Thursday, June 1, 2023

Matt Morgan: Is medicine no longer a vocation?

Junior doctors in the UK have recently gone on strike simply in a bid to be paid the same as sandwich shop workers, and the naysayers have been dusting off familiar playbooks used by governments in years past. For those with a genuine interest in truth and in resolving the dispute, any arguments around doctors’ relative pay, inflation, lifetime earnings, pensions, and international comparisons should quickly turn to ash. That leaves only the political choice of where finite resources should be directed. And this is where the actual debate, difficult decisions, discussion—and, hopefully, resolution—should lie.

But one claim often waged against doctors can feel like an uncomfortable truth. It is one that needs to be extinguished rather than left to smoulder. When other arguments have been exhausted, cynics retort that “being a doctor is a calling, a vocation, a privilege” and that “vocation has nothing to do with pay.” Are they right? Or is vocation dead?

Some say good riddance to vocation. Why should a health system be powered by guilt, endless duty, and sacrifice rather than by safe working conditions, fair pay, and patient centred reorganisation? Some say that they do come to work mainly to be paid. That it is in fact just a job. And for those people, perhaps this view is an antidote to burnout—you can’t burn out if there’s no fuel in your fire. But I take a different view.

For me, pay is a requirement but in no way sufficient. I would rather “burn in” through believing that I’ve made a difference, gone that extra mile, and worked at something that’s more than just a job. I do have a vocation and not just a function. But that can’t shackle me from shouting “No!” on occasion. I can still say that enough is enough. I can still put my worth, and that of my colleagues, at the front when needed. In fact, I, and all of us, must.

For having a vocation is not just about now. It’s about the future, about ensuring that there’ll be something for others to be called towards. A profession that can continue to care for patients and their families. Not a just functional job that was kept limping along, fuelled by guilt, duty, and sacrifice, until it fell face first into the fire.

Vocation is not dead. But it is being strangled. You can be called to something only if those already there have enough breath to beckon you to join them. Asking for fairness, pay restoration, better conditions, or negotiations at the very least, but still being left with industrial action as your only option, is not evidence that vocation is dead. This is evidence that it’s still alive.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: commissioned; not externally peer reviewed.

  • Matt Morgan is an adjunct clinical professor at Curtin University, Australia, an honorary senior research fellow at Cardiff University, UK, a consultant in intensive care medicine at the Royal Perth Hospital in Australia, and an editor of BMJ OnExamination.

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