from the movie Kingdom of Heaven comes to mind: “What man is a man who does not make the world better?”
If we don’t like what we see, we shouldn’t walk away from it—we should try to shape it. As trainers, let’s strive not just to protect our trainees, but to prepare them. Let’s challenge the system—not to go back, but to go forward better.
Deputy Editor’s note – see also: https://bjgplife.com/the-clock-ticks-differently-now/
Featured photo by Markus Spiske on Unsplash
Amen to that! Very grateful for having it explained and stated so clearly and empathically for all concerned. What can the powers that be do to help reset the balance to help the individual doctors, their teams, their patients and the NHS?
I agree with Dr Chathley wholeheartedly here. Yes, we must protect our trainees and ensure that adequate supervision is provided throughout training, but I share the worry that under-exposure is leading to churning out under-prepared General Practitioners. Perhaps “burnout” rate is so high because our new generation of colleagues are unable to handle the pressures of real-world general practice when they do not have so much protected time and they are not sheltered from the true rigors of the system we work in.
At the moment, across all of the NHS (not just primary care), the demand for the service far outweighs our resources. Ultimately we need an increase in workforce of 10, 20, 30% possibly – but the new wave need to be adequately trained and prepped for the nature of the work. This would start at the level of primary education, secondary school, medical school, and then foundation and specialty training. Can this overhaul be done? What will we do in the meantime?
This is a powerful and honest reflection on the evolving nature of medical training and the shifting identity of our profession. The concerns raised are deeply valid—there is indeed a growing tension between structured training and the often chaotic reality of clinical practice. But perhaps it also points to a larger truth: general practice is increasingly expected to be both the backbone and the front door of the NHS, yet it lacks the capacity, time, and resources to meet that burden. Maybe it’s time to accept that we can no longer do everything—and that’s not a failure, but a reality check. Instead of striving to meet impossible expectations, we should focus on doing the best we can in a broken system.
One way forward might be to ask trainees how prepared they feel at the end of training—and again three months into the job—and use their insights to adapt how we teach, support, and shape their transition into practice? Something that could be easily implemented by the training program I feel…
Clearly a very caring doctor and very much in tune with the systematic dismantling of General Practice that has been occurring over the Last 10-15yrs.
The mind set of medical students-young doctors( not just GP registrars) of ”clocking in and clocking out” has made it much easier for the government to hasten the decline.
In order to change the mindset it is time the educators–at medical school/trainers in genreral practice –encourage and highlight the importance of learning form clinical exposure to patients. Not what is currently occurring–eg -if doing 40hr per week in GP less than 20hr is spent dealing directly with patients.
The current training system does not adequately prepare trainees for real-world clinical practice. A significant contributing factor is the stringent regulations surrounding working hours, which, while well-intentioned, may inadvertently limit hands-on experience. Additionally, some trainees exploit these policies by excessively claiming time in lieu for minor extensions, such as an extra 15 minutes spent in surgery.
It is important to emphasize that the most valuable learning occurs through direct patient care, rather than textbook study alone. While structured education is essential, excessive focus on rigid working hours and compensation for minimal overtime detracts from the core purpose of training: developing practical competence and clinical judgment.
A more balanced approach—one that prioritizes experiential learning while maintaining reasonable working conditions—would better serve both trainees and the healthcare system as a whole