Medics on the Move

Siobhan Harris

Disclosures

April 23, 2021

Why are so many doctors thinking of leaving the UK to practise in another country? Our recent Medscape UK Salary and Satisfaction Report suggests 29% are considering working abroad. It's an even higher percentage for younger doctors with 45% under the age of 45 thinking of leaving the NHS and working overseas.

Dr Samantha Batt-Rawden/Credit: DAUK

Some of those surveyed may have decided to return to their country of origin. However, the research also suggests a degree of frustration with the NHS among doctors. Reasons cited included red tape, workload, burnout, reorganisation, poor management, and tax on pensions.

Dr Samantha Batt-Rawden is an intensive care doctor and president of the Doctors' Association UK. She says she's not surprised that so many doctors are thinking about leaving the NHS.

Making Exit Plans

"Many of my colleagues are actively making exit plans, whether that be retiring early, looking for jobs in other countries, or indeed leaving medicine altogether.

"Whilst most of us will have suffered moral injury and moral distress to varying extents during the pandemic, when you really listen to people about why they want to leave this is actually rarely mentioned. Instead, most people talk about deteriorating work conditions, and how this has made them feel," says Dr Batt-Rawden.

Dr Hannah Wilson/Credit Dr Hannah Wilson

Dr Hannah Wilson is a junior doctor working in A&E, acute medicine and primary care. She coined the term 'Drexit' or 'Doctor-Exit' to describe the phenomenon of doctors leaving the NHS.

She and her colleague Dr Arabella Simpkin suggested exit interviews be conducted to understand why doctors were leaving, either to work abroad, go into private practice, or leaving the profession altogether. Their research was carried out before COVID-19 but the reasons for wanting to leave are familiar. She says: "Our doctors reflected that they were increasingly frustrated and were leaving the NHS at an early stage of their career to work overseas. We found pay, value, work-life balance, and opportunities overseas all to be large factors in these decisions."

Work-Life Balance

"I think the need to feel valued as a doctor is what attracts so many to move abroad to practise medicine. Many doctors I have trained with over the years have left for Australia or New Zealand. It has been a real shame to lose so many talented and dedicated doctors, but they all seem so much happier there," says Dr Batt-Rawden.

"There seems to be much more of a focus on work/life balance in the Antipodes. The hours are limited, there is a heightened awareness of burnout and fatigue. On-call accommodation is plentiful and it is often described as a much higher standard than what we have here (if we have it at all!). Trainees are given months of paid study leave for exams, the cost of which is also covered. Many doctors describe having thousands of pounds of a study budget a year which they are actively encouraged to use to broaden their horizons. The pay is much better too. All the doctors I know who have left for Australia for just one year have not returned, and it's easy to understand why," she adds.

More Professional Freedom

Guy Hazel runs the company austmedics.com which helps UK GPs find jobs and relocate to Australia.

"The quality of life as a doctor is certainly a lot better here and there's more professional freedom. In Australia you tend to be an independent practitioner - you bill Medicare Australia, they aren't your employer. In the UK it's more prescriptive in terms of the numbers of patients you see," he explains.

"Generally, you, as the doctor, determine your workload. If you want to see five patients an hour, come in at 10am and leave at 5pm that's OK. There isn't that regimentation and there's more flexibility. One UK GP who's moved to Australia said to me recently, 'I was at the point in the UK of hating work, it was too draining and I didn't enjoy it. Now I've fallen back in love with being a GP.' She enjoys her work and determines the workload she's happy with," says Guy Hazel.

Changes to Rules for GPs

He does point out though that the Australian Government made changes in 2018 which makes it more difficult for GPs to move there.

"The Australian Government thought they'd save money by having fewer foreign GPs, and the ones that come now have to work in rural areas, rather than the big cities," he explains.

Visas for GPs are now linked to location and a job rather than being more general. Hospitals however, have an exemption from those rules.

"The GPs wanting to move over here tend to be younger as they have fewer ties. They are either without children or with young children and are aged normally somewhere between 30 and 37," he says.

Leave for a Year and Never Return

Dr Wilson says: "There are many different reasons why doctors leave, not least family overseas. Outside of the desire to travel or relatives overseas we focused our research into why doctors who trained in the UK left to work abroad. Two clear ideas that came through were the paradox of being burnt out of the NHS v being burnt out of medicine. Secondly, the notion that once doctors left the NHS and worked in another healthcare system it was increasingly difficult for them to consider returning to the NHS, as they had perhaps seen how it could be working somewhere else."

Disillusioned Doctors

"I have only been a doctor in the NHS for 10 years, but in those 10 years it’s become so much harder to do an already hard job," admits Dr Batt-Rawden.

"At both ends of the scale we have a whole generation of disillusioned doctors as a consequence of the junior doctor contract, and a raft of disillusioned consultants at the other end, many of whom have been forced into early retirement or dropping sessions due to the pensions tax crisis.

"Training for junior doctors has become particularly difficult with never ending hoops to jump through. The administrative burden of training, which junior doctors are mostly expected to complete in their own time, has increased exponentially. Being shunted around every few months means that juniors often feel like just another number on the rota, and never really part of the team. It also means uprooting their lives every few months or face a long commute. For me, training with a young family has been incredibly hard, and at points has felt almost impossible."

The Future Post Pandemic

The General Medical Council is well aware of the need to retain doctors in the UK, not least as it's so expensive to train medical students only for them to leave to practise elsewhere. However, the more urgent crisis of COVID-19 has been a priority. 

"COVID has understandably changed the focus and we have all been in survival mode,” says Dr Wilson. “As we emerge from the pandemic, we must refocus our efforts on the retention of staff who did reflect, certainly in our research, that they were suffering from burnout well before the onset of the pandemic."

Dr Batt-Rawden believes the pandemic has unmasked many deep-seated problems or legacy issues.
"It's become abundantly clear that there was very little practical support for frontline healthcare workers on the ground. These are simple things that are hugely damaging for morale - not being able to park at work, having nowhere to buy hot food overnight, not having a staff room because it has been turned into an office," explains Dr Batt-Rawden.

She goes on to say: "I believe that there now is a desire to change these things, to reverse the slow erosion in working conditions that has happened so insidiously over many years. With many of my colleagues considering leaving the NHS, or indeed hanging up their stethoscopes for good, I can only hope that this isn’t too little, too late."

Article image credit: Kathrin Ziegler via Getty Images

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