Why Doctors are Leaving the UK
A once desired and respected profession is on its last legs.
When I was 12 my parents asked me what I wanted to be when I was older:
My Taiwanese mother nodded approvingly, while my Austrian father looked quietly concerned.
I was top of my class with perfect grades and my parents were both medical — it seemed an obvious decision.
Seventeen years and two degrees later, I’m not so sure of my answer anymore.
Doctors have been at open war with the UK Government for over two years now. Even after a series of walk-outs and doctors strikes across the country, peace is nowhere in sight. (Yes, doctors can strike. No, nobody died as a result. )
What could doctors possibly have to whine about?
We have a respected job. We change, and save, people’s lives. We gain personal gratification from the intellectual challenge.
For some, this is enough to keep them motivated and performing at their best. But the reality isn’t so glossy for doctors and many are leaving medicine for Finance, Consulting, Business School, or to practice medicine in other countries.
So what’s the problem?
Let me tell you:
Made a Mistake? That’s a Crime.
In a recent public case, six year-old Jack Adcock died under the watch of Dr. Hadiza Bawa-Garba during a 13-hour shift. She reflected on the tragic incident in her educational portfolio, conceeding that she made mistakes. This personal reflection was used as evidence against her in court, and she was convicted of manslaughter.
This case shook the medical profession, as it sent the loud and clear message that making a mistake as a doctor is now a criminal offence. It doesn’t matter what conditions we’re working in, whether we’re three doctors under-staffed or dealing with failing hospital IT — it doesn’t matter — if anyone dies, it’s your fault.
The psychological stress of working under these conditions is extreme.
Between 2005 and 2013, nearly 30 doctors comitted suicide while under investigation for malpractice. Being a doctor is a life profession, but when you make a serious mistake, suddenly your life’s work and fitness to practice medicine is called into question.
There are warning signs that the situation is worsening, as the General Medical Council now seeks to extend the powers granted to it by Parliament in the Medical Act 1983 so that it can erase doctors from the register without trial.
But Surely You’re Not in it For the Money!
In 2017 the Government proudly announced a 1% pay rise for all healthcare workers. But inflation in the same year was at 2.3%, so in real terms we received a pay cut.
But surely you’re not in it for the money.
No, but the general population seem to think doctors make more than they do. Here are a few numbers to put things into perspective:
Basic annual pay for a first year London doctor in 2017: £28,776.
Average rent for one bedroom in London in 2016: £13,596.
Compulsory GMC fees and exams for an FY1 doctor: £951.
London underground annual travelcard: £1600.
That leaves a junior doctor with £35 a day for groceries, utility bills, books, and life. No, not poverty, but certainly not riches either.
Tired? Take a Nap on the Floor.
I have never worked in a UK hospital that provides a bed for you during a night shift, or even a comfortable place to rest. When I tell my European colleagues this, they don’t believe me.
It is the inevitable reality, that if you are lucky enough to get a break during a night shift, you will end up curling up with a dirty blanket on the floor somewhere.
If your hospital has a doctor’s mess with some (likely old and broken) sofas, you will have to battle for one of these with all the other doctors on night shift at your hospital. But before you count your lucky stars that you’re on a sofa, remember that as soon as anyone’s pager goes off (which it 100% will) you will bolt right up along with anyone else drifting off in the cramped room.
You Work Where You Are Told.
During a junior doctor’s training, we don’t get to choose where we work.
Depending on which specialty you pursue, that’s around 12 years of your life after medical school were you have little or no say which part of the country you work, and will have to move every 1–3 years.
Sure, we get to rank all the hospitals in the UK in order of preference, and submit this into an online system. But getting a job anywhere near your preferred city or location is far from guaranteed.
Dreams of making a home and starting a family? Sure, as long as you’re happy to uproot and move again every couple of years.
I can hold my pee for 13 hours.
It’s usually because I’ve not drunk anything for longer than that.
If there are patients waiting to be seen, we see them. Unfortunately, there are rarely no patients to be seen. Official contracts say we should take breaks where they “naturally” arise, and so no set break times are factored into shifts. The only problem is breaks often don’t “naturally arise”. And in some hospitals breaks are forbidden outright:
We consistently prioritise the needs of our patients above our own basic human needs. Even if it means we have to wait until the end of our 13-hour shift for that pee-break or a glass of water.
So You Want to Take Your Annual Leave?
Most junior doctors will not be able to request any leave more than four months in advance, due to the “rotation” system.
When you can request leave, your personal leave understandably takes lowest priority over patient care and the greater good of the department. This means is if there is a gap in the rota, or any other doctors have already requested leave, you cannot have leave.
In reality, there are almost always rota gaps.
We’ve all had colleagues who have had to change their wedding date, cancel/move their booked honeymoon, or miss important family events due to work. Most of us will have worked jobs where we were not able to take all of the leave we’re entitled to due to staff shortages.
When this happens once or twice, no big deal. But it’s a life-long reality for us, where we’ll never be able to promise we can attend that birthday celebration, be at our brother’s graduation, or see our daughter’s play.
Every event in our life is constantly weighed up against patient care in importance. No points for guessing which one trumps each time.
“Unimportant” things like seeing your favourite band live, or getting your scuba diving certification, or going hiking with your friends, will always take a back seat.
Before you know it, you’ve missed out on life.