Career Suicide and some Unspoken Rules

“The best advice I can give you is to just swallow. Don’t spit it out, don’t complain. Just swallow”

Advice from Anonymous PGY3 Junior Doctor

I always thought career suicide would consist of something more dramatic. Stealing drugs from the hospital, posting something unethical on social media, or even just simply not doing your job. Never did I imagine that career suicide could come from something much simpler. As a medical student, I’m not yet privileged enough to experiences the trials and tribulations of a junior doctor. However, the stories I hear from some of the doctors I know make me wonder about what life is truly like on the other side of my degree. These stories talk of a couple of unspoken rules, not written into any contract or job description, that if broken could result in you no longer being able to pursue the career of your dreams.

Rule 1 – Don’t complain. Just swallow.

One of the many perks of my part-time job is that I sometimes get advice/anecdotes from junior doctors that come for a drink (I work in a hospital bar). I remember back in my first year of working in this job (which coincidentally was also my first year in medical school), I got some advice from a junior doctor which I will never forget. That advice was the quote at the beginning. Whether this junior doctor was just overly cynical or whether he just had a bad experience that day, it was, to me, the beginnings of being taught the unspoken rules of junior doctoring.

My next experience of a similar manner would come after catching up with a friend of mine who is currently a junior doctor. They were telling me about an incident where they were, for lack of a better term, ‘bullied’ by one of their seniors. Whilst I couldn’t fully judge the severity of the situation as I was only hearing one side of the story, I nevertheless asked them if they would put in a complaint. Without hesitation, their answer was no. This was because, despite being deeply impacted by the situation, they were too afraid to speak out on it due to the fear of burning all bridges with that senior’s specialty.

Maybe he will get a black mark by his name, but I will be deemed as a person who is a complainer and therefore not easy to work with so won’t get chosen if I do decide to apply

Anonymous PGY1 Junior Doctor

It doesn’t make sense to me why a junior doctor has to fear career suiciding just to put in a complaint about a matter that deeply impacted them. Nor does it make sense to me why junior doctors have to take the hazing of some senior doctors without complaint just to ensure that their career progresses.

Rule 2 – Overtime is free of charge.

Another junior doctor I know talked to me about the joys of working overtime. They told me the number of hours they had to do was, for some rotations, severely disproportionate to the actual hours they were contracted to be there for. As an example, for a certain surgery rotation, whilst they were only contracted from 7:30am – 4pm, most days they would be working from 7am – 7pm. This was not due to a lack of efficiency, but rather due to the sheer volume of work that was placed upon them. It was not a once-off incident either, as the rotation itself had garnered a reputation for being brutal on junior doctors. I asked if it was possible for them to claim overtime pay, but once again, the response was that claiming overtime was akin to career suicide.

Sure, I can try claim overtime. But your overtime forms have to go through the head of department for that specialty, so they will come to know you as being picky/pedantic about claiming overtime and not being dedicated enough to put in the extra time. And so, your chances of getting chosen for the specialty will be lower.

Anonymous PGY1 Junior Doctor

To me, as a naïve medical student, I try to understand the argument from both sides. On one hand, you obviously have the question about the ethical practice of forcing people to work unpaid. Although forcing may be a bit of a strong word, the idea that claiming overtime is akin to career suicide results in subtle blackmail for junior doctors who wish to try and get into that specialty.

The other side of things does have a few counterpoints though. Firstly, it could be said that junior doctors are currently overpaid. The average intern’s base salary in Western Australia is $72,0001. This is excluding penalty rates for weekends and nights, and an extra $5000 for Professional Development Allowance. On the other hand, a qualified accountant will still only be earning on average around $54,000 four years out of university2 (the equivalent time it takes to finish a postgraduate medical degree). This is nearly a $20,000 difference between base pay for someone who is fresh out of university with no work experience compared to someone who has already been in the workforce for three years. If you then take into account the copious amount of unpaid overtime some accountants have to do (there are periods where a 17-21 hour day is the norm), you then begin to realise that working as an intern doctor has a much better hourly rate than working as an accountant. Understandably, the jobs are different, but it is not a lie to say that being a doctor is still one of the most affluent things that you can do, and therefore some might argue that this affluence should be earned through hard work (i.e. unpaid overtime).

Another counterpoint, which could be also used for justification of hazing, arises through, what one might call, a passing of tradition of sorts; all seniors once had to deal with the same issues when they were juniors (albeit always much worse back in their time) and therefore are just passing this tradition onward. But times are changing, and will always change. It wasn’t that long ago that people of non-European descent were heavily discriminated by those who were, but nowadays this discrimination has lessened dramatically and there are elements in place that protect those who speak out against this discrimination. In the same light, it may no longer be as appropriate for seniors to impose these sorts of unspoken rules on juniors as it once used to be. Or rather, one might say, it should not.

I distinctly remember attending a grand round of one of the peripheral hospitals where one of their key points was striving to achieve an egalitarian workplace; no hierarchy, no unspoken rules. I wondered on that day whether something like this was even possible to achieve, but I guess the first step to achieving anything is to realise what the problem is. It may be that these unspoken rules are unfounded, that they do not exist and are merely an exaggeration within my mind, but for me to have heard these experiences from multiple sources suggests that, regardless of whether these rules actually exist or not, the very idea of them certainly does.

But what is the point of me writing about this?

As an assignment, I was asked to think about something that I had seen which impacted me relating to the medical field. The reason I chose to write about this specific issue was because I was seeing the impacts it was having on the people I know and I guess, I wanted to raise advocacy. If all goes well and I pass my exams, in under a year and a half I will get the privilege of being a junior doctor and with that, having to deal with these unspoken rules. I cannot fully give an opinion on how I feel about them, because hearing about something and experiencing something can be two very different things, but at the moment I can say that I’m not in favour of having these rules exist.

Regardless, if these are the rules that I must play by, then so be it. I only hope that the idea of unspoken rules will fade as time progresses, and I aim to, if I ever find myself in a position of such seniority, not pass on these ideas to the future generation.

  1. Department of Health. WA Intern. 2019. Available from: https://search.jobs.wa.gov.au/print.php?advertID=160896
  2. PayScale. Average Accountant Salary in Australia. 2019. Available from: https://www.payscale.com/research/AU/Job=Accountant/Salary
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Lewis is an RMO at Royal Perth Hospital. He is currently interested in critical care medicine.


  1. These unspoken rules also apply with the Ambulance Service I worked for. Never question a senior clinician even if they miss something, Never report a senior for bullying. I made both these mistakes and was bullied out of the service.

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